| Objective:The high incidence of chronic pain after breast cancer surgery and the long-term pathological pain torture of chronic pain seriously affect the quality of life of a large number of breast cancer patients.In recent years,multi-level brain imaging analysis based on magnetic resonance imaging(MRI)has been considered to be of great significance in evaluating the degree of pain and judging the pathological development of pain.In the process of acute pain turning to chronic pain,the change of central nervous system is a gradual process.In this study,voxel-based morphology(VBM),regional homogeneity(Re Ho)and fractional amplitude of low frequency fluctuation(f ALFF)were used to explore the early changes of brain structure and neuron function in patients with chronic pain after breast cancer surgery.To provide reference for the mechanism research,clinical prevention and treatment of chronic pain.Method:53 patients,18-65 years old,ASA grade I or II,with breast cancer undergoing radical mastectomy were enrolled in this study.They were divided into two groups according to the Numerical Rating Scale(NRS)of the third month after operation: 31 patients in the chronic pain group(NRS > 0,P group)and 22 patients in the painless group(NRS = 0,NP group).Whole brain MRI was performed in all patients within 7 days after operation to obtain resting state MRI images,high resolution 3D T1 weighted image(WI),conventional T1 and T2 WI data.The volume of gray matter,Re Ho,f ALFF and DC in the early stage after operation were compared between P group and NP group.Results:(1)The volume of right posterior central gyrus grey matter was decreased and the volume of right superior frontal gyrus grey matter was increased in the chronic pain group compared with the painless group(cluster size> 50,P<0.001).(2)The Re Ho values of left anterior,posterior cerebellum and right frontal rolandic operculum were increased,while the Re Ho values of right inferior parietal lobule(IPL),supramarginal gyrus(Sm G),left superior parietal lobule(SPL),left precuneus(PCUN),right SPL and right PCUN were decreased in chronic pain group(cluster size≥15,P<0.005).P group patients showed significantly higher f ALFF than NP group in right cerebellar foot,while the f ALFF in P group was significantly lower than that in NP group in right medial prefrontal cortex(m PFC)and anterior cingulate cortex(ACC),left posterior cingulate cortex(PCC)and PCUN(cluster size≥15,P<0.005).(3)The degree centrality of left anterior central gyrus was significantly increased and bilateral medial cingulate gyrus was significantly decreased in patients with chronic pain after breast cancer surgery.The accuracy of DC classification can reach 73.21% and AUC value is 0.79 by using linear support vector machine classification calculation.Conclusion:Early postoperative changes in brain structure,function and brain functional network occurred in patients with chronic pain after breast cancer surgery,which occured much earlier than chronic pain.Default pattern networks and neuronal dysfunction in cerebellar subregions can lead to abnormal pain perception and emotional regulation in patients after breast cancer surgery.The degree centrality changes of MCC suggest that the formation and development of hyperalgesia begin early after breast cancer surgery.Changes in these brain regions may be one of the important factors that ultimately lead to chronic pain.However,there were not much functional changes in the primary somatosensory cortex and the secondary somatosensory cortex,which were the first stimulated areas after acute pain,suggesting that These results suggest that the occurrence of chronic pain in these patients may be more related to early postoperative surgical stress,emotional disorders caused by pain stimuli,pain regulation disorders and hyperalgesia.The level of neurological activity in these brain regions may become a clinical indicator for monitoring the transition from acute pain to chronic pain,which provides new ideas and directions for further study. |
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