Abstract
Chronic neck pain (CNP), a global health problem, involves a large amount of psychological and socioeconomic burdens. Not only physical causes but also behavioral disorders such as a fear-avoidance belief (FAB) can associate with the chronicity of neck pain. However, functional brain mechanisms underlying CNP and its related behavioral disorders remain unknown. The aim of the current resting-state functional magnetic resonance imaging (fMRI) study was to explore how the functional brain networks differed between CNP patients and age- and sex-matched healthy, pain-free controls (HCs). We also investigated whether these possible brain network changes in CNP patients were associated with fear avoidance belief (FAB) and the intensity of pain. We analyzed the resting-state fMRI data of 20 CNP patients and 20 HCs. FAB and the intensity of pain were assessed by Tampa Scale for Kinesiophobia (TSK) and Visual Analog Scale (VAS) of pain. The whole brain analysis showed that CNP patients had significant different functional connectivity (FC) compared with HCs, and the right dorsolateral prefrontal cortex (DLPFC) was a core hub of these altered functional networks. Furthermore, general linear model analyses showed that, in CNP patients, the increased FC between the right DLPFC and the right anterior insular cortex (aIC) significantly associated with increased TSK (p = 0.01, statistical significance after Bonferroni correction: p<0.025), and the FC between the right DLPFC and dorsal posterior cingulate cortex had a trend of inverse association with VAS (p = 0.04). Our findings suggest that aberrant FCs between the right DLPFC and aIC associated with CNP and its related FAB.
Highlights
Chronic neck pain (CNP), a global health problem, poses a large socioeconomic burden, including restrictions on social life, reduced work productivity, and the cost of healthcare
In the resting state, CNP patients had significant different functional brain networks compared with HCs, and the right dorsolateral prefrontal cortex (DLPFC) was a core hub of these altered functional networks
We showed that the functional connectivity (FC) between the right DLPFC and the right anterior insular cortex (aIC) significantly associated with patients’ kinesiophobia, suggesting that aberrant right DLPFC connectivity to the right aIC may play a key role in fear avoidance beliefs (FAB) in CNP patients
Summary
Chronic neck pain (CNP), a global health problem, poses a large socioeconomic burden, including restrictions on social life, reduced work productivity, and the cost of healthcare. CNP is attributed to biological causes and behavioral disorders, such as pain catastrophizing and fear avoidance beliefs (FAB).[15,16,17] A fear avoidance model involving these psychological and behavioral disorders is broadly accepted to explain a vicious cycle of persistent pain.[18] FAB has been reported to associate with the prevalence and prognosis of chronic musculoskeletal pain including neck pain.[16, 17, 19,20,21] Several neuroimaging studies of CLBP indicated that behavioral components included in fear avoidance model such as pain catastrophizing and FAB may be associated with the disrupted functional brain network.[5, 7, 22] the underlying brain mechanisms of FAB in CNP is unknown
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