Specific brain morphometric changes in spinal cord injury with and without neuropathic pain

Abstract

Why only certain patients develop debilitating pain after spinal chord injury and whether structural brain changes are implicated remain unknown. The aim of this study was to determine if patients with chronic, neuropathic below-level pain have specific cerebral changes compared to those who remain pain-free. Voxel-based morphometry of high resolution, T1-weighted images was performed on three subject groups comprising patients with pain (SCI-P, n = 18), patients without pain (SCI-N, n = 12) and age- and sex-matched controls (n = 18). The SCI-P group was first compared directly with the SCI-N group and then subsequently with controls. Overall, grey and white matter changes dependent on the presence of pain were revealed. Significant changes were found within the somatosensory cortex and also in corticospinal tracts and visual-processing areas. When the SCI-P group was directly compared with the SCI-N group, reduced grey matter volume was found in the deafferented leg area of the somatosensory cortex bilaterally. This region negatively correlated with pain intensity. Relative to controls, grey matter in this paracentral primary sensory cortex was decreased in SCI-P but conversely increased in SCI-N. When compared with controls, discrepant corticospinal tract white matter reductions were found in SCI-P and in SCI-N. In the visual cortex, SCI-N showed increased grey matter, whilst the SCI-N showed reduced white matter. In conclusion, structural changes in SCI are related to the presence and degree of below-level pain and involve but are not limited to the sensorimotor cortices. Pain-related structural plasticity may hold clinical implications for the prevention and management of refractory neuropathic pain.

Motor recovery at 6 months after admission is related to structural and functional reorganization of the spine and brain in patients with spinal cord injury

“…Third, this study focused on motor function recovery in patients with SCI. Whether the cortical reorganization after SCI contributed to maladaptive changes such as neuropathic pain and mood disorders [Mole et al, ; Nicotra et al, ] remains to be determined. Theoretically, cortical reorganization following SCI is neither good nor bad [Moxon et al, ].…”

Amygdala and dlPFC abnormalities, with aberrant connectivity and habituation in response to emotional stimuli in females with BPD

“…In a study of schizophrenic patients, the largest volume difference in a voxel-based-morphometry study was found in the left ventral striatum of patients only with severe emotional dysregulation and not in patients without emotional dysregulation 64 . However, underlying mechanisms at the cellular level driving observed changes remain unclear from voxel-based morphometry studies 65,66 . Additionally, striatal abnormalities could play a role in intense outbursts of aggression prevalent in BPD, given its implication in intermittent explosive disorder 67 .…”

Tracking sensory system atrophy and outcome prediction in spinal cord injury

“…structural [10][11][12][13][14][15] and functional changes 16,17 within the sensory system. However, such cross-sectional studies in chronic SCI do not allow for assessment of the spontaneous evolution of structural and functional changes attributable to (1) the acute onset of deafferentation, [18][19][20] (2) spontaneous partial sensory recovery, or (3) relearning of compensatory approaches relevant for activities of daily living (ie, visual inputs).…”