Loss of nucleus accumbens low-frequency fluctuations is a signature of chronic pain
| Autor: | Guillermo A. Cecchi, Ivan deAraujo, Paul Geha, Donna A. Thomas, Dana M. Small, Daniel S. Barron, Meena M. Makary, Peter G. Whang, Todd Constable, Pablo Polosecki, Hani Mowafi |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Disease Nucleus accumbens Gyrus Cinguli Corrections Nucleus Accumbens Limbic system limbic system Risk Factors Internal medicine Neural Pathways medicine Back pain Humans Anterior cingulate cortex Brain Mapping Multidisciplinary medicine.diagnostic_test business.industry Chronic pain Brain Magnetic resonance imaging Biological Sciences medicine.disease Magnetic Resonance Imaging Pathophysiology medicine.anatomical_structure Back Pain Cardiology Female medicine.symptom Chronic Pain Nerve Net business Neuroscience |
| Zdroj: | Proceedings of the National Academy of Sciences of the United States of America Proc Natl Acad Sci U S A |
| Popis: | Significance The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering, chronic pain is associated with psychiatric and medical comorbidities, notably substance misuse. Chronic pain does not have a cure or quantitative diagnostic or prognostic tools. Here we show that brain imaging can provide such measures. First, we show that the brain limbic system of patients with subacute back pain at risk for becoming chronic back pain patients exhibits limbic system structural alterations, which predate the onset of chronic pain. Second, we show that the nucleus accumbens activity shows loss of low-frequency fluctuations only when patients transition to the chronic phase, an observation that was reproduced in multiple datasets collected at different sites. Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain. |
| Databáze: | OpenAIRE |
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