Department of Neurosurgery, U.S. Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
PLoS One. 2020 Feb 19;15(2):e0228306. doi: 10.1371/journal.pone.0228306. eCollection 2020.
Chronic pain has been associated with alterations in brain structure and function that appear dependent on pain phenotype. Functional connectivity (FC) data on chronic back pain (CBP) is limited and based on heterogeneous pain populations. We hypothesize that failed back surgery syndrome (FBSS) patients being considered for spinal cord stimulation (SCS) therapy have altered resting state (RS) FC cross-network patterns that 1) specifically involve emotion and reward/aversion functions and 2) are related to pain scores.
RS functional MRI (fMRI) scans were obtained for 10 FBSS patients who are being considered for but who have not yet undergone implantation of a permanent SCS device and 12 healthy age-matched controls. Seven RS networks were analyzed including the striatum (STM). The Wilcoxon signed-rank test evaluated differences in cross-network FC strength (FCS). Differences in periaqueductal grey (PAG) FC were assessed with seed-based analysis.
Cross-network FCS was decreased (p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC with network elements and amygdala but increased FC with the sensorimotor cortex and cingulate gyrus.
Decreased FC between STM and other RS networks in FBSS has not been previously reported. This STMFCS index may represent a more objective measure of chronic pain specific to FBSS which may help guide patient selection for SCS and subsequent management.
慢性疼痛与大脑结构和功能的改变有关，这些改变似乎依赖于疼痛表型。慢性腰痛（CBP）的功能连接（FC）数据有限，且基于异质的疼痛人群。我们假设，考虑接受脊髓刺激（SCS）治疗的失败性脊柱手术综合征（FBSS）患者具有改变的静息状态（RS）跨网络模式，这些模式 1）特别涉及情绪和奖励/厌恶功能，2）与疼痛评分相关。
对 10 名 FBSS 患者进行 RS 功能磁共振成像（fMRI）扫描，这些患者正在考虑但尚未接受永久性 SCS 设备植入，同时还纳入 12 名年龄匹配的健康对照者。分析了包括纹状体（STM）在内的 7 个 RS 网络。Wilcoxon 符号秩检验评估了跨网络 FC 强度（FCS）的差异。采用种子点分析评估了中脑导水管周围灰质（PAG）FC 的差异。
这些 FBSS 患者的 STM 与所有其他网络之间的跨网络 FCS 降低（p<0.05）。STMFCS 指数与疼痛评分呈负线性关系（R2 = 0.76，p<0.0022）。PAG 与网络元素和杏仁核的 FC 降低，但与感觉运动皮层和扣带回的 FC 增加。
FBSS 中 STM 与其他 RS 网络之间的 FC 降低以前尚未报道过。这个 STMFCS 指数可能代表了一种更客观的 FBSS 慢性疼痛指标，这可能有助于指导 SCS 患者选择和后续管理。
