Corticolimbic anatomical characteristics predetermine risk for chronic pain

• Published in: Brain (London, England : 1878) Vol. 139; no. Pt 7; pp. 1958 - 1970
• Main Authors: Vachon-Presseau, Etienne, Tétreault, Pascal, Petre, Bogdan, Huang, Lejian, Berger, Sara E, Torbey, Souraya, Baria, Alexis T, Mansour, Ali R, Hashmi, Javeria A, Griffith, James W, Comasco, Erika, Schnitzer, Thomas J, Baliki, Marwan N, Apkarian, A Vania
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-07-2016
• Subjects: Adult; Amygdala - drug effects; Amygdala - physiopathology; Back Pain - diagnostic imaging; Back Pain - physiopathology; Chronic Pain - diagnostic imaging; Chronic Pain - physiopathology; Diffusion Tensor Imaging - methods; Female; Functional Neuroimaging - methods; Hippocampus - diagnostic imaging; Hippocampus - physiopathology; Humans; Longitudinal Studies; Magnetic Resonance Imaging - methods; Male; Middle Aged; Nerve Net - diagnostic imaging; Nerve Net - physiopathology; Original; Prefrontal Cortex - diagnostic imaging; Prefrontal Cortex - physiopathology; Risk Factors; White Matter - diagnostic imaging; White Matter - physiopathology; magnetic resonance imaging (MRI); limbic system; chronic pain; diffusion tensor imaging (DTI); brain network
• ISSN: 0006-8950; 1460-2156; 1460-2156
• DOI: 10.1093/brain/aww100

SEE TRACEY DOI101093/BRAIN/AWW147 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: 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.