Differences in brain structure in patients with distinct sites of chronic pain: A voxel-based morphometric analysis

Cuiping Mao, Longxiao Wei, Qiuli Zhang, Xia Liao, Xiaoli Yang, Ming Zhang, Cuiping Mao, Longxiao Wei, Qiuli Zhang, Xia Liao, Xiaoli Yang, Ming Zhang

Abstract

A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine differences in brain morphology in patients with low back pain or neck and upper back pain, we investigated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pallidum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left postcentral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume increases are found only in patients with low back pain.

Keywords: atrophy; basal ganglia; brain injury; chronic low back pain; chronic pain; grants-supported paper; gray matter; magnetic resonance imaging; neural regeneration; neuroregeneration; upper back pain; voxel-based morphometry.

Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
Gray matter volume reductions in cortical structures in low back pain (LBP) and upper back pain (UBP) patients revealed by whole-brain analysis. In LBP patients, gray matter volume was decreased in the left postcentral cortex and the left precuneus and bilateral cuneal cortex (the upper left side of the picture) after controlling for the effects of age, sex and total intracranial volume. In UBP patients, a reduction in gray matter volume was only found in the left precentral cortex and part of the left postcentral cortex (the right side of the upper picture). Between-group differences are represented as statistical maps color-coded on a red-yellow scale, with brighter (more yellow) regions corresponding to more significant differences. Images are presented with right hemisphere structures shown on the right. R: Right.
Figure 2
Figure 2
Gray matter volume increases in low back pain (LBP) and upper back pain (UBP) patients revealed by region of interest voxel-based morphometry analyses. In LBP patients, increased gray matter volume was observed in the bilateral putamen and nucleus accumbens, the left amygdala, the right caudate nucleus and the pallidum (the upper left side of the picture). In UBP patients, no significant gray matter increases were found in subcortical regions. Between-group differences are represented as statistical maps color-coded on a red-yellow scale, with brighter (more yellow) regions corresponding to more significant differences. R: Right.
Figure 3
Figure 3
Correlation between gray matter density in the bilateral insular cortex, pain intensity and psychometric variables in upper back pain (UBP) patients (Pearson correlation). (A) Negative correlation between clinical pain intensity and gray matter density in the bilateral insular cortex is observed in UBP patients (r = −0.195, P < 0.05). (B) Negative correlation between HAMA scores and gray matter density in the insular cortex is observed in UBP patients (r = −0.436, P < 0.05). (C) Positive correlation between clinical pain intensity and HAMD scores is observed in UBP patients (r = 0.691, P < 0.001). (D) Positive correlation between pain intensity and HAMA scores is observed in UBP patients (r = 0.612, P < 0.05). R2: Calculated from multivariate linear regression; r: correlation coefficient; SF_MPQ: short-form McGill pain questionnaire; HAMD: Hamilton Depression Rating Scale; HAMA: Hamilton Anxiety Scale.
Figure 4
Figure 4
Correlations between psychological variables in low back pain (LBP) and upper back pain (UBP) patients. Positive correlation between affective and cognitive scores was revealed by correlation analyses. (A) Positive correlation between HAMD scores and HAMA scores in LBP patients (Spearman rank test: r = 0.803, P < 0.001). (B) Positive correlation between HAMD scores and HAMA scores in UBP patients (Spearman rank test: r = 0.792, P < 0.001). (C) Positive correlation between MMSE and MoCA scores in LBP patients (Pearson coefficient: r = 0.645, P < 0.001). (D) The correlations between MMSE and MoCA scores are not significant in UBP patients (Spearman rank test: r = 0.365, P > 0.05). R2: Calculated from multivariate linear regression; r: correlation coefficient; MMSE: Mini-Mental State examination; HAMD: Hamilton Depression Rating Scale; HAMA: Hamilton Anxiety Scale; MoCA: Montreal Cognitive Assessment.

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