The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study

Patients with chronic low back pain (CLBP) experience comorbid depression. However, the central neural processing profile of CLBP with comorbid depression remains unclear. Therefore, this study aimed to investigate specific brain abnormalities in CLBP with comorbid depression by functional magnetic...

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Main Authors: Yanqiao Zhao, Chen Gong, Pan Zhu, Suimin Guo, Yangyang Lin, Yafei Wang, Beibei Feng, Xiaochun Meng, Yuling Wang
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Brain Research Bulletin
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Online Access:http://www.sciencedirect.com/science/article/pii/S0361923025002205
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author Yanqiao Zhao
Chen Gong
Pan Zhu
Suimin Guo
Yangyang Lin
Yafei Wang
Beibei Feng
Xiaochun Meng
Yuling Wang
author_facet Yanqiao Zhao
Chen Gong
Pan Zhu
Suimin Guo
Yangyang Lin
Yafei Wang
Beibei Feng
Xiaochun Meng
Yuling Wang
author_sort Yanqiao Zhao
collection DOAJ
description Patients with chronic low back pain (CLBP) experience comorbid depression. However, the central neural processing profile of CLBP with comorbid depression remains unclear. Therefore, this study aimed to investigate specific brain abnormalities in CLBP with comorbid depression by functional magnetic resonance imaging. Fourteen CLBP patients with depression, 25 CLBP patients without depression, and 24 matched controls were included. Alterations in spontaneous brain activity and connectivity were examined through regional homogeneity (ReHo) and functional connectivity (FC). Analysis of variance and post hoc analyses among groups were conducted. Correlational analyses were performed between neuroplasticity and clinical variables. Mediation analysis was conducted to elucidate the interrelationships among brain alterations, pain, and depression. Significant between-group differences in ReHo values were found across extensive brain regions, particularly the right dorsolateral prefrontal cortex (DLPFC). Altered FC between the DLPFC and cerebellum as well as the orbitofrontal cortex was noted. ReHo and FC were associated with depression, pain catastrophizing, and back pain-related disability. ReHo values of superior frontal gyrus and its FC to cerebellum mediated the correlation between BDI and variables such as pain intensity and pain catastrophizing. CLBP patients with comorbid depression exhibit abnormal regional homogeneity in regions involving the DLPFC, and altered functional networks are observed between the DLPFC and other areas. Central changes are correlated with back pain-related outcomes and mediate the relationship between pain and depression. Our findings contribute additional insights for identifying potential biomarkers of refractory CLBP with depression comorbidity, potentially aiding in pain phenotype stratification and optimizing pain management strategies.
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spelling doaj-art-1bb452da99c14f23aa0ea3f2706879792025-08-20T03:22:29ZengElsevierBrain Research Bulletin1873-27472025-09-0122911140810.1016/j.brainresbull.2025.111408The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI studyYanqiao Zhao0Chen Gong1Pan Zhu2Suimin Guo3Yangyang Lin4Yafei Wang5Beibei Feng6Xiaochun Meng7Yuling Wang8Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Faculty of Health, Xuzhou Vocational College of Bioengineering, Xuzhou, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, Shenzhen, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Correspondence to: Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26, Yuancun 2nd Cross Road, Guangzhou, 510655, China.Patients with chronic low back pain (CLBP) experience comorbid depression. However, the central neural processing profile of CLBP with comorbid depression remains unclear. Therefore, this study aimed to investigate specific brain abnormalities in CLBP with comorbid depression by functional magnetic resonance imaging. Fourteen CLBP patients with depression, 25 CLBP patients without depression, and 24 matched controls were included. Alterations in spontaneous brain activity and connectivity were examined through regional homogeneity (ReHo) and functional connectivity (FC). Analysis of variance and post hoc analyses among groups were conducted. Correlational analyses were performed between neuroplasticity and clinical variables. Mediation analysis was conducted to elucidate the interrelationships among brain alterations, pain, and depression. Significant between-group differences in ReHo values were found across extensive brain regions, particularly the right dorsolateral prefrontal cortex (DLPFC). Altered FC between the DLPFC and cerebellum as well as the orbitofrontal cortex was noted. ReHo and FC were associated with depression, pain catastrophizing, and back pain-related disability. ReHo values of superior frontal gyrus and its FC to cerebellum mediated the correlation between BDI and variables such as pain intensity and pain catastrophizing. CLBP patients with comorbid depression exhibit abnormal regional homogeneity in regions involving the DLPFC, and altered functional networks are observed between the DLPFC and other areas. Central changes are correlated with back pain-related outcomes and mediate the relationship between pain and depression. Our findings contribute additional insights for identifying potential biomarkers of refractory CLBP with depression comorbidity, potentially aiding in pain phenotype stratification and optimizing pain management strategies.http://www.sciencedirect.com/science/article/pii/S0361923025002205Chronic low back painDepressionFunctional connectivityFunctional magnetic resonance imagingRegional homogeneity
spellingShingle Yanqiao Zhao
Chen Gong
Pan Zhu
Suimin Guo
Yangyang Lin
Yafei Wang
Beibei Feng
Xiaochun Meng
Yuling Wang
The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
Brain Research Bulletin
Chronic low back pain
Depression
Functional connectivity
Functional magnetic resonance imaging
Regional homogeneity
title The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
title_full The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
title_fullStr The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
title_full_unstemmed The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
title_short The role of prefrontal cortex in chronic low back pain with comorbid depression: A resting-state fMRI study
title_sort role of prefrontal cortex in chronic low back pain with comorbid depression a resting state fmri study
topic Chronic low back pain
Depression
Functional connectivity
Functional magnetic resonance imaging
Regional homogeneity
url http://www.sciencedirect.com/science/article/pii/S0361923025002205
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