Low back pain is the most common pain condition and cause for disability in older adults. Older adults suffering from low back pain are more disabled than their healthy peers, are more predisposed to frailty, and tend to be undertreated. The cause of increased prevalence and severity of this chronic pain condition in older adults is unknown. Here, we draw on accumulating data demonstrating a critical role for brain limbic and sensory circuitries in the emergence and experience of chronic low back pain (CLBP) and the availability of resting-state brain activity data collected at different sites to study how brain activity patterns predictive of CLBP differ between age groups. We apply a data-driven multivariate searchlight analysis to amplitude of low-frequency fluctuation brain maps to classify patients with CLBP with >70% accuracy. We observe that the brain activity pattern including the paracingulate gyrus, insula/secondary somatosensory area, inferior frontal, temporal, and fusiform gyrus predicted CLBP. When separated by age groups, brain patterns predictive of older patients with CLBP showed extensive involvement of limbic brain areas including the ventromedial prefrontal cortex, the nucleus accumbens, and hippocampus, whereas only anterior insula paracingulate and fusiform gyrus predicted CLBP in the younger patients. In addition, we validated the relationships between back pain intensity ratings and CLBP brain activity patterns in an independent data set not included in our initial patterns' identification. Our results are the first to directly address how aging affects the neural signature of CLBP and point to an increased role of limbic brain areas in older patients with CLBP.

腰痛是最常见的疼痛状况，也是老年人残疾的原因。患有腰痛的老年人比健康同龄人更残疾，更容易虚弱，并且往往得不到充分治疗。老年人这种慢性疼痛的患病率和严重程度增加的原因尚不清楚。在这里，我们利用积累的数据证明大脑边缘和感觉回路在慢性腰痛 (CLBP) 的出现和经历中发挥着关键作用，并利用在不同部位收集的静息态大脑活动数据来研究大脑活动模式CLBP 的预测因年龄组而异。我们将数据驱动的多变量探照灯分析应用于低频波动脑图的振幅，以 >70% 的准确度对 CLBP 患者进行分类。我们观察到，包括副扣带回、岛叶/次级体感区、额下回、颞回和梭状回在内的大脑活动模式可预测 CLBP。按年龄组划分时，预测老年 CLBP 患者的大脑模式显示边缘脑区域广泛受累，包括腹内侧前额叶皮层、伏核和海马，而只有前岛岛副扣带回和梭状回预测年轻患者的 CLBP。此外，我们还在一个独立的数据集中验证了背痛强度评级与 CLBP 大脑活动模式之间的关系，该数据集未包含在我们最初的模式识别中。我们的研究结果首次直接解决了衰老如何影响 CLBP 的神经特征，并指出边缘脑区域在老年 CLBP 患者中的作用增强。