Article Dans Une Revue European Journal of Pain Année : 2024

Imaging of glial cell changes in individuals with chronic low back pain: A commentary on Shraim et al.

Camille Fauchon

Résumé

This journal recently published a paper by Shraim et al., entitled "'"Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: a preliminary proofof-concept study"' (Shraim et al., 2024). Using simultaneous positron emission tomography (PET) / functional MR imaging and the radioligand ([ 18 F]-FEMPA), which binds to the translocator protein (TSPO), this study demonstrated potential glial changes in individuals with chronic low back pain (LBP) located in the primary sensory and motor cortices (S1/M1).

Neuroinflammatory glial activation was higher in nociplastic LBP than nociceptive LBP and pain-free groups. This activation was correlated with various markers of sensorimotor functions (e.g., sensitivity to hot/cold stimuli, and intracortical facilitation assessed by TMS) and patient characteristics (e.g., poor sleep, depression, disability, and BMI). This is an ambitious proof-of-concept study, creating new testable hypotheses about the differential mechanisms of distinct types of pain. However, the study has certain limitations that need to be considered. PET targeting 18 kDa TSPO is widely used for localizing inflammation in vivo, but its quantitative interpretation remains uncertain (Nutma et al., 2023). Furthermore, given that the experiment was conducted on a small sample of individuals with LBP, it remains to be established whether these findings can be generalized and specific to a subtype of LBP associated with central sensitization. Over the last few years, a plethora of works have pointed out the importance of precise pain phenotyping to optimize individual treatments of chronic pain. Clinical (QST, quantification of sensory systems), electrophysiological (high-density EEG/ MEG/ TMS) and functional imaging (MRI or PET) approaches have proved useful to disclose at the individual level some This redlined PDF shows all copy edited changes made to your manuscript. They are for your reference only. Please make all edits in the HTML version of the proofs. capacity to distinguish microgliosis from astrogliosis. Emvalomenos et al. (2024) summarized alternative potential markers for gliosis, and technical advances for monitoring glial changes over time in the context of chronic pain. In conclusion, the study by Shraim et al. holds potential importance, as it may lead to new studies to fill existing gap gaps in the field regarding the contribution of gliosis to LBP subtypes and identify potential targets for interventions. Future studies should further refine the methodological approach, interpretations and validate the heterogeneity in sensory/motor and glial functions between different LBP phenotypes. REFERENCESReferences Emvalomenos GM, Kang JWM, Jupp B, Mychasiuk R, Keay KA, Henderson LA. Recent developments and challenges in positron emission tomography imaging of gliosis in chronic neuropathic pain. PainPain. 2024. doi: 10.1097/j.pain.0000000000003247. Epub ahead of print. PMID: 38713812.

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Neurosciences
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hal-04947431 , version 1 (14-02-2025)

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Camille Fauchon. Imaging of glial cell changes in individuals with chronic low back pain: A commentary on Shraim et al.. European Journal of Pain, 2024, 28 (9), pp.1413-1414. ⟨10.1002/ejp.4707⟩. ⟨hal-04947431⟩

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