Quantitative imaging in medicine and surgery · 2026
From localized to long-range: functional connectivity alterations in mild to moderate chronic low back pain patients.
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Hu Han-Jun, Wang Luo-Yu, Deng Jia-Yi, Lin Yi, Ding Zhong-Xiang, Tang Xue, Zhu Yi-Di, Ge Xiu-Hong, Zhang Han, Yu Liang, Zhang Li-Qing
Аннотация
BACKGROUND: Mild pain can influence brain function, yet its central neurobiological mechanisms in chronic low back pain (CLBP) remain insufficiently defined. This study aimed to quantitatively evaluate localized and long-range functional connectivity (FC) alterations in patients with mild to moderate CLBP using static/dynamic regional homogeneity (sReHo/dReHo) and seed-based FC, and to assess their statistical relationships with clinical pain and psychological metrics.
METHODS: A total of 55 mild to moderate CLBP patients and 39 healthy controls (HCs) underwent 3.0 T resting-state functional magnetic resonance imaging (rs-fMRI) and clinical assessments, including Visual Analogue Scale (VAS), Short-Form of the McGill Pain Questionnaire (SF-MPQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). sReHo and dReHo (sliding window =50 TRs, step size =5 TRs) maps were computed to identify abnormal localized brain regions. Brain regions showing significant group differences were selected as seeds (6-mm spherical regions of interest, ROIs) for whole-brain FC analysis. Statistical comparisons were corrected using Gaussian random field (GRF) theory (voxel-level P<0.005, cluster-level P<0.05). Partial correlation analyses were used to control for age, sex, education, and head motion (Bonferroni-corrected threshold P<0.007).
RESULTS: Compared with HCs, patients exhibited significantly reduced sReHo in the third cerebellar vermis (peak t=-4.253, GRF P<0.05), alongside reduced dReHo in the right parahippocampal gyrus (t=-4.796, GRF P<0.05) and left inferior temporal gyrus (t=-3.935, GRF P<0.05). Seed-based FC analysis revealed decreased connectivity between the third cerebellar vermis and right hippocampus (t=-4.678, GRF P<0.05), and increased connectivity between the left inferior temporal gyrus and left pallidus (t=4.441, GRF P<0.05). Patients showed significantly higher SAS anxiety scores (25.15±5.01 vs. 23.08±2.18, P=0.008). Correlation analyses demonstrated that sReHo in the third cerebellar vermis was negatively correlated with SAS scores (r=-0.384, P=0.005), whereas FC between the left inferior temporal gyrus and left pallidus was positively correlated with SF-MPQ sensory (r=0.381, P=0.006), affective (r=0.386, P=0.005), and total scores (r=0.445, P=0.001).
CONCLUSIONS: Patients with mild to moderate CLBP exhibit distinct localized and long-range FC alterations within cerebello-hippocampal and cortico-basal ganglia pathways. These neurofunctional changes may contribute to the integration of subjective pain dimensions and comorbid anxiety. Combining static/dynamic ReHo with seed-based FC provides complementary neurobiological insight into how low-intensity chronic pain may affect the central nervous system and highlights the importance of early clinical recognition.
METHODS: A total of 55 mild to moderate CLBP patients and 39 healthy controls (HCs) underwent 3.0 T resting-state functional magnetic resonance imaging (rs-fMRI) and clinical assessments, including Visual Analogue Scale (VAS), Short-Form of the McGill Pain Questionnaire (SF-MPQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). sReHo and dReHo (sliding window =50 TRs, step size =5 TRs) maps were computed to identify abnormal localized brain regions. Brain regions showing significant group differences were selected as seeds (6-mm spherical regions of interest, ROIs) for whole-brain FC analysis. Statistical comparisons were corrected using Gaussian random field (GRF) theory (voxel-level P<0.005, cluster-level P<0.05). Partial correlation analyses were used to control for age, sex, education, and head motion (Bonferroni-corrected threshold P<0.007).
RESULTS: Compared with HCs, patients exhibited significantly reduced sReHo in the third cerebellar vermis (peak t=-4.253, GRF P<0.05), alongside reduced dReHo in the right parahippocampal gyrus (t=-4.796, GRF P<0.05) and left inferior temporal gyrus (t=-3.935, GRF P<0.05). Seed-based FC analysis revealed decreased connectivity between the third cerebellar vermis and right hippocampus (t=-4.678, GRF P<0.05), and increased connectivity between the left inferior temporal gyrus and left pallidus (t=4.441, GRF P<0.05). Patients showed significantly higher SAS anxiety scores (25.15±5.01 vs. 23.08±2.18, P=0.008). Correlation analyses demonstrated that sReHo in the third cerebellar vermis was negatively correlated with SAS scores (r=-0.384, P=0.005), whereas FC between the left inferior temporal gyrus and left pallidus was positively correlated with SF-MPQ sensory (r=0.381, P=0.006), affective (r=0.386, P=0.005), and total scores (r=0.445, P=0.001).
CONCLUSIONS: Patients with mild to moderate CLBP exhibit distinct localized and long-range FC alterations within cerebello-hippocampal and cortico-basal ganglia pathways. These neurofunctional changes may contribute to the integration of subjective pain dimensions and comorbid anxiety. Combining static/dynamic ReHo with seed-based FC provides complementary neurobiological insight into how low-intensity chronic pain may affect the central nervous system and highlights the importance of early clinical recognition.