Article

OBJECTIVE: To primarily explore differences in global and regional white matter
hyperintensities (WMH) in older adults with self-reported disabling and
nondisabling chronic low back pain (CLBP) and to examine the association of WMH
with gait speed in all participants with CLBP. To secondarily compare WMH of the
participants with CLBP with the pain-free controls.
DESIGN: A cross-sectional,
case-control study. SETTING: University of Pittsburgh. PARTICIPANTS: Twenty-four
community-dwelling older adults: 8 with self-reported disabling CLBP, 8 with
nondisabling CLBP, and 8 were pain-free. Exclusions were psychiatric or
neurologic disorders (either central or peripheral), substance abuse, opioid use,
or diabetes mellitus. METHODS: All participants underwent structural brain
magnetic resonance imaging, and all participants with CLBP underwent the 4-m walk
test. MAIN OUTCOME MEASUREMENTS: All the participants were assessed for both
global and regional WMH by using an automated localization and segmentation
method, and gait speed of participants with CLBP. RESULTS: The disabled group
demonstrated statistically significant regional WMH in a number of left
hemispheric tracts: anterior thalamic radiation (P = .0391), lower cingulate (P =
.0336), inferior longitudinal fasciculus (P = .0367), superior longitudinal
fasciculus (P = .0011), and the superior longitudinal fasciculus branch to the
temporal lobe (P = .0072). Also, there was a statistically significant negative
association (rs = -0.57; P = .0225) between the left lower cingulate WMH and the
gait speed in all the participants with CLBP. There was a statistical difference
in global WMH burden (P = .0014) and nearly all regional tracts (both left and
right hemispheres) when comparing CLBP with pain-free participants. CONCLUSIONS:
Our findings suggest that WMH is associated with, and hence, may be accelerated
by chronic pain manifesting as perceived disability, given the self-reported
disabled CLBP patients had the greatest burden, and the pain free the least, and
manifesting as measurable disability, given increasing WMH was associated with
decreasing gait speed in all chronic pain participants.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS