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However, brain metabolites alterations in chronic non-specific neck pain remain unknown. This study aimed to investigate brain metabolite concentrations in individuals with chronic non-specific neck pain and their relationships with pain-related outcomes. Participants included 30 individuals with chronic non-specific neck pain and 30 pain-free controls. Absolute concentrations and metabolite ratios of total creatine (tCr), choline (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and glutamate\/glutamine (Glx) were measured in regions involved in pain processing and modulation, including dorsolateral prefrontal cortex (DLPFC), primary somatosensory cortex (S1), insula and thalamus, using proton magnetic resonance spectroscopy (\n                    <jats:sup>1<\/jats:sup>\n                    H-MRS). Compared to controls, participants with neck pain exhibited decreased mI and mI\/tCr (left DLPFC and thalamus), NAA and NAA\/tCr (right S1) and Glx and Glx\/tCr (right DLPFC) and increased Cho and Cho\/tCr (left S1) (adjusted p-values\u2009&lt;\u20090.05). Altered metabolite levels were correlated with pain duration, intensity, extent, disability and PPT at C2-3 (r ranged from \u2212\u20090.48 to 0.55, adjusted p-values\u2009&lt;\u20090.05). The results suggest that \u00b9H-MRS detects altered levels of mI, NAA, Glx and Cho in specific brain regions involved in pain regulation, which may contribute to the persistence of neck pain.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-24339-3","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T13:49:54Z","timestamp":1763473794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Brain metabolic alterations in individuals with chronic non-specific neck pain assessed using proton magnetic resonance spectroscopy"],"prefix":"10.1038","volume":"15","author":[{"given":"Rungtawan","family":"Chaikla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchart","family":"Kothan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Barbero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Falla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munlika","family":"Sremakaew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5012-4437","authenticated-orcid":false,"given":"Sureeporn","family":"Uthaikhup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"24339_CR1","doi-asserted-by":"publisher","unstructured":"Guzman, J. et al. 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