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Ed. Note: The following is a press
release from the Radiological Society of North America.
November 28, 2006 -- A German
research team using a specialized imaging technique revealed that
individuals suffering from chronic low back pain also had microstructural
changes in their brains. The findings were presented today at the annual
meeting of the Radiological Society of North America (RSNA).
The researchers, led by Jürgen Lutz, M.D., a radiology resident at
University Hospital, Ludwig-Maximilians University in Munich, Germany, used
a technique called diffusion tensor imaging (DTI) to track the movement of
water molecules in the brain’s gray and white matter.
“A major problem for patients with chronic pain is making their condition
believable to doctors, relatives and insurance carriers. DTI could play an
important role in this regard,” Dr. Lutz said. “With these objective and
reproducible correlates in brain imaging, chronic pain may no longer be a
subjective experience. For pain diagnosis and treatment, the consequences
could be enormous.”
Individual water molecules are constantly in motion, colliding with each
other and other nearby molecules, causing them to spread out, or diffuse.
DTI allows scientists to analyze water diffusion in the tissues of the brain
that indicate changes in brain cell organization.
“In normal white matter, water diffuses in one main direction,” Dr. Lutz
explained. “But when fiber pathways are developing during childhood or are
extensively used, their microstructural organization becomes more organized
and complex with measurable changes in diffusion.”
Dr. Lutz and colleagues studied 20 patients experiencing chronic back pain
with no precisely identifiable cause and 20 age- and gender-matched healthy
control patients. DTI was performed to measure the diffusion in several
areas of each patient’s brain.
Compared to the healthy volunteers, the patients with chronic low back pain
had a significantly more directed diffusion in the three pain-processing
regions of the brain, including the cingulate gyrus, postcentral gyrus and
superior frontal gyrus.
“Our results reveal that in chronic pain sufferers, the organization of
cerebral microstructure is much more complex and active in the areas of the
brain involved in pain processing, emotion and the stress response,” said
co-author Gustav Schelling, M.D., Ph.D. from the Department of
Anaesthesiology at Munich University.
The researchers said the findings may help explain the extreme resistance to
treatment for chronic low back pain and provide much-needed evidence for
individual sufferers. However, it is unclear which occurs first, the chronic
back pain or the microstructural changes in the brain.
“It’s difficult to know whether these are pre-existing changes in the brain
that predispose an individual to developing chronic pain, whether ongoing
pain creates the hyperactivity that actually changes the brain organization,
or if it is some mixture of both,” Dr. Schelling said. “DTI may help explain
what’s happening for some of these patients, and direct therapeutic
attention from the spine to the brain,” he added.
Co-authors are Maximilian F. Reiser, M.D., Olaf Dietrich, Ph.D., Lorenz
Jaeger, M.D. and Robert Stahl, M.D.
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