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ORIGINAL RESEARCH article

Front. Neuroimaging
Sec. Neuroimaging and Neuromodulation
Volume 3 - 2024 | doi: 10.3389/fnimg.2024.1474060

Multimodal functional imaging and clinical correlates of pain regions in chronic low-back pain patients treated with spinal cord stimulation: A pilot study.

Provisionally accepted
Yazan Shamli Oghli Yazan Shamli Oghli 1*Arjun Ashok Arjun Ashok 1Steven Glener Steven Glener 1Isaiah Ailes Isaiah Ailes 1Mashaal Syed Mashaal Syed 1Ki Chang Kang Ki Chang Kang 1Sara Naghizadehkashani Sara Naghizadehkashani 1Islam Fayed Islam Fayed 2Feroze Mohamed Feroze Mohamed 1Kiran Talekar Kiran Talekar 1Laura Krisa Laura Krisa 1Chengyuan Wu Chengyuan Wu 1Caio M. Matias Caio M. Matias 1Mahdi Alizadeh Mahdi Alizadeh 1
  • 1 Thomas Jefferson University Hospital, Jefferson University Hospitals, Philadelphia, United States
  • 2 Cooper University Hospital, Camden, New Jersey, United States

The final, formatted version of the article will be published soon.

    Objective: Spinal cord stimulation (SCS) is an invasive treatment option for patients suffering from chronic low-back pain (cLBP). It is an effective treatment which has been shown to reduce pain and increase quality of life in patients. However, activation of pain processing regions of cLBP patients receiving SCS has not been assessed using objective, quantitative functional imaging techniques. The purpose of the present study was to compare quantitative resting-state (rs)-fMRI and arterial spin labeling (ASL) measures between SCS patient and healthy controls, and to correlate clinical measures with quantitative multimodal imaging indices in pain regions. Methods: Multi-delay 3D GRASE pseudo-continuous ASL and rs-fMRI data was acquired in five patients post-SCS with cLBP and five healthy controls. Three ASL measures and four rsfMRI measures were derived and normalized into MNI space and smoothed. Averaged values for each measure from a pain atlas were extracted and compared between patients and controls. Clinical pain scores assessing intensity, sensitization, catastrophizing, as well as others assessing global pain effects (sleep quality, disability, anxiety and depression) were obtained in patients and correlated to pain regions using linear regression analysis. Results: Arterial transit time derived from ASL and several rs-fMRI measures were significantly different in patients in regions involved with sensation (primary somatosensory cortex, ventral posterolateral thalamus; VPL), pain input (posterior short gyrus of the insula; PS), cognition (dorsolateral prefrontal cortex; DLPC, posterior cingulate cortex; PCC), and fear/stress response (hippocampus, hypothalamus). Unidimensional pain rating and sensitization scores were linearly associated to PS, VPL, DLPC, PCC, and/or amygdala activity in cLBP patients. Conclusion: The present results provide evidence that ASL and rs-fMRI can contrast functional activation in pain regions of cLBP patients receiving SCS and healthy subjects, and they can be associated with clinical pain evaluations as quantitative assessment tools.

    Keywords: Spinal Cord Stimulation, Chronic low-back pain, resting-state functional MRI (RS-fMRI), Pseudo-continuous arterial spin labelling (PCASL), Pain neuromatrix

    Received: 31 Jul 2024; Accepted: 09 Sep 2024.

    Copyright: © 2024 Shamli Oghli, Ashok, Glener, Ailes, Syed, Kang, Naghizadehkashani, Fayed, Mohamed, Talekar, Krisa, Wu, Matias and Alizadeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yazan Shamli Oghli, Thomas Jefferson University Hospital, Jefferson University Hospitals, Philadelphia, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.