{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T15:05:46Z","timestamp":1787151946054,"version":"build-2736575974"},"reference-count":98,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH\/NCCIH","award":["R33AT009341"],"award-info":[{"award-number":["R33AT009341"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Both transcranial direct current stimulation (tDCS) and acupuncture are promising methods for managing chronic low back pain (cLBP), however, their underlying mechanisms remain unclear. Methods: To explore the neural mechanisms of tDCS and acupuncture on cLBP, we examined how real and sham tDCS applied to the bilateral motor cortex (M1), combined with real or sham acupuncture, influenced cerebral blood flow (CBF) using pulsed continuous arterial spin labeling (pCASL) imaging. tDCS was administered over six sessions, combined with real or sham acupuncture, over one month. Results: Following real tDCS, we observed increased CBF in the bilateral occipital cortex, precuneus, left hippocampus, and parahippocampal gyrus\/posterior cingulate cortex. After sham tDCS, CBF decreased in regions including the bilateral superior parietal lobule, precuneus, bilateral precentral and postcentral gyri, and left angular gyrus. Real acupuncture led to reduced CBF in the bilateral occipital cortex and hippocampus, and left posterior cingulate gyrus, and increased CBF in the right postcentral gyrus, superior parietal lobule, and frontal areas. Sham acupuncture was associated with decreased CBF in the bilateral hippocampus and anterior cingulate gyrus. Conclusions: These results suggest both shared and distinct patterns of CBF changes between real and sham tDCS, as well as between real and sham acupuncture, reflecting mode-dependent effects on brain networks involved in pain processing and modulation. Our findings highlight the different neural circuits implicated in the therapeutic mechanisms of tDCS and acupuncture in the management of cLBP.<\/jats:p>","DOI":"10.3390\/brainsci15030261","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T04:28:18Z","timestamp":1740716898000},"page":"261","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Assessing the Modulatory Effects of tDCS and Acupuncture on Cerebral Blood Flow in Chronic Low Back Pain Using Arterial Spin Labeling Perfusion Imaging"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-8110","authenticated-orcid":false,"given":"Valeria","family":"Sacca","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasim","family":"Maleki","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sveta","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra","family":"Hodges","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1113\/jphysiol.1964.sp007425","article-title":"The Action of Brief Polarizing Currents on the Cerebral Cortex of the Rat (I) During Current Flow and (2) in the Production of Long-Lasting After-Effects","volume":"172","author":"Lippold","year":"1964","journal-title":"J. Physiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.neuroimage.2011.06.018","article-title":"Effects of Transcranial Direct Current Stimulation (TDCS) on Human Regional Cerebral Blood Flow","volume":"58","author":"Zheng","year":"2011","journal-title":"Neuroimage"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11425","DOI":"10.1523\/JNEUROSCI.3887-12.2013","article-title":"Widespread Modulation of Cerebral Perfusion Induced during and after Transcranial Direct Current Stimulation Applied to the Left Dorsolateral Prefrontal Cortex","volume":"33","author":"Stagg","year":"2013","journal-title":"J. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"120433","DOI":"10.1016\/j.neuroimage.2023.120433","article-title":"Modulation Effects of Repeated Transcranial Direct Current Stimulation on the Dorsal Attention and Frontal Parietal Networks and Its Association with Placebo and Nocebo Effects","volume":"284","author":"Sacca","year":"2023","journal-title":"Neuroimage"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2101273118","DOI":"10.1073\/pnas.2101273118","article-title":"Manipulating Placebo Analgesia and Nocebo Hyperalgesia by Changing Brain Excitability","volume":"118","author":"Tu","year":"2021","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/head.13479","article-title":"Transcranial Magnetic and Direct Current Stimulation (TMS\/TDCS) for the Treatment of Headache: A Systematic Review","volume":"59","author":"Stilling","year":"2019","journal-title":"Headache"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1176\/appi.ajp.2012.11071091","article-title":"Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia","volume":"169","author":"Brunelin","year":"2012","journal-title":"Am. J. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jpsychires.2015.12.018","article-title":"A Systematic Review of the Clinical Efficacy of Transcranial Direct Current Stimulation (TDCS) in Psychiatric Disorders","volume":"74","author":"Kekic","year":"2016","journal-title":"J. Psychiatr. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1017\/S1461145707007833","article-title":"A Randomized, Double-Blind Clinical Trial on the Efficacy of Cortical Direct Current Stimulation for the Treatment of Major Depression","volume":"11","author":"Boggio","year":"2008","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Babakhani, B., Tabatabaei, N.H., Elisevich, K., Sadeghbeigi, N., Barzegar, M., Mobarakeh, N.M., Eyvazi, F., Khazaeipour, Z., Taheri, A., and Nazem-Zadeh, M.R. (2022). A Preliminary Study of the Efficacy of Transcranial Direct Current Stimulation in Trigeminal Neuralgia. Front. Hum. Neurosci., 16.","DOI":"10.3389\/fnhum.2022.848347"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/TGR.0000000000000430","article-title":"Transcranial Direct Current Stimulation Combined with Aerobic Exercise for the Treatment of Chronic Nonspecific Low Back Pain Study Protocol for a Randomized Clinical Trial","volume":"40","author":"Maffezzoli","year":"2024","journal-title":"Top. Geriatr. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Corti, E.J., Nguyen, A.T., Marinovic, W., Gasson, N., and Loftus, A.M. (2022). Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain. Brain Sci., 12.","DOI":"10.1101\/2022.03.13.484179"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.neuroimage.2017.05.060","article-title":"Multifocal TDCS Targeting the Resting State Motor Network Increases Cortical Excitability beyond Traditional TDCS Targeting Unilateral Motor Cortex","volume":"157","author":"Fischer","year":"2017","journal-title":"Neuroimage"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"h1640","DOI":"10.1136\/bmj.h1640","article-title":"Effectiveness of Transcranial Direct Current Stimulation Preceding Cognitive Behavioural Management for Chronic Low Back Pain: Sham Controlled Double Blinded Randomised Controlled Trial","volume":"350","author":"Luedtke","year":"2015","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.brs.2014.01.058","article-title":"Targeting Chronic Recurrent Low Back Pain from the Top-down and the Bottom-up: A Combined Transcranial Direct Current Stimulation and Peripheral Electrical Stimulation Intervention","volume":"7","author":"Schabrun","year":"2014","journal-title":"Brain Stimul."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sehm, B., Kipping, J., Schaefer, A., Villringer, A., and Ragert, P. (2013). A Comparison between Uni-and Bilateral TDCS Effects on Functional Connectivity of the Human Motor Cortex. Front. Hum. Neurosci., 7.","DOI":"10.3389\/fnhum.2013.00183"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.neulet.2017.08.024","article-title":"Delayed Pain Decrease Following M1 TDCS in Spinal Cord Injury: A Randomized Controlled Clinical Trial","volume":"658","author":"Thibaut","year":"2017","journal-title":"Neurosci. Lett."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1038\/nrneurol.2017.122","article-title":"Brain Imaging Tests for Chronic Pain: Medical, Legal and Ethical Issues and Recommendations","volume":"13","author":"Davis","year":"2017","journal-title":"Nat. Rev. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"DosSantos, M.F., Ferreira, N., Toback, R.L., Carvalho, A.C., and DaSilva, A.F. (2016). Potential Mechanisms Supporting the Value of Motor Cortex Stimulation to Treat Chronic Pain Syndromes. Front. Neurosci., 10.","DOI":"10.3389\/fnins.2016.00018"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"189","DOI":"10.58837\/CHULA.CMJ.66.2.9","article-title":"Effects of Transcranial Direct-Current Stimulation Combined with Physical Therapy in Chronic Low Back Pain Treatments: A Randomized Controlled Pilot Study","volume":"66","year":"2022","journal-title":"Chulalongkorn Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13075-016-0934-0","article-title":"Changes in Resting State Functional Connectivity after Repetitive Transcranial Direct Current Stimulation Applied to Motor Cortex in Fibromyalgia Patients","volume":"18","author":"Cummiford","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s10194-018-0924-5","article-title":"Polarity-Specific Modulation of Pain Processing by Transcranial Direct Current Stimulation\u2014A Blinded Longitudinal FMRI Study","volume":"19","author":"Naegel","year":"2018","journal-title":"J. Headache Pain."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kandi\u0107, M., Moliadze, V., Andoh, J., Flor, H., and Nees, F. (2021). Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence from Non-Invasive Brain Stimulation. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.732034"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/j.1460-9568.2005.04233.x","article-title":"How Does Transcranial DC Stimulation of the Primary Motor Cortex Alter Regional Neuronal Activity in the Human Brain?","volume":"22","author":"Lang","year":"2005","journal-title":"Eur. J. Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sacca, V., Maleki, N., Wen, Y., Hodges, S., and Kong, J. (2023). Modulation Effects of Repeated Transcranial Direct Current Stimulation at the Dorsolateral Prefrontal Cortex: A Pulsed Continuous Arterial Spin Labeling Study. Brain Sci., 13.","DOI":"10.3390\/brainsci13030395"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1148\/radiol.2016150789","article-title":"Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications","volume":"281","author":"Haller","year":"2016","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1002\/ejp.1212","article-title":"Delineation between Different Components of Chronic Pain Using Dimension Reduction\u2014An ASL FMRI Study in Hand Osteoarthritis","volume":"22","author":"Keszthelyi","year":"2018","journal-title":"Eur. J. Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1038\/nature09613","article-title":"Glial and Neuronal Control of Brain Blood Flow","volume":"468","author":"Attwell","year":"2010","journal-title":"Nature"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e750","DOI":"10.1097\/PR9.0000000000000750","article-title":"Imaging Clinically Relevant Pain States Using Arterial Spin Labeling","volume":"4","author":"Loggia","year":"2019","journal-title":"Pain. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.neuroimage.2010.11.085","article-title":"Transcranial Direct Current Stimulation over the Primary Motor Cortex during FMRI","volume":"55","author":"Antal","year":"2011","journal-title":"Neuroimage"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.neuroimage.2006.08.037","article-title":"Motor Cortex Stimulation in Neuropathic Pain. Correlations between Analgesic Effect and Hemodynamic Changes in the Brain. A PET Study","volume":"34","author":"Peyron","year":"2007","journal-title":"Neuroimage"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/j.1469-7793.2000.t01-1-00633.x","article-title":"Excitability Changes Induced in the Human Motor Cortex by weak Transcranial Direct Current Stimulation","volume":"527","author":"Nitsche","year":"2000","journal-title":"J. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1001\/jama.2013.285478","article-title":"Acupuncture for Chronic Pain","volume":"311","author":"Vickers","year":"2014","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(86)90057-6","article-title":"Efficacy of Electroacupuncture and TENS in the Rehabilitation of Chronic Low Back Pain Patients","volume":"26","author":"Lehmann","year":"1986","journal-title":"Pain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1136\/bjsports-2013-092949","article-title":"Acupuncture Applied as a Sensory Discrimination Training Tool Decreases Movement-Related Pain in Patients with Chronic Low Back Pain More than Acupuncture Alone: A Randomised Cross-over Experiment","volume":"47","author":"Wand","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/aje\/kwj224","article-title":"Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain","volume":"164","author":"Witt","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1142\/S0192415X13500018","article-title":"Acupuncture for Chronic Low Back Pain in Long-Term Follow-up: A Meta-Analysis of 13 Randomized Controlled Trials","volume":"41","author":"Xu","year":"2013","journal-title":"Am. J. Chin. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s11606-020-05871-6","article-title":"Medicare Coverage of Acupuncture for Chronic Low Back Pain: Does It Move the Needle on the Opioid Crisis?","volume":"36","author":"Liou","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kim, Y.K., Park, J.Y., Kim, S.N., Yeom, M., Lee, S., Oh, J.Y., Lee, H., Chae, Y., Hahm, D.H., and Park, H.J. (2017). What Intrinsic Factors Influence Responsiveness to Acupuncture in Pain?: A Review of Pre-Clinical Studies That Used Responder Analysis. BMC Complement. Altern. Med., 17.","DOI":"10.1186\/s12906-017-1792-2"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1080\/17434440.2020.1816168","article-title":"Methods and Strategies of TDCS for the Treatment of Pain: Current Status and Future Directions","volume":"17","author":"Thibaut","year":"2020","journal-title":"Expert. Rev. Med. Devices"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1001\/archinternmed.2009.65","article-title":"A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain","volume":"169","author":"Cherkin","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_43","first-page":"54","article-title":"Developing Methods for Acupuncture Research: Rationale for and Design of a Pilot Study Evaluating the Efficacy of Acupunture for Chronic Low Back Pain","volume":"9","author":"Sherman","year":"2003","journal-title":"Altern. Ther. Health Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0304-3959(99)00107-4","article-title":"Randomised Clinical Trial Comparing the Effects of Acupuncture and a Newly Designed Placebo Needle in Rotator Cuff Tendinitis","volume":"83","author":"Kleinhenz","year":"1999","journal-title":"Pain"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1001\/Archinte.167.17.1892","article-title":"German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial with 3 Groups","volume":"167","author":"Haake","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1089\/acm.2006.12.733","article-title":"Designing an Acupuncture Study: II. The Nationwide, Randomized, Controlled German Acupuncture Trials on Low-Back Pain and Gonarthrosis","volume":"12","author":"Molsberger","year":"2006","journal-title":"J. Altern. Complement. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1136\/aim.25.1-2.36","article-title":"Sham Acupuncture Devices\u2014Practical Advice for Researchers","volume":"25","author":"McManus","year":"2007","journal-title":"Acupunct. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1097\/j.pain.0000000000001829","article-title":"Brain Perfusion Patterns Are Altered in Chronic Knee Pain: A Spatial Covariance Analysis of Arterial Spin Labelling MRI","volume":"161","author":"Iwabuchi","year":"2020","journal-title":"Pain"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/brain\/awl004","article-title":"The Precuneus: A Review of Its Functional Anatomy and Behavioural Correlates","volume":"129","author":"Cavanna","year":"2006","journal-title":"Brain"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Baliki, M.N., Mansour, A.R., Baria, A.T., and Apkarian, A.V. (2014). Functional Reorganization of the Default Mode Network across Chronic Pain Conditions. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0106133"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.nicl.2017.10.019","article-title":"Disruption of Default Mode Network Dynamics in Acute and Chronic Pain States","volume":"17","author":"Alshelh","year":"2018","journal-title":"Neuroimage Clin."},{"key":"ref_52","first-page":"e58511","article-title":"The Role of the Insula in Chronic Pain and Associated Structural Changes: An Integrative Review","volume":"16","author":"McBenedict","year":"2024","journal-title":"Cureus"},{"key":"ref_53","first-page":"2981","article-title":"Differences in Brain Structure in Patients with Distinct Sites of Chronic Pain: A Voxel-Based Morphometric Analysis","volume":"8","author":"Mao","year":"2013","journal-title":"Neural Regen. Res."},{"key":"ref_54","first-page":"1","article-title":"Gray Matter Abnormalities in Patients with Chronic Primary Pain: A Coordinate-Based Meta-Analysis","volume":"25","author":"Zhou","year":"2022","journal-title":"Pain Physician"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.pain.2007.06.021","article-title":"Quantification of Pain-Induced Changes in Cerebral Blood Flow by Perfusion MRI","volume":"136","author":"Owen","year":"2008","journal-title":"Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.pain.2009.10.003","article-title":"Using Perfusion MRI to Measure the Dynamic Changes in Neural Activation Associated with Tonic Muscular Pain","volume":"148","author":"Owen","year":"2010","journal-title":"Pain"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1093\/cercor\/bhs378","article-title":"Multivariate Classification of Structural MRI Data Detects Chronic Low Back Pain","volume":"24","author":"Ung","year":"2014","journal-title":"Cereb. Cortex"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"101775","DOI":"10.1016\/j.nicl.2019.101775","article-title":"Visual Network Alterations in Brain Functional Connectivity in Chronic Low Back Pain: A Resting State Functional Connectivity and Machine Learning Study","volume":"22","author":"Shen","year":"2019","journal-title":"Neuroimage Clin."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1056\/NEJMoa1204471","article-title":"An FMRI-Based Neurologic Signature of Physical Pain","volume":"368","author":"Wager","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s10143-014-0583-1","article-title":"New Insights in the Limbic Modulation of Visual Inputs: The Role of the Inferior Longitudinal Fasciculus and the Li-Am Bundle","volume":"38","author":"Latini","year":"2015","journal-title":"Neurosurg. Rev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/0166-4328(83)90145-6","article-title":"Structural Development of the Lateral Geniculate Nucleus and Visual Cortex in Monkey and Man","volume":"10","author":"Garey","year":"1983","journal-title":"Behav. Brain Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3936","DOI":"10.1002\/art.37685","article-title":"Alterations in Resting-State Regional Cerebral Blood Flow Demonstrate Ongoing Pain in Osteoarthritis: An Arterial Spin-Labeled Magnetic Resonance Imaging Study","volume":"64","author":"Howard","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.jpain.2013.03.001","article-title":"Structural Brain Anomalies and Chronic Pain: A Quantitative Meta-Analysis of Gray Matter Volume","volume":"14","author":"Smallwood","year":"2013","journal-title":"J. Pain"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1093\/brain\/aws371","article-title":"The Stress Model of Chronic Pain: Evidence from Basal Cortisol and Hippocampal Structure and Function in Humans","volume":"136","author":"Roy","year":"2013","journal-title":"Brain"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1093\/brain\/aww100","article-title":"Corticolimbic Anatomical Characteristics Predetermine Risk for Chronic Pain","volume":"139","author":"Tetreault","year":"2016","journal-title":"Brain"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1744-8069-6-27","article-title":"A Key Role of the Basal Ganglia in Pain and Analgesia\u2014Insights Gained through Human Functional Imaging","volume":"6","author":"Borsook","year":"2010","journal-title":"Mol. Pain"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/1744-8069-7-71","article-title":"Migraine Attacks the Basal Ganglia","volume":"7","author":"Maleki","year":"2011","journal-title":"Mol. Pain"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/AJP.0000000000000295","article-title":"Basal Ganglia Perfusion in Fibromyalgia Is Related to Pain Disability and Disease Impact: An Arterial Spin Labeling Study","volume":"32","author":"Shokouhi","year":"2016","journal-title":"Clin. J. Pain"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.nicl.2014.04.007","article-title":"Gray Matter Alterations in Chronic Pain: A Network-Oriented Meta-Analytic Approach","volume":"4","author":"Cauda","year":"2014","journal-title":"Neuroimage Clin."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Bergeron, D., Obaid, S., Fournier-Gosselin, M.P., Bouthillier, A., and Nguyen, D.K. (2021). Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework. Brain Sci., 11.","DOI":"10.3390\/brainsci11050639"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1016\/j.wneu.2019.11.026","article-title":"Comparison of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation Surgery on Parkinson Disease\u2013Related Pain","volume":"135","author":"Gong","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1136\/jnnp.73.4.395","article-title":"Effect of Chronic Pallidal Deep Brain Stimulation on off Period Dystonia and Sensory Symptoms in Advanced Parkinson\u2019s Disease","volume":"73","author":"Loher","year":"2002","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.pain.2013.09.024","article-title":"Expectation Requires Treatment to Boost Pain Relief: An FMRI Study","volume":"155","author":"Schenk","year":"2014","journal-title":"Pain"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/0300060516679345","article-title":"Abnormality of Spontaneous Brain Activities in Patients with Chronic Neck and Shoulder Pain: A Resting-State FMRI Study","volume":"45","author":"Yu","year":"2017","journal-title":"J. Int. Med. Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/ALN.0b013e318220e880","article-title":"Neural Correlates of Chronic Low Back Pain Measured by Arterial Spin Labeling","volume":"115","author":"Wasan","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1002\/hbm.25750","article-title":"Patients with Chronic Pain Exhibit Individually Unique Cortical Signatures of Pain Encoding","volume":"43","author":"Mayr","year":"2022","journal-title":"Hum. Brain Mapp."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1744-8069-9-43","article-title":"S1 Is Associated with Chronic Low Back Pain: A Functional and Structural MRI Study","volume":"9","author":"Kong","year":"2013","journal-title":"Mol. Pain."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1038\/s41467-023-38798-7","article-title":"Primary Somatosensory Cortex Bidirectionally Modulates Sensory Gain and Nociceptive Behavior in a Layer-Specific Manner","volume":"14","author":"Ziegler","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Zhu, W., Tang, W., Liang, Y., Jiang, X., Li, Y., Chen, Z., and Zhu, C. (2022). Aberrant Functional Connectivity of Sensorimotor Network and Its Relationship with Executive Dysfunction in Bipolar Disorder Type I. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.823550"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.pain.2009.11.008","article-title":"Exploring the Brain in Pain: Activations, Deactivations and Their Relation","volume":"148","author":"Kong","year":"2010","journal-title":"Pain"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.nicl.2014.08.019","article-title":"Disrupted Functional Connectivity of the Periaqueductal Gray in Chronic Low Back Pain","volume":"6","author":"Yu","year":"2014","journal-title":"Neuroimage Clin."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1126\/science.1093065","article-title":"Placebo-Induced Changes in FMRI in the Anticipation and Experience of Pain","volume":"303","author":"Reiman","year":"2004","journal-title":"Science"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1523\/JNEUROSCI.3556-05.2006","article-title":"Brain Activity Associated with Expectancy-Enhanced Placebo Analgesia as Measured by Functional Magnetic Resonance Imaging","volume":"26","author":"Kong","year":"2006","journal-title":"J. Neurosci."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.clinph.2023.07.010","article-title":"Pain-Motor Integration in Chronic Pain: A Neurophysiological Study","volume":"154","author":"Asci","year":"2023","journal-title":"Clin. Neurophysiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.nicl.2015.09.012","article-title":"Repeated Verum but not Placebo Acupuncture Normalizes Connectivity in Brain Regions Dysregulated in Chronic Pain","volume":"9","author":"Egorova","year":"2015","journal-title":"Neuroimage Clin."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/brain\/awt162","article-title":"The Role of the Posterior Cingulate Cortex in Cognition and Disease","volume":"137","author":"Leech","year":"2014","journal-title":"Brain"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Shimo, K., Ueno, T., Younger, J., Nishihara, M., Inoue, S., Ikemoto, T., Taniguchi, S., and Ushida, T. (2011). Visualization of Painful Experiences Believed to Trigger the Activation of Affective and Emotional Brain Regions in Subjects with Low Back Pain. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026681"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Japee, S., Holiday, K., Satyshur, M.D., Mukai, I., and Ungerleider, L.G. (2015). A Role of Right Middle Frontal Gyrus in Reorienting of Attention: A Case Study. Front. Syst. Neurosci., 9.","DOI":"10.3389\/fnsys.2015.00023"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Scott, J.G., and Schoenberg, M.R. (2011). Frontal Lobe\/Executive Functioning. The Little Black Book of Neuropsychology, Springer.","DOI":"10.1007\/978-0-387-76978-3"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.neubiorev.2020.09.016","article-title":"The Neural Correlates of Pain-Related Fear: A Meta-Analysis Comparing Fear Conditioning Studies Using Painful and Non-Painful Stimuli","volume":"119","author":"Biggs","year":"2020","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.jpain.2011.06.007","article-title":"Executive Function in Chronic Pain Patients and Healthy Controls: Different Cortical Activation during Response Inhibition in Fibromyalgia","volume":"12","author":"Glass","year":"2011","journal-title":"J. Pain"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"117024","DOI":"10.1016\/j.neuroimage.2020.117024","article-title":"Placebo-Induced Pain Reduction Is Associated with Negative Coupling between Brain Networks at Rest","volume":"219","author":"Wagner","year":"2020","journal-title":"Neuroimage"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Fuchs, P.N., Peng, Y.B., Boyette-Davis, J.A., and Uhelski, M.L. (2014). The Anterior Cingulate Cortex and Pain Processing. Front. Integr. Neurosci., 8.","DOI":"10.3389\/fnint.2014.00035"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1038\/nrn1704","article-title":"Pain and Emotion Interactions in Subregions of the Cingulate Gyrus","volume":"6","author":"Vogt","year":"2005","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cortex.2018.08.024","article-title":"Functional Mapping and Effective Connectivity of the Human Operculum","volume":"109","author":"Donos","year":"2018","journal-title":"Cortex"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ejpain.2004.11.001","article-title":"Human Brain Mechanisms of Pain Perception and Regulation in Health and Disease","volume":"9","author":"Apkarian","year":"2005","journal-title":"Eur. J. Pain"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/01.aco.0000433060.59939.fe","article-title":"Functional MRI and Pain","volume":"26","author":"Fomberstein","year":"2013","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Wen, Y.-R., Shi, J., Hu, Z.-Y., Lin, Y.-Y., Lin, Y.-T., Jiang, X., Wang, R., Wang, X.-Q., and Wang, Y.-L. (2022). Is Transcranial Direct Current Stimulation Beneficial for Treating Pain, Depression, and Anxiety Symptoms in Patients with Chronic Pain? A Systematic Review and Meta-Analysis. Front. Mol. Neurosci., 15.","DOI":"10.3389\/fnmol.2022.1056966"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/3\/261\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:44:18Z","timestamp":1760028258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/3\/261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,28]]},"references-count":98,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["brainsci15030261"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15030261","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,28]]}}}