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Background <p>Chronic somatic pain (CSP) and major depressive disorder (MDD) frequently co-occur and are associated with poor prognosis. However, the neural circuit mechanisms underlying the modulation of MDD pathology by CSP remain unclear.</p> Methods <p>This case-control study included 129 participants who underwent fNIRS during a verbal fluency task (VFT) and at rest. Participants were divided into three groups (<i>n</i> = 43 each): MDD patients with comorbid CSP (MDD + CSP), MDD patients without CSP (MDD-CSP), and healthy controls (HC). This study aimed to identify CSP-specific neural signatures and examine their mediating role between pain and depression.</p> Results <p>Compared with HC, all MDD patients exhibited reduced activation in the bilateral frontopolar cortex during the task. A key finding was that, relative to both HC and the MDD-only group, the comorbid group showed selectively lower activation in the right-hemispheric Broca’s homologue (RH-Broca) (<i>p</i> = 0.003). Pain intensity was negatively correlated with RH-Broca activation (<i>p</i> &lt; 0.001). Mediation analysis revealed a bidirectional mediating effect of RH-Broca activation on the pain-depression relationship: it mediated both the pathway from pain to depression (indirect effect <i>β</i> = 1.17, 95% CI: 0.66–1.71) and the pathway from depression to pain (indirect effect <i>β</i> = 0.13, 95% CI: 0.08–0.18). At rest, the comorbid group displayed hyperactivation in the right frontopolar cortex, whereas the MDD-only group showed alterations in small-world network properties.</p> Conclusion <p>Selective hypoactivation in the right-hemispheric language network, particularly in the RH-Broca, is closely associated with the comorbidity of chronic somatic pain and major depressive disorder and may contribute to their mutual exacerbation. These findings support the view that the RH-Broca serves as a putative neural node connecting pain and depressive symptoms, potentially forming a bidirectional loop in comorbid patients. This neural circuit may represent a promising target for neuromodulation therapy in patients with MDD comorbid with CSP.</p>

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Right broca homologue mediates the pain-depression circuit: a case-control Functional Near-Infrared Spectroscopy (fNIRS) study on language network remodeling in chronic pain-depression comorbidity*

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Jiaren Zheng,
  • Ning Zhu,
  • Jiaxi Huang,
  • Hongyu Sun,
  • Huimin Lv,
  • Jing Zhang,
  • Zhenhua Li,
  • Manyu Zhang,
  • Jing Li,
  • Bo Zheng,
  • Yibin Xie,
  • Zhong Zheng

摘要

Background

Chronic somatic pain (CSP) and major depressive disorder (MDD) frequently co-occur and are associated with poor prognosis. However, the neural circuit mechanisms underlying the modulation of MDD pathology by CSP remain unclear.

Methods

This case-control study included 129 participants who underwent fNIRS during a verbal fluency task (VFT) and at rest. Participants were divided into three groups (n = 43 each): MDD patients with comorbid CSP (MDD + CSP), MDD patients without CSP (MDD-CSP), and healthy controls (HC). This study aimed to identify CSP-specific neural signatures and examine their mediating role between pain and depression.

Results

Compared with HC, all MDD patients exhibited reduced activation in the bilateral frontopolar cortex during the task. A key finding was that, relative to both HC and the MDD-only group, the comorbid group showed selectively lower activation in the right-hemispheric Broca’s homologue (RH-Broca) (p = 0.003). Pain intensity was negatively correlated with RH-Broca activation (p < 0.001). Mediation analysis revealed a bidirectional mediating effect of RH-Broca activation on the pain-depression relationship: it mediated both the pathway from pain to depression (indirect effect β = 1.17, 95% CI: 0.66–1.71) and the pathway from depression to pain (indirect effect β = 0.13, 95% CI: 0.08–0.18). At rest, the comorbid group displayed hyperactivation in the right frontopolar cortex, whereas the MDD-only group showed alterations in small-world network properties.

Conclusion

Selective hypoactivation in the right-hemispheric language network, particularly in the RH-Broca, is closely associated with the comorbidity of chronic somatic pain and major depressive disorder and may contribute to their mutual exacerbation. These findings support the view that the RH-Broca serves as a putative neural node connecting pain and depressive symptoms, potentially forming a bidirectional loop in comorbid patients. This neural circuit may represent a promising target for neuromodulation therapy in patients with MDD comorbid with CSP.