Department of Veterans Affairs, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
Pain. 2017 Dec;158(12):2364-2375. doi: 10.1097/j.pain.0000000000001038.
Chronic musculoskeletal pain (CMP) affects ∼25% of the 700,000 Veterans deployed during the Persian Gulf War (1990-1991). The cause of their pain is unknown, and there are no efficacious treatments. A small body of literature suggests that brain abnormalities exist in Gulf War Veterans (GVs), yet relationships between brain abnormalities and disease symptoms remain largely unexplored. Our purpose was to compare white matter (WM) integrity between GVCMP and matched, healthy Veteran controls (GVCO) and investigate relationships between cerebral WM integrity and symptoms. Thirty GVCMP and 31 controls completed magnetic resonance imaging with diffusion tensor imaging. Tract-based spatial statistics estimated WM fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity over the whole brain (P < 0.05) and were corrected using threshold-free cluster enhancement. GVCMP had greater pain symptoms and mood disturbance and lower quality of life and physical function compared with GVCO (P < 0.05). GVCMP had lower WM integrity across several brain regions implicated in chronic pain (P < 0.05) including the middle and inferior frontal gyrus, corpus callosum, corona radiata, precentral gyrus, external capsule, and posterior thalamic radiation. For GVCMP, WM integrity was associated with pain and mood symptoms in widespread brain areas that were found to be different between groups (P < 0.05). Results indicate widespread WM microstructure disruption across brain regions implicated in pain processing and modulation in chronic pain. The observed relationships between WM microstructure and symptoms encourage the testing of treatments designed to improve the brain health of affected Veterans.
慢性肌肉骨骼疼痛（CMP）影响了约 700,000 名在波斯湾战争（1990-1991 年）中部署的退伍军人中的 25%。他们疼痛的原因尚不清楚，也没有有效的治疗方法。有少量文献表明海湾战争退伍军人（GVs）存在大脑异常，但大脑异常与疾病症状之间的关系在很大程度上仍未得到探索。我们的目的是比较慢性肌肉骨骼疼痛的海湾战争退伍军人（GVCMP）和匹配的健康退伍军人对照组（GVCO）之间的大脑白质（WM）完整性，并研究大脑 WM 完整性与症状之间的关系。30 名 GVCMP 和 31 名对照组完成了磁共振成像和弥散张量成像。基于束流的空间统计学估计了整个大脑的 WM 各向异性分数、平均弥散度、径向弥散度和轴向弥散度（P < 0.05），并使用无阈值聚类增强进行了校正。与 GVCO 相比，GVCMP 具有更高的疼痛症状和情绪障碍，以及更低的生活质量和身体功能（P < 0.05）。GVCMP 在几个与慢性疼痛相关的大脑区域的 WM 完整性较低（P < 0.05），包括额中回和额下回、胼胝体、辐射冠、中央前回、外囊和丘脑后辐射。对于 GVCMP，WM 完整性与疼痛和情绪症状相关，这些症状与在组间发现的不同大脑区域相关（P < 0.05）。结果表明，疼痛处理和调制中涉及的大脑区域的 WM 微观结构中断广泛存在。观察到的 WM 微观结构与症状之间的关系鼓励了测试旨在改善受影响退伍军人大脑健康的治疗方法。
