Influence of chronic pain on regional brain volume reduction in a general older Japanese population: A longitudinal imaging analysis from the Hisayama Study

Longitudinal analyses of the influence of chronic pain on pain-related regional brain volumes in general populations are warranted. This prospective cohort study investigated the association between the presence of chronic pain at baseline and the subsequent changes in pain-related regional brain volumes among Japanese community-dwelling older residents. Participants aged 65 years or older who underwent brain magnetic resonance imaging (MRI) scans in both 2012 and 2017 were included. According to the presence or absence of chronic pain (defined as pain lasting for longer than 3 months) in 2012, participants were categorized into a 'chronic pain' group and 'no chronic pain' group. Region-of-interest analyses for the ventrolateral prefrontal cortex, dorsolateral prefrontal cortex, orbitofrontal cortex, postcentral gyrus, insular cortex, thalamus, anterior cingulate cortex, posterior cingulate cortex, amygdala and hippocampus were performed using FreeSurfer software. Whole-brain analysis was conducted by voxel-based morphometry. Rates of change in regional brain volume at 5 years after baseline were estimated using analysis of covariance. Among the 766 participants included in the FreeSurfer analysis, 444 (58%) were female and 287 (37%) were categorized into the chronic pain group. The results of FreeSurfer analysis showed that the chronic pain group had significantly greater decreases in regional volume in the postcentral gyrus (-2.187% in the chronic pain group versus -1.681% in the no chronic pain group, P = 0.01), thalamus (-4.400% versus -3.897%, P = 0.006), anterior cingulate cortex (-2.507% versus -1.941%, P = 0.004) and amygdala (-4.739% versus -4.022%, P = 0.03) compared to the no chronic pain group after adjusting for age, sex, education attainment, marital status, hypertension, diabetes, serum total cholesterol level, body mass index, current smoking, current drinking, regular exercise, cerebrovascular lesions on MRI, activities in daily living disability and depressive symptoms. Among the 730 participants included in the voxel-based morphometry analysis, 433 (59%) were female and 272 (37%) were categorized into the chronic pain group. The voxel-based morphometry analysis showed that the chronic pain group had a significantly greater regional volume decrease in the right anterior insula than the no chronic pain group. Our findings suggest that the presence of chronic pain at baseline is associated with a significantly greater decrease in the volume of pain-related brain regions at 5 years after baseline in community-dwelling older Japanese.