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


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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Available from: David Seminowicz, Dec 17, 2014
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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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    • "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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    • "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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