title: Brain white matter structural properties predict transition to chronic pain.
abstract: Neural mechanisms mediating the transition from acute to chronic pain remain largely unknown. In a longitudinal brain imaging study, we followed up patients with a single sub-acute back pain (SBP) episode for more than 1 year as their pain recovered (SBPr), or persisted (SBPp) representing a transition to chronic pain. We discovered brain white matter structural abnormalities (n=24 SBP patients; SBPp=12 and SBPr=12), as measured by diffusion tensor imaging (DTI), at entry into the study in SBPp in comparison to SBPr. These white matter fractional anisotropy (FA) differences accurately predicted pain persistence over the next year, which was validated in a second cohort (n=22 SBP patients; SBPp=11 and SBPr=11), and showed no further alterations over a 1-year period. Tractography analysis indicated that abnormal regional FA was linked to differential structural connectivity to medial vs lateral prefrontal cortex. Local FA was correlated with functional connectivity between medial prefrontal cortex and nucleus accumbens in SBPr. As we have earlier shown that the latter functional connectivity accurately predicts transition to chronic pain, we can conclude that brain structural differences, most likely existing before the back pain-inciting event and independent of the back pain, predispose subjects to pain chronification.
authors.affiliation: Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Mansour
authors.forename: Marwan N
authors.initials: MN
authors.lastname: Baliki
authors.forename: Lejian
authors.initials: L
authors.lastname: Huang
authors.forename: Souraya
authors.initials: S
authors.lastname: Torbey
authors.forename: Kristi M
authors.initials: KM
authors.lastname: Herrmann
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schnitzer
authors.forename: Vania A
authors.initials: VA
authors.lastname: Apkarian
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D059350:Chronic Pain / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D056324:Diffusion Tensor Imaging / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000378:metabolism / Q000473:pathology*; D011237:Predictive Value of Tests
keywords: Brain; Chronic pain; Connectivity; DTI; Prediction
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