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Central plasticity resulting from chronic low back pain in degenerative disorders of the spine.

Luchtmann M, Firsching R - Neural Regen Res (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, Germany.

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Degenerative disorders of the spine are the most common cause of chronic low back pain (cLBP); in Western Europe alone, billions of euros are spent each year on both conservative and surgical treatments for cLBP... And though only 5% of all patients with low back pain suffer from lumbar disc herniation (LDH), more than 30% of the overall annual cost of treating cLBP goes to this one agonizing and disabling pain disorder... The regions illustrated there are believed to be crucially involved in the pain perception and processing that form the concept of the pain matrix... As we had expected, we found no morphological alterations resulting from LDH-induced chronic back pain in the primary somatosensory cortex... Interestingly, we observed that these specific regions showed decreased gray matter volume after microsurgical lumbar discectomy in patients with lumbar disc herniation, indicating that pain-induced maladaptive structural reorganization of the brain is potentially reversible after successful treatment (Luchtmann et al., 2015)... The reverse constellation was found around the region of the basal ganglia... While Smallwood et al. (2013) observed in their meta-analyses that the largest, most significant decrease in GM volume of chronic pain patients was in a region that includes the putamen and the claustrum, we found the largest increase in GMV in the pallidum and putamen after successful treatment... These results are inline with the findings of several other studies investigating structural brain alterations associated with chronic pain... Seminowicz et al. (2011) likewise provided strong evidence, in their measurement of cortical thickness in patients who suffered cLBP due to spondylolisthesis, lumbar disc herniation and spinal facet arthropathy, that pain-induced changes of the brain are reversible after effective treatment... Studying the cortical and subcortical reorganizations of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of cLBP and sciatica and therefore may help to optimize future conservative and surgical treatment options... Particularly, the classification of specific structural alterations of the brain associated with the treatment of LDH prove useful for identifying individual predictive factors in the evaluation of whether a patient is likely to improve by non-surgical management or would instead benefit from surgery... It is interesting to speculate as to whether more advanced neuroimaging techniques and data-processing methods would enable the identification of specific patterns of altered brain functions and anatomy and thus yield additional objective diagnostic criteria that might then guide therapeutic interventions targeting the brain for effective individual management of LDH... Becoming better able to illuminate and understand more of the details underlying central pain processing in LDH, not to mention the potential economic impact of such an amplified understanding, in our view warrants future large-scale clinical studies undertaken to confirm or modify the results that we have presented here.

No MeSH data available.


Related in: MedlinePlus

Chronic low back pain in degenerative disorders of the spine (e.g., lumbar disc herniation) can lead to specific structural alterations of the brain.These changes can be observed using voxel-based morphometry as increased (orange) or decreased (blue) gray matter volumes. The precise cytoarchitectonic causes of the structural alterations of the central nervous system are not fully understood yet. However, studying the cortical and subcortical changes of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of chronic low back pain therefore may help to optimize future conservative and surgical treatment options.
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Figure 1: Chronic low back pain in degenerative disorders of the spine (e.g., lumbar disc herniation) can lead to specific structural alterations of the brain.These changes can be observed using voxel-based morphometry as increased (orange) or decreased (blue) gray matter volumes. The precise cytoarchitectonic causes of the structural alterations of the central nervous system are not fully understood yet. However, studying the cortical and subcortical changes of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of chronic low back pain therefore may help to optimize future conservative and surgical treatment options.

Mentions: Using voxel-based morphometry (Ashburner and Friston, 2000), we recently observed several cortical and subcortical regions with altered gray matter volume (GMV) in patients suffering from lumbar disc herniation, including a decrease in the right caudate nucleus, the orbitofrontal cortex, and the cerebellum (Luchtmann et al., 2014). In contrast, we found increased GMV in the dorsal anterior cingulate cortex (dACC) and the precuneal area, as seen in the Figure 1. The regions illustrated there are believed to be crucially involved in the pain perception and processing that form the concept of the pain matrix. As we had expected, we found no morphological alterations resulting from LDH-induced chronic back pain in the primary somatosensory cortex. Some authors explain that absence of GMV changes with the theory of cognitive maladaptation to acute pain. They speculate that significant noxious input is no longer present and that it is the brain that mostly drives the experience of constant pain. In a recent quantitative meta-analysis, Smallwood et al. (2013) investigated structural brain anomalies in different chronic pain syndromes. Several clusters were identified where GMV was altered in chronic pain patients but not in healthy controls. The only regions in the brains of the chronic pain patients found to have increased in GMV were the hippocampus and the parahippocampal gyrus. Interestingly, we observed that these specific regions showed decreased gray matter volume after microsurgical lumbar discectomy in patients with lumbar disc herniation, indicating that pain-induced maladaptive structural reorganization of the brain is potentially reversible after successful treatment (Luchtmann et al., 2015). The hippocampus itself is critically involved in anxiety, learning, and memory, and it is essential in contextual conditioning and extinction. Until recently, though, it was thought that the hippocampus was not essential in pain processing and modulation. An increasing body of evidence has confirmed, however, that the hippocampus receives afferent pain impulses and plays an important role in pain modulation. It is an intriguing fact that the impact of preoperative pain intensity on the GMV changes in the hippocampus is significantly stronger than is the impact of pain duration prior to the surgery. The reverse constellation was found around the region of the basal ganglia. While Smallwood et al. (2013) observed in their meta-analyses that the largest, most significant decrease in GM volume of chronic pain patients was in a region that includes the putamen and the claustrum, we found the largest increase in GMV in the pallidum and putamen after successful treatment. These results are inline with the findings of several other studies investigating structural brain alterations associated with chronic pain. Seminowicz et al. (2011) likewise provided strong evidence, in their measurement of cortical thickness in patients who suffered cLBP due to spondylolisthesis, lumbar disc herniation and spinal facet arthropathy, that pain-induced changes of the brain are reversible after effective treatment. In support of the contemporary hypothesis that chronic low back pain is associated with a specific pattern of abnormal brain structure, Ung and colleagues (Ung et al., 2012) demonstrated that these changes can be classified for diagnostic purposes. With a support vector machine, they were able to distinguish, on the basis of high-resolution MRIs of the brain, between people who did in fact suffer chronic low back pain and those who did not. Their approach indicates promising progress in both our understanding of the cerebral role in cLBP and our ability to objectively classify pain syndromes.


Central plasticity resulting from chronic low back pain in degenerative disorders of the spine.

Luchtmann M, Firsching R - Neural Regen Res (2015)

Chronic low back pain in degenerative disorders of the spine (e.g., lumbar disc herniation) can lead to specific structural alterations of the brain.These changes can be observed using voxel-based morphometry as increased (orange) or decreased (blue) gray matter volumes. The precise cytoarchitectonic causes of the structural alterations of the central nervous system are not fully understood yet. However, studying the cortical and subcortical changes of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of chronic low back pain therefore may help to optimize future conservative and surgical treatment options.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590233&req=5

Figure 1: Chronic low back pain in degenerative disorders of the spine (e.g., lumbar disc herniation) can lead to specific structural alterations of the brain.These changes can be observed using voxel-based morphometry as increased (orange) or decreased (blue) gray matter volumes. The precise cytoarchitectonic causes of the structural alterations of the central nervous system are not fully understood yet. However, studying the cortical and subcortical changes of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of chronic low back pain therefore may help to optimize future conservative and surgical treatment options.
Mentions: Using voxel-based morphometry (Ashburner and Friston, 2000), we recently observed several cortical and subcortical regions with altered gray matter volume (GMV) in patients suffering from lumbar disc herniation, including a decrease in the right caudate nucleus, the orbitofrontal cortex, and the cerebellum (Luchtmann et al., 2014). In contrast, we found increased GMV in the dorsal anterior cingulate cortex (dACC) and the precuneal area, as seen in the Figure 1. The regions illustrated there are believed to be crucially involved in the pain perception and processing that form the concept of the pain matrix. As we had expected, we found no morphological alterations resulting from LDH-induced chronic back pain in the primary somatosensory cortex. Some authors explain that absence of GMV changes with the theory of cognitive maladaptation to acute pain. They speculate that significant noxious input is no longer present and that it is the brain that mostly drives the experience of constant pain. In a recent quantitative meta-analysis, Smallwood et al. (2013) investigated structural brain anomalies in different chronic pain syndromes. Several clusters were identified where GMV was altered in chronic pain patients but not in healthy controls. The only regions in the brains of the chronic pain patients found to have increased in GMV were the hippocampus and the parahippocampal gyrus. Interestingly, we observed that these specific regions showed decreased gray matter volume after microsurgical lumbar discectomy in patients with lumbar disc herniation, indicating that pain-induced maladaptive structural reorganization of the brain is potentially reversible after successful treatment (Luchtmann et al., 2015). The hippocampus itself is critically involved in anxiety, learning, and memory, and it is essential in contextual conditioning and extinction. Until recently, though, it was thought that the hippocampus was not essential in pain processing and modulation. An increasing body of evidence has confirmed, however, that the hippocampus receives afferent pain impulses and plays an important role in pain modulation. It is an intriguing fact that the impact of preoperative pain intensity on the GMV changes in the hippocampus is significantly stronger than is the impact of pain duration prior to the surgery. The reverse constellation was found around the region of the basal ganglia. While Smallwood et al. (2013) observed in their meta-analyses that the largest, most significant decrease in GM volume of chronic pain patients was in a region that includes the putamen and the claustrum, we found the largest increase in GMV in the pallidum and putamen after successful treatment. These results are inline with the findings of several other studies investigating structural brain alterations associated with chronic pain. Seminowicz et al. (2011) likewise provided strong evidence, in their measurement of cortical thickness in patients who suffered cLBP due to spondylolisthesis, lumbar disc herniation and spinal facet arthropathy, that pain-induced changes of the brain are reversible after effective treatment. In support of the contemporary hypothesis that chronic low back pain is associated with a specific pattern of abnormal brain structure, Ung and colleagues (Ung et al., 2012) demonstrated that these changes can be classified for diagnostic purposes. With a support vector machine, they were able to distinguish, on the basis of high-resolution MRIs of the brain, between people who did in fact suffer chronic low back pain and those who did not. Their approach indicates promising progress in both our understanding of the cerebral role in cLBP and our ability to objectively classify pain syndromes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, Germany.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Degenerative disorders of the spine are the most common cause of chronic low back pain (cLBP); in Western Europe alone, billions of euros are spent each year on both conservative and surgical treatments for cLBP... And though only 5% of all patients with low back pain suffer from lumbar disc herniation (LDH), more than 30% of the overall annual cost of treating cLBP goes to this one agonizing and disabling pain disorder... The regions illustrated there are believed to be crucially involved in the pain perception and processing that form the concept of the pain matrix... As we had expected, we found no morphological alterations resulting from LDH-induced chronic back pain in the primary somatosensory cortex... Interestingly, we observed that these specific regions showed decreased gray matter volume after microsurgical lumbar discectomy in patients with lumbar disc herniation, indicating that pain-induced maladaptive structural reorganization of the brain is potentially reversible after successful treatment (Luchtmann et al., 2015)... The reverse constellation was found around the region of the basal ganglia... While Smallwood et al. (2013) observed in their meta-analyses that the largest, most significant decrease in GM volume of chronic pain patients was in a region that includes the putamen and the claustrum, we found the largest increase in GMV in the pallidum and putamen after successful treatment... These results are inline with the findings of several other studies investigating structural brain alterations associated with chronic pain... Seminowicz et al. (2011) likewise provided strong evidence, in their measurement of cortical thickness in patients who suffered cLBP due to spondylolisthesis, lumbar disc herniation and spinal facet arthropathy, that pain-induced changes of the brain are reversible after effective treatment... Studying the cortical and subcortical reorganizations of the brain that result from degenerative spine disorders has the potential to enhance our understanding of the neuropathology of cLBP and sciatica and therefore may help to optimize future conservative and surgical treatment options... Particularly, the classification of specific structural alterations of the brain associated with the treatment of LDH prove useful for identifying individual predictive factors in the evaluation of whether a patient is likely to improve by non-surgical management or would instead benefit from surgery... It is interesting to speculate as to whether more advanced neuroimaging techniques and data-processing methods would enable the identification of specific patterns of altered brain functions and anatomy and thus yield additional objective diagnostic criteria that might then guide therapeutic interventions targeting the brain for effective individual management of LDH... Becoming better able to illuminate and understand more of the details underlying central pain processing in LDH, not to mention the potential economic impact of such an amplified understanding, in our view warrants future large-scale clinical studies undertaken to confirm or modify the results that we have presented here.

No MeSH data available.


Related in: MedlinePlus