Classification and characterisation of brain network changes in chronic back pain: a multicenter study.
Chronic pain is a common and often disabling condition, and is thought to involve a combination of peripheral and central neurobiological factors. However, the extent and nature of changes in the brain is poorly understood. Here, we investigated brain network architecture using resting state fMRI data collected from chronic back pain patients in UK and Japan (41 patients, 56 controls). Using a machine learning approach (support vector machine), we found that brain network patterns reliably classified chronic pain patients in a third, independent open data set with an accuracy of 63%, whilst 68% was attained in cross validation of all data. We then developed a deep learning classifier using a conditional variational autoencoder, which also yield yielded 63% generalisation and 68% cross-validation accuracy. Given the existence of reliable network changes, we next studied the graph topology of the network, and found consistent evidence of hub disruption based on clustering and betweenness centrality of brain nodes in pain patients. To examine this in more detail, we developed a multislice modularity algorithm to identify a consensus pattern of modular reorganisation of brain nodes across the entire data set. This revealed evidence of significant changes in the modular identity of several brain regions, most notably including broad regions of bilateral sensorimotor cortex, subregions of which also contributed to classifier performance. These results provide evidence of consistent and characteristic brain network changes in chronic pain, and highlight extensive reorganisaton of the network architecture of sensorimotor cortex.