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Evaluation of Chronic Pain Using Magnetic Resonance (MR) Neuroimaging Approaches: What the Clinician Needs to Know

Kumbhare, Dinesh A. MD, MSc, FRCPC, DABPMR; Elzibak, Alyaa H. PhD; Noseworthy, Michael D. PhD, PEng

doi: 10.1097/AJP.0000000000000415
Review Article

Objectives: Numerous neuroimaging techniques have been recently used to investigate central mechanisms involved in pain perception and to examine morphological and functional brain alterations associated with chronic pain. Compared to self-reporting approaches, objective imaging techniques are expected to potentially lead to better pain assessment and guide management. This comprehensive scoping review aims to identify recent magnetic resonance imaging (MRI) approaches that have been used to characterize the brain of chronic pain subjects, using structural, chemical and functional MRI techniques.

Methods: A systematic search and review of the literature was conducted and the resultant studies were critically examined for relevance.

Results: MRI neuroimaging of various chronic pain conditions were summarized. We classified the collected studies into: structural brain alterations, VBM (voxel based morphology) examination of structural changes, DTI, changes in brain chemistry, functional and blood flow brain alterations.

Discussion: From our clinical experience, we have noted that most clinicians are not aware of the capabilities of advanced MRI methods in assessing cortical manifestations of chronic pain. In addition, many clinicians are not aware of the cortical alterations present in individuals with chronic pain. This comprehensive scoping review thus sets out to first summarize MRI neuroimaging techniques that are available in the current literature to examine chronic pain. We then identify cortical MR approaches that have been able to reliably predict transition from acute to chronic pain. Finally, we summarize MRI neuroimaging techniques that have been used to track treatment response of individuals with chronic pain.

*Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto

McMaster School of Biomedical Engineering

Department of Medical Physics and Applied Radiation Sciences

§Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada

The authors declare no conflict of interest.

Reprints: Dinesh A. Kumbhare, MD, MSc, FRCPC, DABPMR, Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, Canada M5G 2A2 (e-mail:

Received December 20, 2015

Received in revised form July 29, 2016

Accepted June 25, 2016

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