Resting state functional connectivity differentiation of neuropathic and nociceptive pain in individuals with chronic spinal cord injury

NeuroImage: Clinical, 2023 · DOI: https://doi.org/10.1016/j.nicl.2023.103414 · Published: April 20, 2023

Simple Explanation

This study investigates how different types of chronic pain (neuropathic and nociceptive) affect brain connectivity in people with spinal cord injuries (SCI). It uses resting state functional magnetic resonance imaging (fMRI) to examine the brain activity of 37 individuals with chronic SCI. The study found that neuropathic pain severity is linked to alterations in intralimbic and limbostriatal connectivity, while nociceptive pain severity is associated with changes in thalamocortical and thalamolimbic connectivity. These findings suggest that different pain types involve distinct brain pathways. The joint effect of both pain types was linked to altered limbocortical connectivity. This means the combined impact of neuropathic and nociceptive pain affects the communication between limbic regions and the cortex.

Study Duration

Not specified

Participants

37 individuals with chronic spinal cord injury

Evidence Level

Not specified

Key Findings

1
Higher neuropathic pain severity was significantly associated with lower connectivity between the right posterior parahippocampal gyrus (pPaHC) to the right putamen and amygdala.
2
Higher nociceptive pain severity was significantly associated with lower connectivity of the left thalamus to the right hippocampus, amygdala, anterior parahippocampal gyrus (aPaHC), temporal fusiform cortex, and inferior temporal gyrus.
3
Higher neuropathic and nociceptive pain intensities were significantly associated with 1) lower connectivity between the right pPaHC to right parietal and occipital cortical regions and 2) higher connectivity between the left amygdala to the left superior parietal lobule and supramarginal gyrus.

Research Summary

This study examined resting-state functional connectivity (rsFC) in individuals with spinal cord injury (SCI) to differentiate between neuropathic and nociceptive pain. The researchers aimed to identify brain regions with altered connectivity related to pain type and severity, potentially revealing underlying mechanisms and treatment targets. The study found that intralimbic and limbostriatal rsFC alterations are uniquely associated with neuropathic pain severity, whereas thalamocortical and thalamolimbic connectivity alterations are associated specifically with nociceptive pain severity. The joint effect and contrast of both pain types were associated with altered limbocortical connectivity. These findings suggest that the experience of pain in individuals with spinal cord injury may be associated with unique alterations in resting state functional connectivity dependent upon pain type.

Practical Implications

Differential Pain Processing

Neuropathic and nociceptive pain engage different brain pathways, suggesting distinct mechanisms.

Targeted Treatments

Identifying specific connectivity patterns associated with pain types could lead to more targeted treatments.

Clinical Assessments

Considering the co-occurrence of neuropathic and nociceptive pain is crucial for accurate assessments and interventions.

Study Limitations

1
Modest sample size limited the number of variables in statistical models.
2
Binary classification of pain (neuropathic/nociceptive) does not fully represent clinical reality.
3
Lack of distinct patient groups (neuropathic only, nociceptive only, both, no pain) limited analysis.

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