360 Diffusion Imaging-Derived Structural Changes in Cerebral Pain Regions of Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

INTRODUCTION: Thoracic spinal cord stimulation (tSCS) is an effective treatment of chronic low-back pain (cLBP). Although diffusion imaging has been conducted in this group of patients, the study of diffusion-derived structural imaging of regions involved in pain processing has not been conducted. METHODS: Diffusion-weighted imaging scans were acquired in five patients (1 female) post-tSCS with cLBP and five healthy subjects (2 female). Patient MRI scans were taken post-implantation with the SCS device turned off during the MRI session. Four DTI maps and four MAP maps were derived and normalized into MNI space and smoothed. DTI and MAP values for each measure from the pain ROI atlas were extracted and compared between patients and controls. RESULTS: Statistically significant differences were found in regions involved with sensory processing of pain (ASG, PSG) as well as affective pain experience (ACC) across the DTI measures. MAP measures showed significance across five ROIs involved with sensory processing of pain, affective pain experience, and fear response (AMYG). CONCLUSIONS: Diffusion-derived structural imaging of pain regions suggests that cLBP patients receiving SCS have differences in diffusion imaging-derived structural parameters involved with pain processing, cognition, and fear response.