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Neuroimmune signatures in chronic low back pain subtypes
Zeynab Alshelh1, Ludovica Brusaferri1, Atreyi Saha1
1Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
Brain : a Journal of Neurology
|September 16, 2021
Summary
Neuroinflammation, marked by 18-kDa translocator protein (TSPO), differs between chronic low back pain subtypes. These neuroinflammatory signatures correlate with clinical presentation and neurophysiology, aiding precision medicine.
Area of Science:
- Neuroscience
- Radiology
- Pain Medicine
Background:
- Neuroinflammation, indicated by 18-kDa translocator protein (TSPO), is implicated in diverse chronic pain conditions.
- Distinct pain disorders may exhibit unique neuroinflammatory patterns, termed 'neuroinflammatory signatures'.
Purpose of the Study:
- To investigate if neuroinflammation can differentiate etiological subtypes of chronic low back pain (CLBP).
- To explore neuroinflammation in radicular versus axial CLBP using PET/MRI and assess correlations with clinical presentation and neurophysiology.
Main Methods:
- Fifty-four CLBP patients (26 axial, 28 radicular) underwent PET/MRI with 11C-PBR28, a TSPO radioligand.
- Functional MRI localized somatosensory cortex regions and assessed thalamic connectivity.
- PET and fMRI data were correlated with each other and 'fibromyalgianess' scores.
Main Results:
- Radicular CLBP patients showed higher 11C-PBR28 signal and thalamic connectivity in the primary somatosensory cortex compared to axial CLBP patients.
- Both measures positively correlated with each other and with 'fibromyalgianess' scores.
- 'Fibromyalgianess' mediated the relationship between TSPO signal and somatosensory cortex-thalamus connectivity.
Conclusions:
- Neuroinflammatory signatures, linked to neurophysiological changes, characterize CLBP subtypes based on clinical presentation.
- These findings support the subtyping of pain syndromes and highlight potential targets for precision medicine in chronic pain.
