Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis

Background: Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the...

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Autores: Ojeda, Fabiola|||0000-0002-6734-9288, Martinez Vilavella, Gerard|||0000-0001-8948-4918, Blanco Hinojo, Laura, 1981-, Deus Yela, Juan|||0000-0002-3305-2662, Tío Barrera, Laura|||0000-0003-1408-7381, Monfort, Jordi|||0000-0002-9103-661X
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::586efd556220f14263ab9c1ab77ee621
Acceso en línea:https://ddd.uab.cat/record/328527
https://dx.doi.org/urn:doi:10.1186/s42836-026-00382-x
Access Level:acceso abierto
Palabra clave:Osteoarthritis
Total knee replacement
Central sensitization
Pain catastrophizing
FMRI
Amygdala
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network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
an fMRI study
title Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
spellingShingle Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
Ojeda, Fabiola|||0000-0002-6734-9288
Osteoarthritis
Total knee replacement
Central sensitization
Pain catastrophizing
FMRI
Amygdala
title_short Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
title_full Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
title_fullStr Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
title_full_unstemmed Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
title_sort Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis
dc.creator.none.fl_str_mv Ojeda, Fabiola|||0000-0002-6734-9288
Martinez Vilavella, Gerard|||0000-0001-8948-4918
Blanco Hinojo, Laura, 1981-
Deus Yela, Juan|||0000-0002-3305-2662
Tío Barrera, Laura|||0000-0003-1408-7381
Monfort, Jordi|||0000-0002-9103-661X
author Ojeda, Fabiola|||0000-0002-6734-9288
author_facet Ojeda, Fabiola|||0000-0002-6734-9288
Martinez Vilavella, Gerard|||0000-0001-8948-4918
Blanco Hinojo, Laura, 1981-
Deus Yela, Juan|||0000-0002-3305-2662
Tío Barrera, Laura|||0000-0003-1408-7381
Monfort, Jordi|||0000-0002-9103-661X
author_role author
author2 Martinez Vilavella, Gerard|||0000-0001-8948-4918
Blanco Hinojo, Laura, 1981-
Deus Yela, Juan|||0000-0002-3305-2662
Tío Barrera, Laura|||0000-0003-1408-7381
Monfort, Jordi|||0000-0002-9103-661X
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Osteoarthritis
Total knee replacement
Central sensitization
Pain catastrophizing
FMRI
Amygdala
topic Osteoarthritis
Total knee replacement
Central sensitization
Pain catastrophizing
FMRI
Amygdala
description Background: Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the amygdala and nucleus accumbens, which are increasingly recognized as key components of the affective-motivational dimension of chronic pain and may show differential activation across clinical treatment contexts. This study is part of the HOLOA Project (Clinical and virtual examination of patients for holistic and objective description of the osteoarthritis progression mechanisms). Methods: We conducted a cross-sectional observational study nested within the HOLOA cohort. Thirty-one patients with KOA (20 managed conservatively [CM] and 11 observed in the surgical treatment context) with Kellgren Lawrence (KL) grades 2-3 were included. Participants underwent two fMRI paradigms involving pressure stimulation (Knee Interline and Tibial Surface tests). Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Numeric Rating Scale (NRS). Group comparisons and correlation analyses were performed to examine associations between clinical measures and brain activation patterns. Results: Groups were broadly comparable with no statistically significant differences in demographic or radiographic severity measures. These patients showed higher WOMAC and PCS scores, indicating greater functional impairment and pain catastrophizing. Across the whole cohort, painful stimulation elicited robust activation of classical pain-processing regions, while no significant amygdala or nucleus accumbens activation was observed at the group level. However, nucleus accumbens activity was positively associated with PCS scores. In between-group analyses, patients observed in the surgical treatment context exhibited significant bilateral amygdala activation during Tibial Surface stimulation, which was absent in the conservatively managed group, and reported higher post-test NRS scores. Conclusion: Limbic system activation and pain catastrophizing were associated with the surgical treatment context in patients with knee osteoarthritis within a similar range of radiographic severity. The observed involvement of the amygdala and nucleus accumbens underscores the relevance of affective-motivational and cognitive processes in chronic KOA pain. These findings support the value of integrating clinical, psychological, and neurobiological perspectives when interpreting symptom burden and treatment context in knee osteoarthritis.
publishDate 2026
dc.date.none.fl_str_mv 2
2026-01-01
2026
2026-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/328527
https://dx.doi.org/urn:doi:10.1186/s42836-026-00382-x
url https://ddd.uab.cat/record/328527
https://dx.doi.org/urn:doi:10.1186/s42836-026-00382-x
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Agencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2021-126469OB-C22
Ministerio de Ciencia e Innovación https://doi.org/10.13039/501100004837 PID2021-127703OBI00
Generalitat de Catalunya https://doi.org/10.13039/501100002809 2017/SGR-00717
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
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eu_rights_str_mv openAccess
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dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
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spelling Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritisan fMRI studyOjeda, Fabiola|||0000-0002-6734-9288Martinez Vilavella, Gerard|||0000-0001-8948-4918Blanco Hinojo, Laura, 1981-Deus Yela, Juan|||0000-0002-3305-2662Tío Barrera, Laura|||0000-0003-1408-7381Monfort, Jordi|||0000-0002-9103-661XOsteoarthritisTotal knee replacementCentral sensitizationPain catastrophizingFMRIAmygdalaBackground: Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the amygdala and nucleus accumbens, which are increasingly recognized as key components of the affective-motivational dimension of chronic pain and may show differential activation across clinical treatment contexts. This study is part of the HOLOA Project (Clinical and virtual examination of patients for holistic and objective description of the osteoarthritis progression mechanisms). Methods: We conducted a cross-sectional observational study nested within the HOLOA cohort. Thirty-one patients with KOA (20 managed conservatively [CM] and 11 observed in the surgical treatment context) with Kellgren Lawrence (KL) grades 2-3 were included. Participants underwent two fMRI paradigms involving pressure stimulation (Knee Interline and Tibial Surface tests). Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Numeric Rating Scale (NRS). Group comparisons and correlation analyses were performed to examine associations between clinical measures and brain activation patterns. Results: Groups were broadly comparable with no statistically significant differences in demographic or radiographic severity measures. These patients showed higher WOMAC and PCS scores, indicating greater functional impairment and pain catastrophizing. Across the whole cohort, painful stimulation elicited robust activation of classical pain-processing regions, while no significant amygdala or nucleus accumbens activation was observed at the group level. However, nucleus accumbens activity was positively associated with PCS scores. In between-group analyses, patients observed in the surgical treatment context exhibited significant bilateral amygdala activation during Tibial Surface stimulation, which was absent in the conservatively managed group, and reported higher post-test NRS scores. Conclusion: Limbic system activation and pain catastrophizing were associated with the surgical treatment context in patients with knee osteoarthritis within a similar range of radiographic severity. The observed involvement of the amygdala and nucleus accumbens underscores the relevance of affective-motivational and cognitive processes in chronic KOA pain. These findings support the value of integrating clinical, psychological, and neurobiological perspectives when interpreting symptom burden and treatment context in knee osteoarthritis. 22026-01-0120262026-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/328527https://dx.doi.org/urn:doi:10.1186/s42836-026-00382-xreponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengAgencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2021-126469OB-C22Ministerio de Ciencia e Innovación https://doi.org/10.13039/501100004837 PID2021-127703OBI00Generalitat de Catalunya https://doi.org/10.13039/501100002809 2017/SGR-00717open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:uabarcelona_::586efd556220f14263ab9c1ab77ee6212026-06-06T12:50:31Z
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