Exploring the differences in resting state functional magnetic resonance imaging brain activity in patients with chronic low back pain based on ALE meta-analysis

Chronic low back pain (cLBP) is a prevalent condition, yet neuroimaging findings across studies remain inconsistent. This inconsistency may stem from overreliance on a priori regions of interest (ROI) hypotheses in prior studies, which neglected the spatial distribution of true functional abnormalities in cLBP. To address methodological heterogeneity, this study conducted an activation likelihood estimation (ALE) meta-analysis, guided by high-quality neuroimaging meta-analysis guidelines, to identify reliable neural features across 17 eligible cLBP studies, providing more robust conclusions than individual neuroimaging studies. Significantly, the cLBP group exhibited enhanced activity in the bilateral medial frontal gyrus (MFG), right precentral gyrus, and right cingulate gyrus. Based on the data-driven and objective ROI, we further analyzed the functional interactions or connectivity between brain regions by including a cohort of 30 patients with chronic nonspecific low back pain (CNLBP) and 30 age- and sex-matched healthy controls. The results revealed decrease functional connectivity in the cortico-limbic circuit in the CNLBP group, particularly between the left MFG and the right hippocampus. Furthermore, effective connectivity from the right to left MFG was significantly reduced in the CNLBP group. Multivariate regression analysis established significant associations between cortico-limbic circuit connectivity alterations and pain catastrophizing. These findings highlight the cortico-limbic circuit as a key biomarker for cLBP, suggesting its targeted modulation could inform novel therapeutic strategies. This study provides novel neurobiological insights into cLBP pathophysiology, while underscoring the necessity for replication in larger cohorts to validate clinically valuable. PERSPECTIVE: This study utilized ALE meta-analysis to investigate abnormal activation regions in cLBP patients, and further analysis revealed functional interactions or connectivity between brain regions. The results highlighted the cortico-limbic circuit as a key biomarker of cLBP, suggesting that modulating this circuit may provide insights into potential therapeutic strategies.