Peripheral Pain Captured Centrally: Altered Brain Morphology on MRI in Small Fiber Neuropathy Patients With and Without an SCN9A Gene Variant - 07/02/24
Abstract |
The current study aims to characterize brain morphology of pain as reported by small fiber neuropathy (SFN) patients with or without a gain-of-function variant involving the SCN9A gene and compare these with findings in healthy controls without pain. The Neuropathic Pain Scale was used in patients with idiopathic SFN (N = 20) and SCN9A-associated SFN (N = 12) to capture pain phenotype. T1-weighted, structural magnetic resonance imaging (MRI) data were collected in patients and healthy controls (N = 21) to 1) compare cortical thickness and subcortical volumes and 2) quantify the association between severity, quality, and duration of pain with morphological properties. SCN9A-associated SFN patients showed significant (P < .017, Bonferroni corrected) higher cortical thickness in sensorimotor regions, compared to idiopathic SFN patients, while lower cortical thickness was found in more functionally diverse regions (eg, posterior cingulate cortex). SFN patient groups combined demonstrated a significant (Spearman’s ρ = .44–.55, P = .005–.049) correlation among itch sensations (Neuropathic Pain Scale-7) and thickness of the left precentral gyrus, and midcingulate cortices. Significant associations were found between thalamic volumes and duration of pain (left: ρ = −.37, P = .043; right: ρ = −.40, P = .025). No associations were found between morphological properties and other pain qualities. In conclusion, in SCN9A-associated SFN, profound morphological alterations anchored within the pain matrix are present. The association between itch sensations of pain and sensorimotor and midcingulate structures provides a novel basis for further examining neurobiological underpinnings of itch in SFN.
Perspective |
Cortical thickness and subcortical volume alterations in SFN patients were found in pain hubs, more profound in SCN9A-associated neuropathy, and correlated with itch and durations of pain. These findings contribute to our understanding of the pathophysiological pathways underlying chronic neuropathic pain and symptoms of itch in SFN.
Le texte complet de cet article est disponible en PDF.Highlights |
• | SCN9A-associated small fiber neuropathy (SFN) and idiopathic patients show no symptom differences. |
• | SCN9A-associated SFN patients had thicker sensorimotor cortices than idiopathic SFN patients. |
• | SCN9A-associated SFN patients had thinner cortex in pain matrix areas than healthy controls. |
• | Left precentral gyrus and midcingulate cortical thickness correlated positively with itch of pain. |
• | Hyperexcitability due to Nav1.7 mutations may explain the observed differences between patients. |
Key Words : Small fiber neuropathy, SCN9A, itch, gray matter, magnetic resonance imaging
Plan
| R.G. and A.F. contributed equally to this work. |
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| J.U. and J.G.J.H. contributed equally to this work. |
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| Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com. |
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| Address reprint requests to Raquel van Gool, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. E-mail: raquel.vangool@childrens.harvard.edu |
Vol 25 - N° 3
P. 730-741 - mars 2024 Retour au numéro
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