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Gray Matter Abnormalities Associated With Chronic Back Pain

A Meta-Analysis of Voxel-based Morphometric Studies

Yuan, CongHu MD*; Shi, HaiCun MD; Pan, PingLei MD; Dai, ZhenYu MD; Zhong, JianGuo MD; Ma, HaiRong MD§; Sheng, LiQin MD§

doi: 10.1097/AJP.0000000000000489
Original Articles

Background: Studies employing voxel-based morphometry have reported inconsistent findings on the association of gray matter (GM) abnormalities with chronic back pain (CBP). We, therefore, performed a meta-analysis of available studies to identify the most consistent GM regions associated with CBP.

Methods: The PubMed, Embase, and Web of Science databases were searched from January 2000 to May 29, 2016. Comprehensive meta-analyses of whole-brain voxel-based morphometry studies to identify the most robust GM abnormalities in CBP were conducted using the Seed-based d Mapping software package.

Results: A total of 10 studies, comprising 293 patients with CBP and 624 healthy controls, were included in the meta-analyses. The most robust findings of regional GM decreases in patients with CBP compared with healthy controls were identified in the bilateral medial prefrontal cortex extending to the anterior cingulate cortex, the right medial prefrontal cortex extending to the orbitofrontal cortex. Regional GM decreases in the left anterior insula were less robustly observed.

Conclusions: The present study demonstrates a pattern of GM alterations in CBP. These data further advance our understanding of the pathophysiology of CBP.

Departments of *Anesthesia and Pain Management


Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng

§Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, P.R. China

C.H.Y. and H.C.S. contributed equally.

Supported by the National Natural Science Foundation of China, Beijing, China (No: 81601161). The authors declare no conflict of interest.

Reprints: LiQin Sheng, MD, Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, 215300, Chaoyang Road 189#, Kunshan, P.R. China (e-mail:

Received October 7, 2016

Received in revised form February 1, 2017

Accepted February 8, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.