Beyond pain relief: the effects of chronic opioid use on brain structure and function in diabetic neuropathy—a multimodal neuroimaging study
Authors' conclusion
We demonstrate that disruption of dopaminergic pathways occurs within the brain when opioids are used for analgesic purposes for painful DPN, which may reflect alterations in reward systems. This study has important clinical implications, as the measures of dopaminergic pathways found in this study may represent neuroimaging biomarkers that could be used to diagnose and monitor the negative consequences of prescription opioid use.
Study context
- Population
- Patients with diabetes with painful diabetic peripheral neuropathy (DPN), and controls with diabetes without DPNfMRI subset n=42
- Participants
- 82 patients
- Exposure
- Long-term opioid prescription vs no opioids vs no DPN
- O+n = 18
- O-n = 39
- No DPNn = 25reference
- Outcome
- Structural and functional brain alterations associated with prescription opioid use (brain MRI at 3 T; resting-state functional MRI in a subset)
Methodological detailsmultimodal neuroimaging, matched for age (± 2 years), sex and type of diabetes
- Multimodal neuroimaging
- Matched for age (± 2 years), sex and type of diabetes
Main finding
As reported in the abstract
Caudate volume
- O+ vs O-: P = 0.03
- O+ vs No DPN: P = 0.01
Observational data: associations, not effects.
Further findings
| Outcome | R β | P value |
|---|---|---|
| Functional connectivity between caudate and thalamusO+ vs No DPN · lower with O+; seed-level correction −3.9 | −0.24 | pFDR ≤0.05 |
Caudate seed-to-voxel functional connectivity (superior frontal gyri bilaterally)
- Significantly lower functional connectivity in O+ vs O- in a cluster encompassing the superior frontal gyri bilaterally
Original publication
Beyond pain relief: the effects of chronic opioid use on brain structure and function in diabetic neuropathy—a multimodal neuroimaging study. Diabetologia. Published 6 October 2025. doi:10.
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