The role of the insula in chronic pain following spinal cord injury: A resting‐state fMRI study

Author:

Mandloi Shreya1ORCID,Syed Mashaal1,Shoraka Omid1,Ailes Isaiah1,Kang Ki Chang1,Sathe Anish1ORCID,Heller Joshua1,Thalheimer Sara1,Mohamed Feroze B.2,Sharan Ashwini1,Harrop James1,Krisa Laura3,Matias Caio1,Alizadeh Mahdi12

Affiliation:

1. Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience Thomas Jefferson University Philadelphia Pennsylvania USA

2. Thomas Jefferson Integrated Magnetic Resonance Imaging Center Department of Radiology Thomas Jefferson University Philadelphia Pennsylvania USA

3. Department of Physical Therapy Jefferson College of Rehabilitation Sciences Thomas Jefferson University Philadelphia Pennsylvania USA

Abstract

AbstractBackground and PurposeSpinal cord injury (SCI) results in the loss of motor and sensory function from disconnections between efferent and afferent pathways. Most SCI patients are affected with chronic neuropathic pain, but there is a paucity of data concerning neuroplastic changes following SCI. Chronic pain disrupts default networks and is associated with abnormal insular connectivity. The posterior insula (PI) is associated with the degree of pain and intensity of pain. The anterior insula (AI) is related to signal changes. Comprehension of SCI pain mechanisms is essential to elucidate effective treatment options.MethodsThis study examines the insular gyri functional connectivity (FC) of seven (five male, two female) SCI participants with moderate‐severe chronic pain compared to 10 (five male, five female) healthy controls (HC). All subjects had 3‐Tesla MRI performed and resting‐state functional MRI (fMRI) was acquired. FC metrics were obtained from the comparisons of resting‐state fMRI among our various groups. A seed‐to‐voxel analysis was pursued, encompassing six gyri of the insula. For multiple comparisons, a correction was applied with a significance level of p < .05.ResultsThere were significant differences in FC of the insula between SCI participants with chronic pain compared with HC. In the SCI participants, there was hyperconnectivity of the AI and PI to the frontal pole. In addition, there was increased FC noted between the PI and the anterior cingulate cortex. Hyperconnectivity was also observed between the AI and the occipital cortex.ConclusionsThese findings illustrate that there is a complex hyperconnectivity and modulation of pain pathways after traumatic SCI.

Publisher

Wiley

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging

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