Brain functional imaging contributions in osteoarthritis-related pain: A viewpoint

Objective: Neuroimaging investigations are critical to provide a more direct assessment of brain disturbances associated with osteoarthritis (OA)-related pain, and to better understand its pathophysiology to develop new treatment strategies. This viewpoint aims to summarize the importance of the brain in OA pain. Method: A European working group on pain in osteoarthritis GO-PAIN (Going Inside Osteoarthritis-related Pain Phenotyping) has been created to work on a global assessment of the OA-related pain. Relevant scientific literature was evaluated, summarized and discussed to expose advances in functional brain alterations related-to OA pain. Results: Findings of neuroimaging studies are highly heterogenous and based on small sample size, but some key brain alterations associated with OA pain can be identified across experiments. A systematic literature review conducted by Hall and colleagues (2023) found lower activity, connectivity, and grey matter volume in the right anterior insula in patients with OA than in healthy controls. Other works also pointed out that activity of specific brain regions could serve as a potential surrogate biomarker, but several limitations and confounding factors needs to be addressed. Conclusions: Brain functional imaging provides opportunities to accurately address an OA-related pain endophenotype. To encompass limitations and fill the gaps from the previous studies, we propose a blueprint for the next 5 years and stimulate ideas for others working in the field.