Brain Alterations in Non-Specific Chronic Spinal Pain: MRI Findings and Associations with Clinical Parameters

Chronic musculoskeletal pain is a persistent condition that can reduce the quality of life and contribute to mental health disorders, leading to structural alterations in the central nervous system. On these grounds, the gray (GM) and white (WM) matter alterations in patients with non-specific chronic spinal pain (CSP) were examined using Magnetic Resonance Imaging (MRI), and explored their associations with clinical measures of mental health and quality of life. In this study, 60 controls (age 46.2 ± 11.8 years, 37 women) and 40 patients with CSP (age 49.5 ± 8.1 years, 31 women) were recruited. Before the MRI session, patients filled out multiple questionnaires and provided basic clinical information. The neuroimaging acquisition included a T1-weighted sequence, to extract the GM morphological features, and diffusion-weighted images (DWI) to calculate the WM diffusion parameters. The relationship of those measures with clinical variables was assessed with partial Spearman's correlation coefficients. Patients with non-specific CSP exhibited significantly reduced GM volume in several brain regions involved in pain processing and modulation. Regarding WM, patients showed increased mean and axial diffusivity in a few regions implicated in proprioception and the sensation of pain. Moreover, significant correlations between these measures and scores from clinical tests were found. In conclusion, MRI-based parameters from GM morphometry and diffusion descriptors allowed to detect structural alterations in the GM and WM of patients with CSP. These MRI-based descriptors were correlated with multiple clinical parameters that suggested a worsening of the patient's physical and mental health. PERSPECTIVE: This article assesses structural gray and white matter alterations of patients with non-specific chronic spinal pain and their relationship with clinical symptoms. Cerebellar and subcortical gray matter volume loss, and white matter altered diffusivity, were associated with reduced pain sensitivity, negative emotional and cognitive pain responses, and amplified pain experience.