Salience, central executive, and sensorimotor network functional connectivity alterations in failed back surgery syndrome.

OBJECTIVE: This study examined the altered patterns of functional connectivity in task-positive resting state networks in failed back surgery syndrome (FBSS) patients compared to healthy controls using functional magnetic resonance imaging (fMRI). This work stems from a previous study in which alterations in the task-negative default mode network were investigated.

DESIGN: Participants underwent a 7-minute resting state fMRI scan in which they lay still, with eyes closed, in the absence of a task.

SETTING: Scanning took place at the National Research Council's 3Tesla MRI magnet in Winnipeg, Canada.

SUBJECTS: Fourteen patients with FBSS and age- and gender-matched controls participated in this study. Three patients were removed from the analyses due to image artefact (n=1) and effective pain treatment (n=2). Eleven patients (5 female, mean age 52.7 years) and their matched controls were included in the final analyses.

METHODS: Resting state fMRI data were analyzed using an independent component analysis, yielding three resting state networks of interest: the salience network (SN), involved in detection of external stimuli, central executive network (CEN), involved in cognitions, and sensorimotor network (SeN), involved in sensory and motor integration. Analysis of Variance contrasts were performed for each network, comparing functional connectivity differences between FBSS patients and healthy controls.

RESULTS: Alterations were observed in all three resting state networks, primarily relating to pain and its processing in the FBSS group. Specifically, compared to healthy controls, FBSS patients demonstrated increased functional connectivity in the anterior cingulate cortex within the SN, medial frontal gyrus in the CEN, and precentral gyrus within the SeN. FBSS patients also demonstrated decreased functional connectivity in the medial frontal gyrus in the SeN compared to healthy controls. Interestingly, we also observed internetwork functional connectivity in the SN and SeN.

CONCLUSIONS: FBSS is associated with altered patterns of functional connectivity in the SN, CEN, and SeN. Taken together with our previous work, this reveals that a chronic pain condition can have a dramatic effect on the connectivity of multiple resting state networks.

IMPLICATIONS: These data suggest that a chronic pain condition-FBSS-is associated with disruptions to networks of functional connectivity in brain areas that are involved in numerous functions, including pain processing, sensation, and movement. It is possible that the alterations in these networks may contribute to other common chronic pain comorbidities, such as disrupted cognitions or anxiety. Previous research shows that during experimentally-induced pain, these networks can return to initial levels of functioning, indicating that these functional alterations are likely not permanent.