Chronic Low Back Pain Duration Alters Brain Network Connectivity in Pain, Emotion, and Cognitive Processing

This study aimed to investigate the differences in brain network connectivity between short-term and long-term chronic low back pain (CLBP) patients.

This retrospective study included 25 CLBP patients who underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance (18F-FDG-PET/MR) imaging between January 2017 and December 2019. This imaging modality, which integrates functional and metabolic data, was used to assess both neural activity and metabolic alterations associated with CLBP. The connectivity between 14 large-scale brain networks (including pain processing, emotional regulation, and cognitive control networks) was analyzed, with pairwise correlations calculated for each participant. Significant differences between short-term and long-term CLBP patients were assessed using permutation testing with false discovery rate (FDR) correction.

Metabolic connectivity analysis revealed significant differences between short-term and long-term CLBP patients, particularly in the connectivity between the left executive control network (LECN) and visual networks, salience and posterior salience networks (SN/pSN), and posterior salience and ventral default mode network (vDMN) (FDR corrected, p < 0.05). Additionally, a positive correlation was found between disease duration and connectivity in the salience, posterior salience, and vDMN networks, with longer disease duration associated with stronger connectivity.

This study demonstrates that chronicity in CLBP is associated with altered brain network connectivity, particularly in networks related to emotional processing and pain perception. These findings highlight the neuroplastic changes that may occur with prolonged pain, providing insights into the underlying mechanisms of CLBP and potential targets for therapeutic intervention.