title: Structural Brain Alterations in Community Dwelling Individuals with Chronic Joint Pain.
abstract: OBJECTIVE
  Central sensitization in chronic pain involves structural brain changes that influence vulnerability to pain. Identifying brain regions involved in pain processing and sensitization can provide more insight into chronic pain. This study examines structural brain changes in chronic pain and experimental pain in a large population-based study.
  
  
  METHODS
  For 3892 participants in the Rotterdam study, global and regional MR imaging brain volumes were automatically segmented and quantified. Chronic joint pain was defined as pain for more than half of all days during the past 6 weeks. Heat pain thresholds were measured in a subset of 1538 individuals. The association between the presence of chronic joint pain and global and lobar brain volumes was studied. Subsequently, literature was reviewed and the association of chronic pain and heat pain thresholds with 11 brain regions associated with musculoskeletal pain in previous publications was studied.
  
  
  RESULTS
  Total gray matter volume was smaller in women with chronic pain (β = -0.066, P = .016). This effect was primarily driven by lower gray matter volume in the temporal lobe (β = 0.086, P = .005), the frontal lobe (β = -0.060, P = .039), and the hippocampus (β = -0.099, P = .002). In addition, we observed that a lower heat pain threshold was associated with smaller volumes of the hippocampus (β = 0.017, P = .048), the thalamus (β = 0.018, P = .009), and the anterior cingulate cortex (β = -0.016, P = .037). In men, no significant associations were observed.
  
  
  CONCLUSIONS
  The primary identified brain areas, the temporal and frontal lobes and the hippocampus, indicated involvement of emotional processing. The volumetric differences found indicated a sex-specific neuroplasticity in chronic pain. These results emphasized sex-specific and multidisciplinary pain treatment.
authors.affiliation: From the Departments of Internal Medicine (M.d.K., A.G.U., J.B.J.v.M.) Anaesthesiology (M.d.K., F.J.P.M.H.).
authors.forename: M
authors.initials: M
authors.lastname: de Kruijf
authors.affiliation: Radiology (D.B., W.J.N., M.W.V., M.A.I.) Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.).
authors.forename: D
authors.initials: D
authors.lastname: Bos
authors.affiliation: Anaesthesiology (M.d.K., F.J.P.M.H.).
authors.forename: F J P M
authors.initials: FJ
authors.lastname: Huygen
authors.affiliation: Radiology (D.B., W.J.N., M.W.V., M.A.I.) Medical Informatics (W.J.N.) Faculty of Applied Sciences (W.J.N.), Delft University of Technology, Delft, the Netherlands.
authors.forename: W J
authors.identifier: http://orcid.org/0000-0002-5822-1995
authors.initials: WJ
authors.lastname: Niessen
authors.affiliation: Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.).
authors.forename: H
authors.initials: H
authors.lastname: Tiemeier
authors.affiliation: Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.).
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9865-121X
authors.initials: A
authors.lastname: Hofman
authors.affiliation: From the Departments of Internal Medicine (M.d.K., A.G.U., J.B.J.v.M.) Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.).
authors.forename: A G
authors.initials: AG
authors.lastname: Uitterlinden
authors.affiliation: Radiology (D.B., W.J.N., M.W.V., M.A.I.) Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.).
authors.forename: M W
authors.identifier: http://orcid.org/0000-0003-4658-2176
authors.initials: MW
authors.lastname: Vernooij
authors.affiliation: Radiology (D.B., W.J.N., M.W.V., M.A.I.) Epidemiology (D.B., H.T., A.H., A.G.U., M.W.V., M.A.I.) Neurology (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: M A
authors.identifier: http://orcid.org/0000-0003-0372-8585
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: From the Departments of Internal Medicine (M.d.K., A.G.U., J.B.J.v.M.) j.vanmeurs@erasmusmc.nl.
authors.forename: J B J
authors.initials: JB
authors.lastname: van Meurs
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000150:complications* / Q000503:physiopathology; D001921:Brain / Q000473:pathology*; D059333:Central Nervous System Sensitization / Q000502:physiology*; D059350:Chronic Pain / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D057187:Independent Living; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012727:Sex Characteristics; D055815:Young Adult