Background: Although the association of gray matter morphology alterations and pain-related
psychosocial characteristics with pain intensity and chronification in people with chronic spinal
pain is evident, research on their mutual interaction is scarce and does not account for possible
gender differences. Gender-based differences are, however, of utmost importance to consider
when examining pain neurobiology.
Objectives: To look for gender differences in the association between magnetic resonance
imaging- (MRI) derived brain gray matter morphology and self-reported psychosocial characteristics.
Study Design: An explorative, observational study.
Setting: University Hospitals Ghent and Brussels, Belgium.
Methods: Brain gray matter morphology (using MRI) and self-reported psychosocial characteristics
were examined in women and men with nonspecific chronic spinal pain. Statistical analyses were
performed in SPSS and R to identify differences between men and women regarding brain gray
matter, self-reported psychosocial characteristics, as well as gender differences in the association
between those outcome measures.
Results: A total of 94 people with chronic spinal pain were studied, including 32 men (15 suffering
from neck pain, 17 suffering from low back pain; demographics [mean ± SD] age: 45.00 ± 12.02
years; pain duration: 128.37 ± 110.45 months), and 62 women (36 suffering from neck pain, 26
suffering from low back pain; demographics [mean ± SD] age: 38.78 ± 12.69 years; pain duration:
114.27 ± 92.45 months). Woman showed larger (positive) associations of several central brain areas
(paracentral, precentral, postcentral, etc.) with perceived consequences (P < 0.001), emotional
representations (P < 0.001), chronicity (P < 0.001), and pain catastrophizing (P< 0.001). Men showed
larger (both positive and negative) associations of the precuneus cortex, the precentral gyrus, and the
insula with perceived personal control (P < 0.001) and kinesiophobia (P < 0.001).
Limitations: Other factors, such as menstrual cycle and medication can have a certain influence,
and were only partly taken into consideration in the present investigation to obtain sufficient
power. Another limitation is the observational study design, which hampers the possibility to look
for causal or temporal interactions.
Conclusions: Gray matter morphology relates differently to psychosocial characteristics in
women and men. These explorative findings provide ideas for further research to investigate if
targeting perceived negative consequences of the illness, perceived emotional representations,
perceived chronicity, and pain catastrophizing in women, and perceived personal control of the
illness and kinesiophobia in men, could contribute to the normalization of brain alterations in
people with nonspecific chronic spinal pain.
Key words: Gray matter, brain morphology, central nervous system, illness perceptions, central
sensitization
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