Highlight from PAIN (Volume 159, No. 8, August 2018)
Patients with Chronic Pain Exhibit a Complex Relationship Triad Between Pain, Resilience, and Within- and Cross-Network Functional Connectivity of the Default Mode Network
Kasey S. Hemington, Anton Rogachov, Joshua C. Cheng, Rachael L. Bosma, Junseok Andrew Kim, Natalie R. Osborne, Robert D. Inman, Karen D. Davis
This study examined whether default mode network (DMN) connectivity tracks pain specifically or whether this brain-behavior relationship in chronic pain is more generally related to resilience. Investigators hypothesized that within-DMN functional connectivity (FC) is related to resilience, and that patients with chronic pain would exhibit within- and cross-network connectivity that tracked their clinical pain. They examined resting-state FC in patients with back pain and ankylosing spondylitis (AS), a form of spondyloarthritis, and measured trait resilience, clinical pain reports, and arthritis disease activity.
Resting-state functional magnetic resonance imaging data were acquired from 51 patients with chronic pain and AS and 51 healthy control participants. Participants completed a questionnaire on their individual trait resilience (the Resilience Scale), and patients reported their clinical pain. Findings revealed a triad relationship among resilience, within- and cross-network connectivity of the DMN, and clinical pain in individuals with chronic pain attributable to AS. In healthy individuals, low resilience scores were observed for those with greater within-DMN FC; in patients with chronic pain, resilience was negatively associated with clinical pain intensity and disease activity. In patients with high levels of clinical pain, the DMN and sensorimotor network (SMN) were abnormally functionally connected, and DMN-SMN functional connectivity was related to level of clinical pain.
Although resilience, pain, and disease activity were tightly linked in people with chronic pain, they all were linked to different features of the dynamic pain connectome. Investigators uncovered a negative relationship between resilience and within-DMN connectivity in healthy individuals, which suggests this relationship is disrupted in people experiencing higher levels of clinical pain. These findings point to the DMN as a functional brain network that plays a key role in multiple dimensions of chronic pain.