Intact corticostriatal and altered subcortical circuits in chronic pain

Previous research has demonstrated the importance of the corticostriatal circuit in chronic pain. By focusing on nucleus accumbens (NAcc) circuits related to reward, we aimed to clarify how altered brain reward systems contribute to chronic pain. Using resting-state functional magnetic resonance imaging, we compared NAcc-medial prefrontal cortex (MPFC) functional connectivity in patients with fibromyalgia vs. healthy controls. Among patients, we analyzed the extent to which functional connectivity correlated with clinical measures. We also examined NAcc functional connectivity to subcortical regions. Lastly, we compared our results to a separate dataset of patients with chronic back pain. We identified robust NAcc-MPFC functional connectivity among patients with fibromyalgia and healthy controls, with no significant group differences. We found a positive correlational trend between NAcc-MPFC functional connectivity and total mood disturbance. Notably, patients with fibromyalgia showed significantly reduced functional connectivity of the right NAcc with mesolimbic circuit regions compared to controls. These results were largely similar to the results from the separate dataset. Our results provide novel evidence of intact corticostriatal but altered subcortical functional connectivity of the NAcc during resting-state in chronic pain and suggest that measured connectivity may relate to changes in mood and the level of cognitive demand during fMRI-based measurement. PerspectiveThis article indicates complex brain valuation system alterations associated with chronic pain. Our findings expand our understanding of the valuation system and its relationship to clinical presentation in patients with fibromyalgia.