353 Comparison of Brain Diffusion-Weighted Imaging of Cerebral Pain Regions Using DTI and MAP to Clinical Scores of Pain in Chronic Low Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

Abstract

INTRODUCTION: Thoracic spinal cord stimulation (SCS) may be an effective treatment option for patients with chronic low back pain (cLBP), and pain levels can be assessed using subjective clinical scores. The use of diffusion-derived imaging of brain regions involved in pain has yet to be studied. METHODS: DTI and MAP data was gathered from five cLBP patients (4 M, 1F) post-tSCS scanned at a 3.0T scanner. Four DTI measures and four MAP measures were extracted and registered against a pain-ROI atlas. The following clinical pain scores were assessed in the same five patients: Numerical Pain Rating Scale (NPRS), Visual Analogue Scale (VAS), Central Sensitization Inventory (CSI), Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). The associations between clinical scores and pain ROIs were investigated using linear regression. RESULTS: Within these eight measures, 16 significant linear associations were found between pain ROIs and clinical pain scores. The regions involved are areas of the cerebrum and thalamus involved in pain perception and processing: the secondary somatosensory cortex, the ventral posterolateral and mediodorsal nuclei of the thalamus, and the anterior long, anterior inferior, and middle short gyri of the insula. CONCLUSIONS: Diffusion-derived imaging, using DTI and AMURA/MAP techniques, shows microstructural changes in brain regions involved in pain with significant linear associations with clinical pain scores. As a result, diffusion-derived indices show potential to be used as a complementary quantitative measure to assess pain in cLBP patients receiving tSCS.