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Significant differences of brain blood flow in patients with chronic low back pain and acute low back pain detected by brain SPECT

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

The aim of this study was to examine and compare the areas of brain blood flow in patients with chronic low back pain (CLBP) without structural abnormality and acute low back pain (ALBP) with lumber disc herniation (LDH). Functional neuroimaging studies provide evidence of abnormalities in the regional cerebral blood flow during low back pain. Recent studies have shown that CLBP is associated with plastic, pathophysiological changes in the brain. However, there has been no report yet statistically or by neuro-images on the compared brain single photon-emission computed tomography (SPECT) findings between CLBP and ALBP patients.

Methods

The subjects comprised 14 patients, 7 CLBP and 7 ALBP patients. The CLBP group included the patients who had no or minor structural abnormality in the lumbar spine on magnetic resonance imaging (MRI) and met the criteria for a classification of “pain disorder” (chronic) according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. The ALBP group included the patients who had symptoms within 3 months of onset and LDH revealed by MRI. All patients were assessed using brain SPECT. We then performed a two-tailed view analysis using the easy Z score imaging system, determined the mean Z scores, and performed vBSEE software (Fujifilm RI Pharma, Tokyo, Japan) for both CLBP and ALBP patients.

Results

The CLBP group showed significantly reduced blood flow in the bilateral prefrontal cortex of the frontal lobe and increased blood flow in the bilateral posterior lobe of the cerebellum.

Conclusions

SPECT images and statistical analyses revealed the brain blood flow alterations in the patients with ALBP and CLBP. These results may suggest that the dysfunction of the prefrontal cortex could lead to the appearance of unconscious pain behavior controlled by the cerebellum in the patients with CLBP.

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Acknowledgments

We thank Mr. Kaneko Hiroyasu, Mr. Akihiro Nanri, and Mr. Shuji Fujita of FUJIFILM RI Pharma Co. Ltd. Tokyo, Japan for their technical advice and support. We thank Professor Katsuhiko Takeda at the International University of Health and Welfare for his valuable advice and suggestions. We also thank the Survey Research Center for their statistical analyses regarding power and effect size in this study. This work was supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Showa Inan General Hospital, Komagane, 399-4117, Japan

    Yukio Nakamura

  2. Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, 390-8621, Japan

    Yukio Nakamura & Hiroyuki Kato

  3. Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Isehara, 259-1132, Japan

    Kenya Nojiri & Takeshi Takahata

  4. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA

    Hiroyuki Yoshihara

  5. Department of Rehabilitation Medicine, Showa Inan General Hospital, Komagane, 399-4117, Japan

    Kumiko Honda-Takahashi & Tetsumi Honda

  6. Faculty of Education and Integrated Arts and Sciences, Waseda University, Tokyo, 169-8050, Japan

    Saori Kubo & Kazuyuki Sakatsume

  7. Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA

    Toshihiko Maruta

Authors
  1. Yukio Nakamura
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  2. Kenya Nojiri
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  3. Hiroyuki Yoshihara
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  5. Kumiko Honda-Takahashi
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  7. Kazuyuki Sakatsume
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  8. Hiroyuki Kato
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  9. Toshihiko Maruta
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  10. Tetsumi Honda
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Corresponding author

Correspondence to Tetsumi Honda.

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Nakamura, Y., Nojiri, K., Yoshihara, H. et al. Significant differences of brain blood flow in patients with chronic low back pain and acute low back pain detected by brain SPECT. J Orthop Sci 19, 384–389 (2014). https://doi.org/10.1007/s00776-014-0534-2

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  • DOI: https://doi.org/10.1007/s00776-014-0534-2

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