Brain structural and functional alterations in chronic non-specific low back pain: A case-control study
Huibiao Li1, Xiaonan Zhan2, Xin Zhao3
1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, China.
Objective:
The relationship between clinical symptoms and associated psychosocial factors of chronic non-specific low back pain (CNLBP) and changes in brain structure and function remains unclear. This study aims to identify changes in gray matter volume (GMV) in patients with CNLBP and to examine changes in resting-state functional connectivity (rsFC) in specific brain regions.
Methods:
This study included 30 CNLBP patients and 30 healthy controls, who underwent clinical assessments and magnetic resonance imaging scans. Voxel-based morphometry analyzed GMV changes in CNLBP patients' brain regions, which were defined as regions of interest for whole-brain rsFC analysis. Partial correlation and mediation analyses elucidated the central nervous mechanisms of CNLBP.
Results:
In CNLBP patients, pain severity is associated with anxiety (P = 0.042), depression (P < 0.001), and pain catastrophizing (P < 0.001), while disability is associated with anxiety (P = 0.002). Reduced GMV was observed in the left precentral gyrus, lingual gyrus, and right cerebellum_Crus1. Altered rsFC was found in the cerebellum-thalamus-precentral network (P < 0.001) and limbic system (P < 0.001). Partial correlation analysis revealed that these changes were associated with clinical symptoms of CNLBP (P < 0.05). Mediation analysis revealed that the severity of BDI-II scores in CNLBP was indirectly mediated by rsFC in the precentral gyrus and cerebellum (P < 0.05).
Conclusions:
This study found that the pain intensity and physical dysfunction in CNLBP patients are associated with psychosocial factors, such as anxiety, depression, and pain catastrophizing. In this context, widespread change in brain structure and function may contribute to a better understanding of CNLBP and its associated psychosocial factors.
