Key result
Unsupervised modeling of resting-state functional connectivity identified three distinct veteran subgroups that differed significantly in pain and trauma symptoms despite similar clinical diagnoses.
Why the study?
Despite the high clinical overlap between trauma and chronic pain, their neural mechanisms are often studied separately.
Cross-Sectional (n=54)
No
p-value: p=0.022
Unsupervised modeling of resting-state fMRI data identified three neurobiologically dissociable biotypes among veterans with pain and trauma, suggesting different mechanisms for managing these conditions.
May support biotype-guided care in veterans with pain and trauma; leaves open prospective validation of clinical utility.
Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.
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Strigo et al. (2022) conducted a cross-sectional in Back pain and/or trauma symptoms (n=54). Resting-state functional connectivity subgroups vs. Between subgroups was evaluated on Differences in PTSD Checklist (PCL-5) scores across connectivity-derived subgroups (p=0.022). Unsupervised modeling of resting-state functional connectivity identified three distinct veteran subgroups that differed significantly in pain and trauma symptoms despite similar clinical diagnoses.
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