Sorger, Clarissa;
(2023)
Exploring Structural Brain Differences in Adolescents with Chronic Neuropathic Pain.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background. Diseases or lesions of the somatosensory nervous system result in chronic neuropathic pain (NeuP). In adults, neuroimaging studies report structural brain changes in regions involved in pain processing, but few studies include paediatric populations. Objectives. To confirm the feasibility of magnetic resonance neuroimaging (MRI) in adolescents with NeuP, and explore structural brain differences compared to age-matched healthy control adolescents. Methods. Adolescents (11-18yrs;54%male) with NeuP in limbs/torso (n=17), head/neck (n=3), or Complex Regional Pain Syndrome (n=8) were recruited from chronic pain clinic. Neuroimaging (3T Siemens Prisma MRI) included T1- and diffusion-weighted images. I assessed: i) whole-brain white matter (WM) using Tract-Based Spatial Statistics (TBSS); ii) WM thalamo-cortical connections; iii) grey matter (GM) volume of thalamus and its parcellated subregions (based on structural connectivity to frontal, precentral, postcentral, parietal-occipital, temporal cortex); and iv) fornix WM microstructure. Participant-reported outcomes included: pain intensity; MRI acceptability; and Pain Catastrophizing Scale (pain magnification/helplessness/worry). Results. Patients reported moderate-severe pain (>4/10) and 93% had moderate-severe pain catastrophizing (>15/52). Recruitment for MRI was high (77%), and 90% rated research scans highly acceptable (≥8/10). Compared to controls (n=28), TBSS indicated increased axial diffusivity (AD) in the left anterior thalamic radiation (p=.037;n=28). In the largest subsample with limb/torso NeuP, AD was increased between right frontal thalamic subregion and right frontal lobe (p=.028), and associated with reduced pain intensity in males (p=.018;n=10). GM volume was increased in left (p=.017) and right (p=.031) precentral thalamic subregions; the latter was associated with reduced pain catastrophising (p=.033). GM volume was decreased in the left parietal-occipital subregion (p=0.17). Fornix WM microstructure did not differ from controls. Conclusions. MRI is feasible in adolescents with moderate-to-severe NeuP. Structural changes in WM connectivity and GM volume highlight the potential for chronic NeuP to alter central pain pathways. Associations with reduced patient-reported pain and catastrophizing suggest mechanisms associated with resilience rather than vulnerability to pain. These data identify potential targets for future evaluation and intervention.
Type: | Thesis (Doctoral) |
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Qualification: | Ph.D |
Title: | Exploring Structural Brain Differences in Adolescents with Chronic Neuropathic Pain |
Language: | English |
Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept UCL |
URI: | https://discovery.ucl.ac.uk/id/eprint/10177320 |
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