Shape shifting pain: chronification of back pain

Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits | Brain

Chronic pain conditions are associated with abnormalities in brain structure and function.

Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain.

We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward 

We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry.

Reward circuitry was equally represented in both groups.

In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group,

  • activity diminished in acute pain regions,
  • increased in emotion-related circuitry, and
  • remained unchanged in reward circuitry

The results demonstrate that brain representation for a constant perception, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain.

These observations challenge long-standing theoretical concepts regarding brain and mind relationships, as well as provide important novel insights regarding definitions and mechanisms of chronic pain.

Conclusion

Brain activity related to the perception of back pain shifts in location from regions involved in acute pain to engage emotion circuitry as the condition persists, thereby providing a percept-linked brain signature for the transition to chronic pain.

We provide a spatial template and time window (6–12 months) for the stabilization of this signature, which identifies a specific functional biomarker for back pain chronification.

Thus, these results have important clinical implications regarding the definition of chronic pain, its aetiology, and the optimal time window for treatments targeting its prevention.

Additionally, these results challenge long standing theoretical constructs of brain-mind relationships.  

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