Heukamp Nils Jannik, Moliadze Vera, Mišić Mina, Usai Katrin, Löffler Martin, Flor Herta, Nees Frauke
Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Pain. 2025 Jan 1;166(1):160-170. doi: 10.1097/j.pain.0000000000003335. Epub 2024 Jul 10.
Research has indicated that the default mode network (DMN) is perturbated in patients with chronic pain when compared with healthy controls, and this perturbation is correlated with the duration of pain during the chronic pain stage. It remains unclear whether DMN adaptations manifest during the subacute pain stage and progress over time because of the duration of pain experience, rather than being a specific correlate of the chronic pain stage. Furthermore, information regarding whether these adaptations are related to cognitive processes of adaptation is lacking. To this end, we examined the DMN in 31 patients with chronic back pain (CBP), 77 patients with subacute back pain (SBP), as well as 39 healthy pain-free controls (HC) applying a graph-theoretic network approach on functional resting-state magnetic resonance imaging. Beyond the comparison between groups, we used a linear analysis considering the years lived with pain (YLP) across all patients with back pain and additionally performed a mediation analysis of the role of cognitive pain coping. In line with previous studies, we found significant DMN perturbation in CBP compared with HC. However, this did not apply to the comparison of CBP with SBP. Instead, we observed a positive correlation between DMN perturbation and YLP. This was significantly mediated by coping attitudes towards pain. Default mode network perturbation may thus reflect neural adaptation processes to pain experience rather than a single correlate of the chronic pain stage and be modulated by cognitive adaption. This points to potentially underinvestigated significant adaptation processes that could enable more fine-grained patient stratification.
研究表明，与健康对照组相比，慢性疼痛患者的默认模式网络（DMN）受到干扰，且这种干扰与慢性疼痛阶段的疼痛持续时间相关。目前尚不清楚DMN的适应性变化是否在亚急性疼痛阶段就已出现，并随着疼痛经历的持续时间而随时间发展，而不是慢性疼痛阶段的特定关联。此外，关于这些适应性变化是否与适应性认知过程相关的信息也很缺乏。为此，我们采用基于静息态功能磁共振成像的图论网络方法，对31例慢性背痛（CBP）患者、77例亚急性背痛（SBP）患者以及39例无疼痛的健康对照（HC）进行了DMN检测。除了组间比较外，我们还采用线性分析考虑了所有背痛患者的疼痛年限（YLP），并额外进行了疼痛应对认知作用的中介分析。与先前的研究一致，我们发现与HC相比，CBP患者存在显著的DMN干扰。然而，CBP与SBP的比较结果并非如此。相反地，我们观察到DMN干扰与YLP之间存在正相关。这一关系由对疼痛的应对态度显著介导。因此，默认模式网络干扰可能反映了对疼痛经历的神经适应过程，而不是慢性疼痛阶段的单一关联，并受认知适应的调节。这表明可能存在尚未充分研究的重要适应过程，这些过程可能使患者分层更加精细。
