Thalamic neurometabolite alterations in chronic low back pain: a common phenomenon across musculoskeletal pain conditions?
Thalamic neurometabolite alterations in chronic low back pain: a common phenomenon across musculoskeletal pain conditions?
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DOI：
10.1097/j.pain.0000000000003002
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发表时间：
2024-01-01
期刊：
影响因子：
7.4
通讯作者：
Loggia，Marco L.
中科院分区：
文献类型：
--
作者：
Weerasekera，Akila;Knight，Paulina C.;Loggia，Marco L.
最近，我们发现与健康对照相比，膝关节骨关节炎（KOA）患者的丘脑中几种代谢物的浓度发生了变化：肌醇（mIns）升高，n -乙酰天冬氨酸（NAA）降低，胆碱（Cho）降低。在这里，我们评估了这些代谢物的改变是KOA特异性的，还是可以在其他肌肉骨骼疾病（如慢性腰痛（cLBP））患者中观察到。使用h -磁共振波谱（MRS）和PRESS（点分辨光谱）序列扫描36例cLBP患者和20例健康对照，并在左丘脑放置体素。与健康对照组相比，在控制年龄的情况下，cLBP患者的NAA和Cho绝对浓度较低（P < 0.05）， mIns绝对浓度较高（P < 0.05），这与我们之前在KOA中的研究结果一致。与我们的KOA研究相反，该人群中的mIns水平与疼痛测量（例如疼痛严重程度或持续时间）没有显着相关性。然而，探索性分析显示，患者的NAA水平与睡眠障碍的严重程度呈负相关（P, 0.01），患者的NAA水平高于健康对照组（P, 0.001）。此外，在患者中，Cho和mIns水平也与年龄呈正相关（分别为P， 0.01和P， 0.05）。总之，这些结果表明丘脑代谢物的变化可能在不同病因的肌肉骨骼慢性疼痛条件下是共同的，包括cLBP和KOA，并且可能与慢性疼痛共病的症状有关，如睡眠障碍。这些大脑变化的功能和临床意义仍有待充分了解。
Recently, we showed that patients with knee osteoarthritis (KOA) demonstrate alterations in the thalamic concentrations of several metabolites compared with healthy controls: higher myo-inositol (mIns), lower N-acetylaspartate (NAA), and lower choline (Cho). Here, we evaluated whether these metabolite alterations are specific to KOA or could also be observed in patients with a different musculoskeletal condition, such as chronic low back pain (cLBP). Thirty-six patients with cLBP and 20 healthy controls were scanned using 1H-magnetic resonance spectroscopy (MRS) and a PRESS (Point RESolved Spectroscopy) sequence with voxel placement in the left thalamus. Compared with healthy controls, patients with cLBP demonstrated lower absolute concentrations of NAA (P 5 0.0005) and Cho (P, 0.05) and higher absolute concentrations of mIns (P 5 0.01) when controlling for age, as predicted by our previous work in KOA. In contrast to our KOA study, mIns levels in this population did not significantly correlate with pain measures (eg, pain severity or duration). However, exploratory analyses revealed that NAA levels in patients were negatively correlated with the severity of sleep disturbance (P, 0.01), which was higher in patients compared with healthy controls (P, 0.001). Additionally, also in patients, both Cho and mIns levels were positively correlated with age (P, 0.01 and P, 0.05, respectively). Altogether, these results suggest that thalamic metabolite changes may be common across etiologically different musculoskeletal chronic pain conditions, including cLBP and KOA, and may relate to symptoms often comorbid with chronic pain, such as sleep disturbance. The functional and clinical significance of these brain changes remains to be fully understood.