{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:46:02Z","timestamp":1785422762139,"version":"3.56.0"},"posted":{"date-parts":[[2026,6,22]]},"group-title":"Radiology and Imaging","reference-count":24,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"award":["R01NS133305"],"award-info":[{"award-number":["R01NS133305"]}],"id":[{"id":"https:\/\/ror.org\/01s5ya894","id-type":"ROR","asserted-by":"publisher"}]},{"award":["R01NS128478"],"award-info":[{"award-number":["R01NS128478"]}],"id":[{"id":"https:\/\/ror.org\/01s5ya894","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Chronic pain is associated with impaired muscle health, but whether these changes reflect site-specific factors, broader systemic factors, or both remains unclear. The purpose of this study is to determine whether normative markers of muscle health derived from MRI show site-specific patterns in chronic pain.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>UK Biobank participants who underwent whole-body MRI from 2006 to 2010 were included in this retrospective cross-sectional study. The MuscleMap Toolbox quantified volume and intramuscular fat (IMF) in 42 muscles of the abdomen, pelvis, and thigh. Normative models trained on a no pain group generated muscle-specific deviations from normal (i.e., Z-scores) for single- and multi-site chronic and acute pain.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 17,843 participants, the primary site-specific analysis included 9,704 no pain, 885 single-site chronic back pain (CBP), 438 single-site chronic hip pain (CHP), and 1,315 single-site chronic knee pain (CKP) participants (n=12,342; mean age 63.7\u00b17.5 years; 52.7% female). Additional analyses included single-site chronic neck\/shoulder pain, acute pain, and multi-site chronic pain groups. In CBP, deviations were localized to abdominal muscles, with decreased volume in 6\/8 and increased IMF in 6\/8. In CHP, deviations were broad, with decreased volume in 3\/8 of the abdominal and 14\/26 of the thigh muscles, and increased IMF in 6\/8 of the abdominal, 5\/8 of the pelvic, and 4\/26 of the thigh muscles. In CKP, deviations were localized to thigh muscles, with decreased volume in 8\/26 and increased IMF in 6\/26. Acute pain groups showed no significant differences except for decreased volume in one thigh muscle in acute knee pain. With each additional chronic pain site, volume decreased (\u03b2=\u2212.078;IQR:\u22120.100\u22120.051), and IMF increased (\u03b2=.085;IQR:0.066\u22120.101). Combined Z-scores classified chronic pain groups better than chance (accuracy: 48.6%;p&lt;.001), but not acute pain groups (accuracy: 39.0%;p=.20).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Whole-body MRI combined with AI-driven muscle segmentation and normative modeling revealed site-specific patterns of muscle health in single-site chronic pain.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.19.26356062","type":"posted-content","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T22:05:18Z","timestamp":1782165918000},"source":"Crossref","is-referenced-by-count":0,"title":["Patterns of Muscle Health in Single- and Multi-Site Chronic Pain: A UK Biobank Normative Modeling Study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8187-4911","authenticated-orcid":false,"given":"Merve","family":"Kaptan","sequence":"first","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustijn","family":"de Boer","sequence":"additional","affiliation":[{"name":"Donders Institute for Cognition, Brain and Behavior, Radboud University, Nijmegen, The Netherlands"},{"name":"Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-998X","authenticated-orcid":false,"given":"Ananya","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA"},{"name":"Department of Bioengineering, Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5423-385X","authenticated-orcid":false,"given":"Skylar","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerem","family":"Ozkan","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, 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