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Functional connectivity and structural analysis of trial spinal cord stimulation responders in failed back surgery syndrome. PLoS One 2020;15(2):e0228306



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Scopus ID

2-s2.0-85079521450 (requires institutional sign-in at Scopus site)   6 Citations


BACKGROUND: Chronic pain has been associated with alterations in brain structure and function that appear dependent on pain phenotype. Functional connectivity (FC) data on chronic back pain (CBP) is limited and based on heterogeneous pain populations. We hypothesize that failed back surgery syndrome (FBSS) patients being considered for spinal cord stimulation (SCS) therapy have altered resting state (RS) FC cross-network patterns that 1) specifically involve emotion and reward/aversion functions and 2) are related to pain scores.

METHODS: RS functional MRI (fMRI) scans were obtained for 10 FBSS patients who are being considered for but who have not yet undergone implantation of a permanent SCS device and 12 healthy age-matched controls. Seven RS networks were analyzed including the striatum (STM). The Wilcoxon signed-rank test evaluated differences in cross-network FC strength (FCS). Differences in periaqueductal grey (PAG) FC were assessed with seed-based analysis.

RESULTS: Cross-network FCS was decreased (p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC with network elements and amygdala but increased FC with the sensorimotor cortex and cingulate gyrus.

CONCLUSIONS: Decreased FC between STM and other RS networks in FBSS has not been previously reported. This STMFCS index may represent a more objective measure of chronic pain specific to FBSS which may help guide patient selection for SCS and subsequent management.

Author List

Pahapill PA, Chen G, Arocho-Quinones EV, Nencka AS, Li SJ


Elsa V. Arocho-Quinones MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Andrew S. Nencka PhD Director, Associate Professor in the Radiology department at Medical College of Wisconsin
Peter A. Pahapill MD, PhD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Case-Control Studies
Chronic Pain
Failed Back Surgery Syndrome
Gyrus Cinguli
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Middle Aged
Neural Pathways
Periaqueductal Gray
Sensorimotor Cortex
Spinal Cord Stimulation