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Psychosomatic Medicine:
doi: 10.1097/PSY.0b013e31818d1e02
Original Articles

Patients With Pain Disorder Show Gray-Matter Loss in Pain-Processing Structures: A Voxel-Based Morphometric Study

Valet, Michael MD; Gündel, Harald MD; Sprenger, Till MD; Sorg, Christian MD; Mühlau, Mark MD; Zimmer, Claus MD; Henningsen, Peter MD; Tölle, Thomas R. MD

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Abstract

Objective: To investigate whether the functional changes in pain disorder might be reflected by structural brain changes. Pain disorder assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria is characterized by persistent and distressing chronic pain at one or more body sites which cannot be fully explained by a physiological process or somatic disorder. Psychological factors are thought to play a major role. Recent neuroimaging studies evidenced altered pain processing in patients suffering from this disorder.

Methods: Fourteen right-handed women fulfilling the DSM-IV criteria for pain disorder and 25 healthy age-matched women were investigated with magnetic resonance imaging. In the voxel-based morphometry analysis, we compared both groups for changes of gray-matter density. We included age and Beck Depression Inventory scores as nuisance variables to minimize possible confounding effects of age or depressive comorbidity.

Results: In the patient group, we found significant gray-matter decreases in the prefrontal, cingulate, and insular cortex. These regions are known to be critically involved in the modulation of subjective pain experiences.

Conclusions: In the context of similar results in patients with other functional pain syndromes, such as fibromyalgia and chronic back pain, we suggest that structural changes in fronto-limbic brain circuits represent not only an objective marker of these pain syndromes but also constitute a critical pathophysiological element. These findings represent a further proof of the important role of central changes in pain disorder.

DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ICD-10 = International Statistical Classification of Diseases and Related Health Problems, 10th Revision; VBM = voxel-based morphometry; fMRI = functional magnetic resonance imaging; GM = gray matter; WM = white matter; CSF = cerebrospinal fluid; BDI = Beck Depression Inventory; MNI = standardized reference space defined by the Montreal Neurological Institute; SOMS = screening for somatoform symptoms; PPS = Pain Perception Scale; SCID = Structured Clinical Interview for DSM-IV disorders.

Copyright © 2009 by American Psychosomatic Society

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