Chronic pain is a pervasive and debilitating condition with increasing implications for public health, affecting millions of individuals worldwide. Despite its high prevalence, the underlying neural mechanisms and pathophysiology remain only partly understood. Since its introduction 35 years ago, brain diffusion magnetic resonance imaging (MRI) has emerged as a powerful tool to investigate changes in white matter microstructure and connectivity associated with chronic pain. This review synthesizes findings from 58 articles that constitute the current research landscape, covering methods and key discoveries. We discuss the evidence supporting the role of altered white matter microstructure and connectivity in chronic primary pain conditions, highlighting the importance of studying multiple chronic pain syndromes to identify common neurobiological pathways. We also explore the prospective clinical utility of diffusion MRI, such as its role in identifying diagnostic, prognostic, and therapeutic biomarkers. Furthermore, we address shortcomings and challenges associated with brain diffusion MRI in chronic primary pain studies, emphasizing the need for the harmonization of data acquisition and analysis methods. We conclude by highlighting emerging approaches and prospective avenues in the field that may provide new insights into the pathophysiology of chronic pain and potential new therapeutic targets. Because of the limited current body of research and unidentified targeted therapeutic strategies, we are forced to conclude that further research is required. However, we believe that brain diffusion MRI presents a promising opportunity for enhancing our understanding of chronic pain and improving clinical outcomes.

中文翻译：

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脑弥散磁共振成像教会了我们关于慢性原发性疼痛的什么：叙述性回顾。


慢性疼痛是一种普遍存在且使人衰弱的疾病，对公共卫生的影响越来越大，影响着全球数百万人。尽管其患病率很高，但潜在的神经机制和病理生理学仍仅部分了解。自 35 年前推出以来，脑弥散磁共振成像 （MRI） 已成为研究与慢性疼痛相关的白质微观结构和连接变化的有力工具。本综述综合了构成当前研究前景的 58 篇文章的结果，涵盖了方法和关键发现。我们讨论了支持白质微结构和连接性改变在慢性原发性疼痛疾病中的作用的证据，强调了研究多种慢性疼痛综合征以确定常见神经生物学途径的重要性。我们还探讨了弥散 MRI 的前瞻性临床效用，例如它在识别诊断、预后和治疗生物标志物方面的作用。此外，我们解决了慢性原发性疼痛研究中与脑扩散 MRI 相关的缺点和挑战，强调需要协调数据采集和分析方法。最后，我们强调了该领域的新兴方法和前瞻性途径，这些方法和途径可能为慢性疼痛的病理生理学和潜在的新治疗靶点提供新的见解。由于目前的研究主体有限且未确定的靶向治疗策略，我们被迫得出结论，需要进一步的研究。然而，我们相信脑扩散 MRI 为增强我们对慢性疼痛的理解和改善临床结果提供了一个有希望的机会。