Chronic Back Pain Linked To Changes In The Brain

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Chronic Back Pain Linked To Changes In The Brain

http://www.medicalnewstoday.com/medicalnews.php?newsid=57724

A German research team using a specialized imaging technique

revealed that individuals suffering from chronic low back pain also

had microstructural changes in their brains. The findings were

presented at the annual meeting of the Radiological Society of North

America (RSNA).

The researchers, led by Jurgen Lutz, M.D., a radiology resident at

University Hospital, Ludwig-Maximilians University in Munich,

Germany, used a technique called diffusion tensor imaging (DTI) to

track the movement of water molecules in the brain's gray and white

matter.

" A major problem for patients with chronic pain is making their

condition believable to doctors, relatives and insurance carriers.

DTI could play an important role in this regard, " Dr. Lutz

said. " With these objective and reproducible correlates in brain

imaging, chronic pain may no longer be a subjective experience. For

pain diagnosis and treatment, the consequences could be enormous. "

Individual water molecules are constantly in motion, colliding with

each other and other nearby molecules, causing them to spread out,

or diffuse. DTI allows scientists to analyze water diffusion in the

tissues of the brain that indicate changes in brain cell

organization.

" In normal white matter, water diffuses in one main direction, " Dr.

Lutz explained. " But when fiber pathways are developing during

childhood or are extensively used, their microstructural

organization becomes more organized and complex with measurable

changes in diffusion. "

Dr. Lutz and colleagues studied 20 patients experiencing chronic

back pain with no precisely identifiable cause and 20 age- and

gender-matched healthy control patients. DTI was performed to

measure the diffusion in several areas of each patient's brain.

Compared to the healthy volunteers, the patients with chronic low

back pain had a significantly more directed diffusion in the three

pain-processing regions of the brain, including the cingulate gyrus,

postcentral gyrus and superior frontal gyrus.

" Our results reveal that in chronic pain sufferers, the organization

of cerebral microstructure is much more complex and active in the

areas of the brain involved in pain processing, emotion and the

stress response, " said co-author Gustav Schelling, M.D., Ph.D. from

the Department of Anaesthesiology at Munich University.

The researchers said the findings may help explain the extreme

resistance to treatment for chronic low back pain and provide much-

needed evidence for individual sufferers. However, it is unclear

which occurs first, the chronic back pain or the microstructural

changes in the brain.

" It's difficult to know whether these are pre-existing changes in

the brain that predispose an individual to developing chronic pain,

whether ongoing pain creates the hyperactivity that actually changes

the brain organization, or if it is some mixture of both, " Dr.

Schelling said. " DTI may help explain what's happening for some of

these patients, and direct therapeutic attention from the spine to

the brain, " he added.