Background & Aims

Working memory (WM) impairment is widely reported in people with chronic pain and is associated with higher chronic pain severity. Loss in WM may underpin CBP pathophysiology, by impairing the cognitive ability to properly contextualise threat cues and regulate. Cognitive regulation of pain occurs through interactions between the dorsolateral prefrontal cortex (dlPFC) and the brain stem periaqueductal gray (PAG) area, but little is understood about how loss in WM affects the responses and interactions between these brain regions

Methods

In this study, we used a data driven method to compare rest and task-related functional MRI data extracted from the dorso lateral and lateral PAG, ventrolateral PAG and dlPFC in 72 people with CBP. We used an expectation task, where visual cues signalled either high or low threat of noxious heat followed by the heat stimulus. Working memory was assessed using the n-back task and the accuracy scores were used for grouping individuals into high and low working memory groups and was also tested as a continuous variable. Task related activations were compared between high and low threat conditions and between high and low working memory groups. Baseline resting state functional connectivity between the regions was also assessed.

Results

Significant differences in activation were observed for left dlPFC and PAG columns between the high and low threat conditions and between the high and low WM groups. Activations increased in the left dlPFC, and decreased in the left vlPAG in the low threat relative to the high threat condition. This decrease in vlPAG activation was significantly less pronounced in people with low WM. Higher resting-state functional connectivity between left dlPFC and left vlPAG predicted worse WM and greater CBP intensity.

Conclusions

These findings indicate that interactions between dlPFC and especially vlPAG, are important for pain modulation, and low WM is associated with abnormalities in their connectivity and activity. Furthermore, aberrations in this system are reflective of a more severe form of CBP.

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Presenting Author

Jennika Veinot

Poster Authors

Javeria Hashmi

PhD

Dalhousie University, Nova Scotia Health

Lead Author

Jennika Veinot

Dalhousie University

Lead Author

Douglas Cane

Nova Scotia Health Authority

Lead Author

Topics

  • Pain Imaging