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PAIN MEDICINE

Magnetic Resonance Spectroscopy Detects Biochemical Changes in the Brain Associated with Chronic Low Back Pain: A Preliminary Report

Philip J. Siddall, MBBS, PhD^*, Peter Stanwell, BSc, Annie Woodhouse, PhD^*, Ray L. Somorjai, PhD, Brion Dolenko, MSc, Alexander Nikulin, PhD, Roger Bourne, PhD, Uwe Himmelreich, PhD, Cynthia Lean, PhD, Michael J. Cousins, AM, MD^*, and Carolyn E. Mountford, DPhil

*Pain Management Research Institute, University of Sydney, Royal North Shore Hospital and Institute for Magnetic Resonance Research and Department of Magnetic Resonance in Medicine, University of Sydney, Sydney, Australia; and Institute for Biodiagnostics, National Research Council Canada, Winnipeg, Canada

Address correspondence and reprint requests to Dr. Philip Siddall, Pain Management Research Institute, Royal North Shore Hospital, St. Leonards NSW 2065, Australia. Address e-mail to phils{at}med.usyd.edu.au

Magnetic resonance (MR) spectroscopy is a noninvasive technique that can be used to detect and measure the concentration of metabolites and neurotransmitters in the brain and other organs. We used in vivo ¹H MR spectroscopy in subjects with low back pain compared with control subjects to detect alterations in biochemistry in three brain regions associated with pain processing. A pattern recognition approach was used to determine whether it was possible to discriminate accurately subjects with low back pain from control subjects based on MR spectroscopy. MR spectra were obtained from the prefrontal cortex, anterior cingulate cortex, and thalamus of 32 subjects with low back pain and 33 control subjects without pain. Spectra were analyzed and compared between groups using a pattern recognition method (Statistical Classification Strategy). Using this approach, it was possible to discriminate between subjects with low back pain and control subjects with accuracies of 100%, 99%, and 97% using spectra obtained from the anterior cingulate cortex, thalamus, and prefrontal cortex, respectively. These results demonstrate that MR spectroscopy, in combination with an appropriate pattern recognition approach, is able to detect brain biochemical changes associated with chronic pain with a high degree of accuracy.

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