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A Randomized, Sham-Controlled Trial of Cranial Electrical Stimulation for Fibromyalgia Pain and Physical Function, Using Brain Imaging Biomarkers

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Brain white matter structural properties predict transition to chronic pain.

Ali R Mansour¹, Marwan N Baliki, Lejian Huang

¹Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

|September 18, 2013

Summary

Brain white matter abnormalities predict chronic pain development. Structural differences, present before pain onset, predispose individuals to persistent pain, offering new insights into pain chronification mechanisms.

Keywords:

Brain Chronic pain Connectivity DTI Prediction

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Area of Science:

Neuroscience
Medical Imaging
Pain Research

Background:

Neural mechanisms driving the transition from acute to chronic pain are poorly understood.
Sub-acute back pain (SBP) offers a model to study pain chronification.

Purpose of the Study:

To investigate brain structural differences associated with pain persistence versus recovery in SBP patients.
To identify predictors of chronic pain development from acute pain episodes.

Main Methods:

Longitudinal diffusion tensor imaging (DTI) study of patients with SBP.
Comparison of white matter fractional anisotropy (FA) between pain-persistent (SBPp) and pain-recovered (SBPr) groups.
Tractography and functional connectivity analyses.

Main Results:

SBPp patients exhibited white matter structural abnormalities at study entry compared to SBPr patients.
These FA differences predicted pain persistence over one year and remained stable.
Abnormal FA correlated with altered structural connectivity to prefrontal cortex regions.

Conclusions:

Pre-existing brain structural differences, independent of the back pain itself, may predispose individuals to chronic pain.
These findings suggest a predisposition to pain chronification rather than pain-induced brain changes.