Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

Alan Edwards Centre for Research on Pain, McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1A4, Canada.
The Journal of Neuroscience : The Official Journal of the Society for Neuroscience (Impact Factor: 6.34). 05/2011; 31(20):7540-50. DOI: 10.1523/JNEUROSCI.5280-10.2011
Source: PubMed

ABSTRACT Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n = 18) and 6 months after (spine surgery or facet joint injections; n = 14) treatment. In addition, we scanned 16 healthy controls, 10 of which returned 6 months after the first visit. We performed cortical thickness analysis on structural MRI scans, and subjects performed a cognitive task during the functional MRI. We compared patients and controls, as well as patients before versus after treatment. After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which was thinner before treatment compared with controls. Increased DLPFC thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left DLPFC activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment. These data indicate that functional and structural brain abnormalities-specifically in the left DLPFC-are reversible, suggesting that treating chronic pain can restore normal brain function in humans.

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    • "Our result suggest that the acupuncture may have prevented the natural rapid cortical thinning process of Knee OA patients by increasing the ability of the left pMPFC to control and modulate one's pain experience, which ultimately decreased the subjects' experience of pain. We observed cortical thickness decrease after one month of treatment, which is comparable in change in brain structure and duration of treatment with other published results438485. "
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    ABSTRACT: In this study, we investigated cortical thickness and functional connectivity across longitudinal acupuncture treatments in patients with knee osteoarthritis (OA). Over a period of four weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before their first, third and sixth treatments. Clinical outcome showed a significantly greater Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (improvement) with verum acupuncture compared to the sham acupuncture. Longitudinal cortical thickness analysis showed that the cortical thickness at left posterior medial prefrontal cortex (pMPFC) decreased significantly in the sham group across treatment sessions as compared with verum group. Resting state functional connectivity (rsFC) analysis using the left pMPFC as a seed showed that after longitudinal treatments, the rsFC between the left pMPFC and the rostral anterior cingulate cortex (rACC), medial frontal pole (mFP) and periaquiduct grey (PAG) are significantly greater in the verum acupuncture group as compared with the sham group. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.
    Scientific Reports 09/2014; 4:6482. DOI:10.1038/srep06482 · 5.58 Impact Factor
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    • "Studies using voxel-based morphometry (VBM), a computationalbased technique that measures focal differences in concentrations of brain tissue using a voxel-wise comparison between two groups of subjects ( Ashburner and Friston, 2000 ), have reported conflicting results suggesting that chronic pain can either decrease ( Apkarian et al., 2004 ; Buckalew et al., 2008 ; Burgmer et al., 2009 ; Davis et al., 2008 ; Draganski et al., 2006 ; Geha et al., 2008 ; Gerstner et al., 2012 ; Gustin et al., 2011 ; Gwilym et al., 2010 ; Kuchinad et al., 2007 ; Rocca et al., 2006 ; Rodriguez-Raecke et al., 2009 ; Schmidt-Wilcke et al., 2006 ; Schmidt-Wilcke et al., 2010 ; Seminowicz et al., 2011 ; Tu et al., 2010 ; Unrath et al., 2007 ; Valet et al., 2009 ; Valfre et al., 2008 ; Vartiainen et al., 2009 ), or increase ( Etgen et al., 2005 ; Garraux et al., 2004 ; Obermann et al., 2007 ; Obermann et al., 2009 ; Schmidt- Wilcke et al., 2006 ; Schmidt-Wilcke et al., 2007 ; Schweinhardt et al., 2008 ; Seminowicz et al., 2011 ; Tu et al., 2010 ; Younger et al., 2010 ) gray matter density. Some authors have even reported a lack of any change ( Hsu et al., 2009 ; Rocca et al., 2006 ; Schmidt-Wilcke et al., 2005 ; Schmidt-Wilcke et al., 2007 ) in gray matter volume or density. "
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    ABSTRACT: Several studies have attempted to characterize morphological brain changes due to chronic pain. Although it has repeatedly been suggested that longstanding pain induces gray matter modifications, there is still some controversy surrounding the direction of the change (increase or decrease in gray matter) and the role of psychological and psychiatric comorbidities. In this study, we propose a novel, network-oriented, meta-analytic approach to characterize morphological changes in chronic pain. We used network decomposition to investigate whether different kinds of chronic pain are associated with a common or specific set of altered networks. Representational similarity techniques, network decomposition and model-based clustering were employed: i) to verify the presence of a core set of brain areas commonly modified by chronic pain; ii) to investigate the involvement of these areas in a large-scale network perspective; iii) to study the relationship between altered networks and; iv) to find out whether chronic pain targets clusters of areas. Our results showed that chronic pain causes both core and pathology-specific gray matter alterations in large-scale networks. Common alterations were observed in the prefrontal regions, in the anterior insula, cingulate cortex, basal ganglia, thalamus, periaqueductal gray, post- and pre-central gyri and inferior parietal lobule. We observed that the salience and attentional networks were targeted in a very similar way by different chronic pain pathologies. Conversely, alterations in the sensorimotor and attention circuits were differentially targeted by chronic pain pathologies. Moreover, model-based clustering revealed that chronic pain, in line with some neurodegenerative diseases, selectively targets some large-scale brain networks. Altogether these findings indicate that chronic pain can be better conceived and studied in a network perspective.
    Frontiers in Human Neuroscience 04/2014; 4:676-686. DOI:10.1016/j.nicl.2014.04.007 · 2.99 Impact Factor
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    • "nd chronic pain patients are at heightened risk of suicide ( Fishbain , 1999 ) . At the biological level , prolonged and intense pain also has the effect of atrophying muscle tissue , impairing tis - sue growth and repair , suppressing the immune system , and causing morphological alterations to brain structures ( Gatchel et al . , 2007 ; see also Seminowicz et al . , 2011 ) . Despite the fact that there are many negative outcomes of pain , positive consequences may be apparent even in con - texts where negative outcomes clearly predominate . A at UQ Library on August 12 , 2014 psr . sagepub . com Downloaded from number of factors related to the pain experience itself influ - ence the likelihood of positi"
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    ABSTRACT: Pain is mostly thought of as a problem-as debilitating or harmful. Despite its unpleasantness, however, under some conditions pain can be associated with positive consequences. In this review, we explore these positive biological, psychological, and social consequences of pain. We highlight three different domains in which pain may be considered to have positive consequences. First, pain facilitates pleasure by providing an important contrast for pleasurable experiences, increasing sensitivity to sensory input, and facilitating self-rewarding behavior. Second, pain augments self-regulation and enhancement by increasing cognitive control, reducing rumination, and demonstrating virtue. Third, pain promotes affiliation by arousing empathy from others, motivating social connection, and enhancing group formation. Drawing on evidence scattered across a range of academic fields, we provide for reflection on how pain is represented, generate insights into pain-seeking behavior, and draw attention to the role of painful experiences in maximizing positive outcomes.
    Personality and Social Psychology Review 04/2014; 18(3). DOI:10.1177/1088868314527831 · 7.55 Impact Factor
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