TY - JOUR
T1 - Patients with pain disorder show gray-matter loss in pain-processing structures
T2 - A voxel-based morphometric study
AU - Valet, Michael
AU - Gündel, Harald
AU - Sprenger, Till
AU - Sorg, Christian
AU - Mühlau, Mark
AU - Zimmer, Claus
AU - Henningsen, Peter
AU - Tölle, Thomas R.
PY - 2009/1
Y1 - 2009/1
N2 - 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.
AB - 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.
KW - Classification
KW - Idiopathic chronic pain
KW - Orbitofrontal cortex
KW - Pain disorder
KW - Ventromedial prefrontal cortex
KW - Voxel-based morphometry
UR - http://www.scopus.com/inward/record.url?scp=65549122637&partnerID=8YFLogxK
U2 - 10.1097/PSY.0b013e31818d1e02
DO - 10.1097/PSY.0b013e31818d1e02
M3 - Article
C2 - 19073757
AN - SCOPUS:65549122637
SN - 0033-3174
VL - 71
SP - 49
EP - 56
JO - Psychosomatic Medicine
JF - Psychosomatic Medicine
IS - 1
ER -