TY - JOUR
T1 - Brain white matter structural properties predict transition to chronic pain
AU - Mansour, Ali R.
AU - Baliki, Marwan N.
AU - Huang, Lejian
AU - Torbey, Souraya
AU - Herrmann, Kristi M.
AU - Schnitzer, Thomas J.
AU - Vania Apkarian, A.
N1 - Funding Information:
We thank all patients and healthy volunteers who participated in the study. This study was funded by National Institutes of Health , National Institute of Neurological Disorders and Stroke NS035115 (A.V.A.), M.N.B. was funded by an anonymous foundation.
PY - 2013/10
Y1 - 2013/10
N2 - Neural mechanisms mediating the transition from acute to chronic pain remain largely unknown. In a longitudinal brain imaging study, we followed up patients with a single sub-acute back pain (SBP) episode for more than 1 year as their pain recovered (SBPr), or persisted (SBPp) representing a transition to chronic pain. We discovered brain white matter structural abnormalities (n = 24 SBP patients; SBPp = 12 and SBPr = 12), as measured by diffusion tensor imaging (DTI), at entry into the study in SBPp in comparison to SBPr. These white matter fractional anisotropy (FA) differences accurately predicted pain persistence over the next year, which was validated in a second cohort (n = 22 SBP patients; SBPp = 11 and SBPr = 11), and showed no further alterations over a 1-year period. Tractography analysis indicated that abnormal regional FA was linked to differential structural connectivity to medial vs lateral prefrontal cortex. Local FA was correlated with functional connectivity between medial prefrontal cortex and nucleus accumbens in SBPr. As we have earlier shown that the latter functional connectivity accurately predicts transition to chronic pain, we can conclude that brain structural differences, most likely existing before the back pain-inciting event and independent of the back pain, predispose subjects to pain chronification.
AB - Neural mechanisms mediating the transition from acute to chronic pain remain largely unknown. In a longitudinal brain imaging study, we followed up patients with a single sub-acute back pain (SBP) episode for more than 1 year as their pain recovered (SBPr), or persisted (SBPp) representing a transition to chronic pain. We discovered brain white matter structural abnormalities (n = 24 SBP patients; SBPp = 12 and SBPr = 12), as measured by diffusion tensor imaging (DTI), at entry into the study in SBPp in comparison to SBPr. These white matter fractional anisotropy (FA) differences accurately predicted pain persistence over the next year, which was validated in a second cohort (n = 22 SBP patients; SBPp = 11 and SBPr = 11), and showed no further alterations over a 1-year period. Tractography analysis indicated that abnormal regional FA was linked to differential structural connectivity to medial vs lateral prefrontal cortex. Local FA was correlated with functional connectivity between medial prefrontal cortex and nucleus accumbens in SBPr. As we have earlier shown that the latter functional connectivity accurately predicts transition to chronic pain, we can conclude that brain structural differences, most likely existing before the back pain-inciting event and independent of the back pain, predispose subjects to pain chronification.
KW - DTI Prediction Chronic pain Brain Connectivity
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U2 - 10.1016/j.pain.2013.06.044
DO - 10.1016/j.pain.2013.06.044
M3 - Article
C2 - 24040975
AN - SCOPUS:84884270721
SN - 0304-3959
VL - 154
SP - 2160
EP - 2168
JO - Pain
JF - Pain
IS - 10
ER -