Structural and functional brain abnormalities in chronic low back pain: A systematic review
Jeroen Kregel1, Mira Meeus2, Anneleen Malfliet1
1Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 3B3, Ghent 9000, Belgium; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; "Pain in Motion" International Research Group.
This review finds moderate evidence of brain changes in chronic low back pain (CLBP) patients, including altered gray and white matter and disrupted functional connectivity. Pain processing areas show increased activity, suggesting an upregulated pain matrix.
Area of Science:
- Neuroscience
- Radiology
- Pain Medicine
Background:
- Chronic low back pain (CLBP) is a prevalent condition with complex underlying mechanisms.
- Brain abnormalities may contribute to the chronification and persistence of CLBP.
- Magnetic resonance imaging (MRI) offers advanced techniques to investigate brain structure and function.
Purpose of the Study:
- To systematically review and analyze brain magnetic resonance imaging (MRI) literature on structural and functional abnormalities in CLBP.
- To synthesize findings regarding gray matter, white matter, and functional connectivity in CLBP patients.
Main Methods:
- Systematic literature search of PubMed and Web of Science for studies using brain MRI in CLBP.
- Inclusion of articles based on specific criteria and hand-searching reference lists.
- Assessment of risk of bias and review by two independent researchers.
Main Results:
- 27 articles met inclusion criteria, with methodological quality varying.
- Moderate evidence for regional gray and white matter changes, though global changes are conflicting.
- Altered functional connectivity at rest and increased activity in pain-related regions upon stimulation were observed.
Conclusions:
- CLBP is associated with neuroplastic changes in gray and white matter and altered functional brain organization.
- An upregulated pain matrix is suggested by increased activity in pain-processing areas.
- Further longitudinal research and integration of diverse MRI techniques are recommended.
