Journal
BRAIN
Volume 139, Issue -, Pages 1958-1970Publisher
OXFORD UNIV PRESS
DOI: 10.1093/brain/aww100
Keywords
chronic pain; brain network; limbic system; magnetic resonance imaging (MRI); diffusion tensor imaging (DTI)
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Funding
- National Institute of Neurological Disorders and Stroke [NS035115]
- Canadian Institutes of Health Research (CIHR)
- Swedish Council for Working Life and Social Research [FAS: 2011-0627]
- Uppsala University
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Mechanisms of chronic pain remain poorly understood. We tracked brain properties in subacute back pain patients longitudinally for 3 years as they either recovered from or transitioned to chronic pain. Whole-brain comparisons indicated corticolimbic, but not pain-related circuitry, white matter connections predisposed patients to chronic pain. Intra-corticolimbic white matter connectivity analysis identified three segregated communities: dorsal medial prefrontal cortex-amygdala-accumbens, ventral medial prefrontal cortex-amygdala, and orbitofrontal cortex-amygdala-hippocampus. Higher incidence of white matter and functional connections within the dorsal medial prefrontal cortex-amygdala-accumbens circuit, as well as smaller amygdala volume, represented independent risk factors, together accounting for 60% of the variance for pain persistence. Opioid gene polymorphisms and negative mood contributed indirectly through corticolimbic anatomical factors, to risk for chronic pain. Our results imply that persistence of chronic pain is predetermined by corticolimbic neuroanatomical factors.
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