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Psychosom Med. 2009 Jan;71(1):49-56. doi: 10.1097/PSY.0b013e31818d1e02. Epub 2008 Dec 10.

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

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  • 1Neurologische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. valet@lrz.tum.de

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.

PMID:
19073757
[PubMed - indexed for MEDLINE]
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