Clinical phenotype matters: structural and functional thalamic changes in neuropathic low-back pain.
Ruiyi Yuan1, Martin Cole1, Jennifer Gewandter2
1Departments of Psychiatry and.
Pain
|December 1, 2025
Summary
Neuropathic chronic low-back pain (neuCLBP) patients show distinct brain structural and functional differences compared to non-neuropathic CLBP patients. These findings suggest unique central plasticity patterns in neuCLBP, impacting treatment strategies.
Area of Science:
- Neuroscience
- Pain Medicine
- Radiology
Background:
- Neuropathic chronic low-back pain (neuCLBP) has poorer outcomes and limited treatments due to poor understanding of its pathophysiology.
- Distinguishing neuCLBP from non-neuropathic CLBP (non-neuCLBP) is crucial for targeted therapies.
Purpose of the Study:
- To compare brain structure and function in neuCLBP versus non-neuCLBP patients using multimodal functional magnetic resonance imaging (fMRI).
- To investigate differences in thalamic volume/shape and somatosensory cortex (S1) thickness and connectivity.
Main Methods:
- Standardized clinical phenotyping of neuropathic pain components.
- Multimodal brain fMRI, including resting-state functional connectivity analysis.
- Comparison of neuCLBP patients (n=28), non-neuCLBP patients (n=28), and healthy controls.
Main Results:
- NeuCLBP patients exhibited more severe symptoms than non-neuCLBP patients.
- Significant differences in thalamic shape were observed in neuCLBP patients, but not in thalamic volume or S1 thickness.
- Non-neuCLBP patients showed the most pronounced alterations in resting-state thalamic connectivity gradients.
Conclusions:
- NeuCLBP patients may exhibit distinct central plasticity patterns, differing from non-neuCLBP patients.
- Findings underscore the importance of differentiating clinical phenotypes in chronic low-back pain research.
- Multimodal fMRI combined with phenotyping offers insights into neuCLBP pathophysiology.
