Patients with pain disorder show gray-matter loss in pain-processing structures: A voxel-based morphometric study

Michael Valet, Harald Gündel, Till Sprenger, Christian Sorg, Mark Mühlau, Claus Zimmer, Peter Henningsen, Thomas R. Tölle

Research output: Contribution to journalArticlepeer-review

138 Scopus citations

Abstract

OBJECTIVE:: To investigate whether the functional changes in pain disorder might be reflected by structural brain changes. Pain disorder assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria is characterized by persistent and distressing chronic pain at one or more body sites which cannot be fully explained by a physiological process or somatic disorder. Psychological factors are thought to play a major role. Recent neuroimaging studies evidenced altered pain processing in patients suffering from this disorder. METHODS:: Fourteen right-handed women fulfilling the DSM-IV criteria for pain disorder and 25 healthy age-matched women were investigated with magnetic resonance imaging. In the voxel-based morphometry analysis, we compared both groups for changes of gray-matter density. We included age and Beck Depression Inventory scores as nuisance variables to minimize possible confounding effects of age or depressive comorbidity. RESULTS:: In the patient group, we found significant gray-matter decreases in the prefrontal, cingulate, and insular cortex. These regions are known to be critically involved in the modulation of subjective pain experiences. CONCLUSIONS:: In the context of similar results in patients with other functional pain syndromes, such as fibromyalgia and chronic back pain, we suggest that structural changes in fronto-limbic brain circuits represent not only an objective marker of these pain syndromes but also constitute a critical pathophysiological element. These findings represent a further proof of the important role of central changes in pain disorder.

Original languageEnglish
Pages (from-to)49-56
Number of pages8
JournalPsychosomatic Medicine
Volume71
Issue number1
DOIs
StatePublished - Jan 2009

Keywords

  • Classification
  • Idiopathic chronic pain
  • Orbitofrontal cortex
  • Pain disorder
  • Ventromedial prefrontal cortex
  • Voxel-based morphometry

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