Structural and functional brain abnormalities in chronic low back pain: a systematic review
Abstract
Objectives The purpose of this systematic review is to analyze the available literature on structural and functional brain abnormalities in chronic low back pain (CLBP) using several brain magnetic resonance imaging (MRI) techniques.Methods PubMed and Web of Science were systematically screened for relevant literature using different combinations of keywords regarding structural and functional brain imaging techniques in patients with CLBP. Reference lists of included articles were hand-searched for additional literature. Eligible articles were assessed on risk of bias and reviewed by two independent researchers.Results The search query returned 27 articles meeting the inclusion criteria. Methodological quality varied from poor to good. A total of 10 studies evaluated structural gray matter changes. There is conflicting evidence in global gray matter changes, with both increases and decreases shown in different studies. Gray matter changes were demonstrated in specific brain regions. Structural white matter changes were reported in five studies. There is conflicting evidence in total white matter volume due to both increases and unchanged white matter. Several regional differences were identified in which white matter changes were shown. Functional organization during rest was evaluated in 10 studies. CLBP patients showed increased activation in specific regions, together with a disrupted default mode network. A total of six studies evaluated brain activity in response to a nociceptive stimulus. Findings suggest that patients demonstrated increased activity in pain-related regions, and decreased activity in analgesic regions.Conclusions Overall, there is moderate evidence for regional changes in gray and white matter, together with an altered functional connectivity during rest and increased activity in pain-related areas following painful stimulation, evidencing an upregulated pain matrix. More longitudinal research is needed to clarify the temporal relationship regarding pain and neuroplastic changes, and integration of different brain imaging techniques is warranted.
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Catastrophizing mediates sex differences in pain-related outcomes, clinical pain, and experimental pain.
“catastrophizing has been shown to mediate the sex differences in pain-related outcomes, clinical pain, and experimental pain 162, 205, 206.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [205]
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References 58 · Cited by 315
Research works printed but not linked: 1
- [34]34. Giesecke T, Gracely RH, Clauw DJ, Nachemson A, Duck MH, Sabatowski R, et al. [Central pain processing in chronic low back pain. Evidence for reduced pain inhibition]. Schmerz 2006;20(5):411-4, 416-7.
- Authors
- Kregel, J., Meeus, M., Malfliet, A., Dolphens, M., Danneels, L., Nijs, J., & Cagnie, B.
- Affiliations
- Vrije Universiteit Brussel (BE)
- University of Antwerp (BE)
- Ghent University (BE)
- Corresponding author
- Cagnie, Barbara
- ORCID
- Venue
- Seminars in Arthritis and Rheumatism
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 45
- Issue
- 2
- Pages
- 229-237
- ISSN
- 0049-0172 (ISSN-L)
- OpenAlex
- W1531443818
- Cited by
- 315
- References
- 58
- Citations by year
- 2026: 31 · 2025: 22 · 2024: 35 · 2023: 51 · 2022: 35 · 2021: 28 · 2020: 28 · 2019: 28 · 2018: 21 · 2017: 21 · 2016: 13 · 2015: 1
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Arthritis and Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic low back pain, brain abnormalities, gray matter changes, white matter changes, default mode network, functional connectivity, pain matrix, nociceptive stimulation, neuroplasticity, neuroimaging
- MeSH terms
- Brain, Brain Mapping, Humans, Magnetic Resonance Imaging, Low Back Pain, Chronic Pain, Neuroimaging
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