Comparison of brain structure between pain-susceptible and asymptomatic individuals following experimental induction of low back pain

Abstract Background Context Peripheral differences often do not adequately account for variation in reports of pain intensity in people with musculoskeletal pain. Purpose Here we sought to determine the extent to which structural differences in the brain (grey matter density) of pain free individuals might relate to subsequent pain (or lack thereof) after standardized peripheral muscle injury (i.e. micro trauma from high intensity exercise). Study design This was an observational laboratory-based study that was a secondary analysis from a larger trial. Methods Participants completed baseline testing (functional MRI and quantitative pain testing) followed by high intensity trunk exercise to induce delayed onset muscle soreness in the erector spinae. Forty-eight hours later, back pain intensity ratings were collected and all participants were re-imaged. Grey matter density was determined using voxel-based morphometry. The ‘asymptomatic’ group (no reports of any pain within 48 hour after induction) to a ‘pain’ group (rating of pain at rest and movement pf >20 on a 101-point numeric rating scale). Results Our results revealed several large clusters where, compared to participants with pain, asymptomatic participants had significant greater grey matter density. These brain regions included left medial frontal gyrus, left middle occipital gyrus, left middle temporal gyrus, left inferior frontal gyrus, and right superior frontal gyrus. Conclusions Lower grey matter density in brain regions previously linked to discriminative, emotional, and cognitive aspects of cortical processing are associated with reporting musculoskeletal pain after a standardized peripheral muscle injury. Clinical Significance Cortical gray matter density of people without any pain may influence response to a standardized high intensity exercise protocol. This finding adds further support to the the relevance of central factors in explaining the tremendous individual variability in pain report following acute musculoskeletal injury.