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Neural correlates of central pain sensitization in chronic low back pain: a resting-state fMRI study

  • Advanced Neuroimaging
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Abstract

Purpose

The objective of this study is to explore the neural correlates of pain sensitization in patients with chronic low back pain (cLBP). While the association between cLBP and pain sensitization has been widely reported, the underlying brain mechanism responsible for this relationship requires further investigation.

Methods

Our study included 56 cLBP patients and 56 healthy controls (HC). Functional magnetic resonance imaging data were obtained, and the voxel-wise amplitude of low-frequency fluctuation (ALFF) was calculated to identify brain alterations in cLBP patients compared to HC groups. Pearson correlation coefficients were computed to explore the association between clinical data and brain alterations. Furthermore, mediation analyses were performed to investigate the path association between brain alterations and pain-related behaviors.

Results

Our findings revealed that patients with cLBP exhibited higher sensitivity, attention, and catastrophizing tendencies towards pain compared to HC. Furthermore, cLBP patients displayed significantly higher ALFF in various brain regions within the “pain matrix” and the default mode network when compared to HC. The altered precuneus ALFF was positively correlated with pain intensity (R = 0.51, P<0.001) and was negatively correlated with pain sensitivity (R = −0.43, P<0.001) in cLBP patients. Importantly, the effect of altered precuneus ALFF on pain intensity was mediated by pain threshold in these patients.

Conclusion

Our study suggests that altered neural activity in the precuneus may contribute to pain hypersensitivity, which further exacerbating pain in cLBP patients.

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Funding

This study was funded by Hebei Medical Science Research Project Plan 20231737.

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Authors and Affiliations

  1. Department of Spinal Surgery, The Second Hospital of Tangshan, Tangshan, China

    NingJian Fan, Bing Zhao, LiYun Liu, WeiZhen Yang, Xian Chen, ZhanBin Lu, LiGong Wang & HengCong Cao

  2. Pediatric Neurology Department EEG Room, Maternal and Child Health Hospital of Tangshan, Tangshan, China

    JiXi Chen

  3. Department of Trauma, The Second Hospital of Tangshan, Tangshan, China

    AiGuo Ma

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  1. NingJian Fan
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Correspondence to AiGuo Ma.

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The authors of this manuscript assert that they have no affiliations or financial ties with any companies that offer products or services related to the topic of the article.

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The Institutional Review Board of the Second Hospital of Tangshan approved our study.

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In this study, all participants, including patients, were provided with written consent after receiving comprehensive information about the study.

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Supplementary information

ESM 1:

Figure S1. The QQ-plots for clinical assessments in both chronic low back pain patients (cLBP) and healthy controls (HC). The black dots represent the clinical measures of cLBP patients and pink dots represent the clinical measures of HC. PVAQ: pain vigilance and awareness questionnaire; PCS: pain catastrophe scale. (PDF 228 kb)

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Fan, N., Chen, J., Zhao, B. et al. Neural correlates of central pain sensitization in chronic low back pain: a resting-state fMRI study. Neuroradiology 65, 1767–1776 (2023). https://doi.org/10.1007/s00234-023-03237-3

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