Department of Anesthesiology, Duke University Medical Center, Durham, USA.
Duke Center for Translational Pain Medicine, Durham, USA.
Sci Rep. 2022 Jul 25;12(1):12683. doi: 10.1038/s41598-022-16835-7.
Brain corticostriatal circuits are important for understanding chronic pain and highly relevant to motivation and cognitive processes. It has been demonstrated that in patients with chronic back pain, altered nucleus accumbens (NAcc)-medial prefrontal cortex (MPFC) circuit fMRI-based activity is predictive of patient outcome. We evaluated the NAcc-MPFC circuit in patients with another chronic pain condition, fibromyalgia, to extend these important findings. First, we compared fMRI-based NAcc-MPFC resting-state functional connectivity in patients with fibromyalgia (N = 32) vs. healthy controls (N = 37). Compared to controls, the NAcc-MPFC circuit's connectivity was significantly reduced in fibromyalgia. In addition, within the fibromyalgia group, NAcc-MPFC connectivity was significantly correlated with trait anxiety. Our expanded connectivity analysis of the NAcc to subcortical brain regions showed reduced connectivity of the right NAcc with mesolimbic circuit regions (putamen, thalamus, and ventral pallidum) in fibromyalgia. Lastly, in an exploratory analysis comparing our fibromyalgia and healthy control cohorts to a separate publicly available dataset from patients with chronic back pain, we identified reduced NAcc-MPFC connectivity across both the patient groups with unique alterations in NAcc-mesolimbic connectivity. Together, expanding upon prior observed alterations in brain corticostriatal circuits, our results provide novel evidence of altered corticostriatal and mesolimbic circuits in chronic pain.
大脑皮质纹状体回路对于理解慢性疼痛非常重要，与动机和认知过程密切相关。已经证明，在慢性背痛患者中，改变伏隔核（NAcc）-内侧前额叶皮层（MPFC）基于 fMRI 的活动可预测患者的预后。我们评估了另一种慢性疼痛疾病纤维肌痛患者的 NAcc-MPFC 回路，以扩展这些重要发现。首先，我们比较了纤维肌痛患者（N = 32）与健康对照者（N = 37）的基于 fMRI 的 NAcc-MPFC 静息状态功能连接。与对照组相比，纤维肌痛患者的 NAcc-MPFC 回路连接显著降低。此外，在纤维肌痛组中，NAcc-MPFC 连接与特质焦虑显著相关。我们对 NAcc 到皮质下脑区的扩展连接分析显示，纤维肌痛中右侧 NAcc 与中脑边缘回路区域（壳核、丘脑和腹侧苍白球）的连接减少。最后，在一项将我们的纤维肌痛和健康对照组与来自慢性背痛患者的另一个独立公开数据集进行比较的探索性分析中，我们发现两个患者组的 NAcc-MPFC 连接都减少了，而 NAcc-中脑边缘连接则有独特的改变。总之，我们的研究结果扩展了先前观察到的大脑皮质纹状体回路的改变，为慢性疼痛中的皮质纹状体和中脑边缘回路改变提供了新的证据。
