Journal
HUMAN BRAIN MAPPING
Volume 36, Issue 6, Pages 2075-2092Publisher
WILEY
DOI: 10.1002/hbm.22757
Keywords
chronic pain; cognitive networks; functional MRI; resting state; intrinsic connectivity; longitudinal
Funding
- Early Career Award from The International Association for the Study of Pain
- Canadian Institutes for Health Research Fellowship [MFE-84987]
- Department of Neural and Pain Sciences at University of Maryland School of Dentistry
- Biology of Pain Young Investigator Award - Canadian Pain Society
- AstraZeneca
- Canadian Institutes for Health Research [XCP-83755]
- Bourse de chercheur-boursier Junior 2 from the Fonds de la recherche en sante du Quebec [14312]
- Pain Research from the Louise and Alan Edwards Foundation
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We previously reported that effective treatment of chronic low back pain (CLBP) reversed abnormal brain structure and functional MRI (fMRI) activity during cognitive task performance, particularly in the left dorsolateral prefrontal cortex (DLPFC). Here, we used resting-state fMRI to examine how chronic pain affects connectivity of brain networks supporting cognitive functioning and the effect of treatment in 14 CLBP patients and 16 healthy, pain-free controls (scans were acquired at baseline for all subjects and at 6-months post-treatment for patients and a matched time-point for 10 controls). The main networks activated during cognitive task performance, task-positive network (TPN) and task-negative network (TNN) (aka default mode) network, were identified in subjects' task fMRI data and used to define matching networks in resting-state data. The connectivity of these cognitive resting-state networks was compared between groups, and before and after treatment. Our findings converged on the bilateral insula (INS) as the region of aberrant cognitive resting-state connectivity in patients pretreatment versus controls. These findings were complemented by an independent, data-driven approach showing altered global connectivity of the INS. Detailed investigation of the INS confirmed reduced connectivity to widespread TPN and TNN areas, which was partially restored post-treatment. Furthermore, analysis of diffusion-tensor imaging (DTI) data revealed structural changes in white matter supporting these findings. The left DLPFC also showed aberrant connectivity that was restored post-treatment. Altogether, our findings implicate the bilateral INS and left DLPFC as key nodes of disrupted cognition-related intrinsic connectivity in CLBP, and the resulting imbalance between TPN and TNN function is partially restored with treatment. Hum Brain Mapp 36:2075-2092, 2015. (c) 2015 Wiley Periodicals, Inc.
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