Task-evoked network connectivity and pain regulation success in chronic low back pain

Resting-state functional connectivity (rsFC) has shown widespread changes in intrinsic functional brain networks in individuals with chronic low back pain (CLBP). However, less is known about rsFC between task-evoked brain networks (i.e., networks formed by regions that are activated to tasks) implicated in cognitive reappraisal and attention regulation in this population. This cross-sectional study analyzed resting-state fMRI and behavioral data from a separate pain regulation task in 184 individuals with CLBP to investigate whether rsFC among ROIs defined from task-based meta-analyses of cognitive reappraisal and attention regulation networks was associated with pain regulation success. We hypothesized that increased rsFC within and between task-based networks would be associated with greater pain regulation success, and that trait cognitive reappraisal and mindfulness would mediate these relationships. Results indicated that increased rsFC between ROIs in the task-based cognitive reappraisal network, including the left ventrolateral prefrontal cortex (vlPFC) and left middle temporal gyrus (MTG), was associated with reduced pain regulation success using either cognitive reappraisal or attention regulation. Conversely, increased rsFC between ROIs in the task-based cognitive reappraisal network left vlFPC and attention regulation network right middle frontal gyrus (MFG) was associated with increased pain regulation success using attention regulation. Examining the relationship between rsFC and self-reported measures of pain, cognition, and emotion, we found that increased rsFC between the task-based cognitive reappraisal network left MTG and attention regulation network right inferior frontal gyrus (IFG) was associated with increased self-reported cognitive distortions. In contrast, increased rsFC between the task-based attention regulation network bilateral vlPFC and left posterior cingulate cortex (PCC) was associated with more habitual use of cognitive reappraisal, lower pain catastrophizing, and lower depression. In a formal mediation analysis, neither trait cognitive reappraisal nor trait mindfulness mediated the relationship between rsFC and pain regulation success. Together, our findings suggest that rsFC between brain regions in task-based cognitive reappraisal and attention regulation networks is related to behavioral outcomes in a separate evoked pain regulation task and may underlie cognition and emotion regulation success in individuals with CLBP.