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Garcia-Larrea L, Peyron R. Pain matrices and neuropathic pain matrices: A review. Pain 2013; 154 Suppl 1:S29-S43. [PMID: 24021862 DOI: 10.1016/j.pain.2013.09.001] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 01/18/2023]
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Owen JP, Li YO, Yang FG, Shetty C, Bukshpun P, Vora S, Wakahiro M, Hinkley LBN, Nagarajan SS, Sherr EH, Mukherjee P. Resting-state networks and the functional connectome of the human brain in agenesis of the corpus callosum. Brain Connect 2013; 3:547-62. [PMID: 24063289 DOI: 10.1089/brain.2013.0175] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The corpus callosum is the largest white matter fiber bundle connecting the two cerebral hemispheres. In this work, we investigate the effect of callosal dysgenesis on functional magnetic resonance imaging (fMRI) resting-state networks and the functional connectome. Since alternate commissural routes between the cerebral hemispheres exist, we hypothesize that bilateral cortical networks can still be maintained in partial or even complete agenesis of the corpus callosum (AgCC). However, since these commissural routes are frequently indirect, requiring polysynaptic pathways, we hypothesize that quantitative measurements of interhemispheric functional connectivity in bilateral networks will be reduced in AgCC compared with matched controls, especially in the most highly interconnected cortical regions that are the hubs of the connectome. Seventeen resting-state networks were extracted from fMRI of 11 subjects with partial or complete AgCC and 11 matched controls. The results show that the qualitative organization of resting-state networks is very similar between controls and AgCC. However, interhemispheric functional connectivity of precuneus, posterior cingulate cortex, and insular-opercular regions was significantly reduced in AgCC. The preserved network organization was confirmed with a connectomic analysis of the resting-state fMRI data, showing five functional modules that are largely consistent across the control and AgCC groups. Hence, the reduction or even complete absence of callosal connectivity does not affect the qualitative organization of bilateral resting-state networks or the modular organization of the functional connectome, although quantitatively reduced functional connectivity can be demonstrated by measurements within bilateral cortical hubs, supporting the hypothesis that indirect polysynaptic pathways are utilized to preserve interhemispheric temporal synchrony.
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Affiliation(s)
- Julia P Owen
- 1 Department of Radiology and Biomedical Imaging, University of California , San Francisco, California
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Vanhaudenhuyse A, Laureys S, Faymonville ME. Neurophysiology of hypnosis. Neurophysiol Clin 2013; 44:343-53. [PMID: 25306075 DOI: 10.1016/j.neucli.2013.09.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/03/2013] [Accepted: 09/29/2013] [Indexed: 11/25/2022] Open
Abstract
We here review behavioral, neuroimaging and electrophysiological studies of hypnosis as a state, as well as hypnosis as a tool to modulate brain responses to painful stimulations. Studies have shown that hypnotic processes modify internal (self awareness) as well as external (environmental awareness) brain networks. Brain mechanisms underlying the modulation of pain perception under hypnotic conditions involve cortical as well as subcortical areas including anterior cingulate and prefrontal cortices, basal ganglia and thalami. Combined with local anesthesia and conscious sedation in patients undergoing surgery, hypnosis is associated with improved peri- and postoperative comfort of patients and surgeons. Finally, hypnosis can be considered as a useful analogue for simulating conversion and dissociation symptoms in healthy subjects, permitting better characterization of these challenging disorders by producing clinically similar experiences.
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Affiliation(s)
- A Vanhaudenhuyse
- Coma Science Group, Cyclotron Research Centre, University of Liège, Sart Tilman B30, Allée du 6 Août n(o) 8, 4000 Liège, Belgium.
| | - S Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège, Sart Tilman B30, Allée du 6 Août n(o) 8, 4000 Liège, Belgium.
| | - M-E Faymonville
- Department of Algology, University Hospital of Liège, Sart Tilman B35, 4000 Liège, Belgium.
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Chatelle C, Thibaut A, Bruno MA, Boly M, Bernard C, Hustinx R, Schnakers C, Laureys S. Nociception Coma Scale–Revised Scores Correlate With Metabolism in the Anterior Cingulate Cortex. Neurorehabil Neural Repair 2013; 28:149-52. [PMID: 24065132 DOI: 10.1177/1545968313503220] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Nociception Coma Scale–Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness. Objective. To identify correlations between cerebral glucose metabolism and NCS-R total scores. Methods. [18F]-fluorodeoxyglucose positron emission tomography, NCS-R, and Coma Recovery Scale–Revised assessments were performed in 49 patients with disorders of consciousness. Results. We identified a significant positive correlation between NCS-R total scores and metabolism in the posterior part of the anterior cingulate cortex, known to be involved in pain processing. No other cluster reached significance. No significant effect of clinical diagnosis (vegetative/unresponsive vs minimally conscious states), etiology or interval since insult was observed. Conclusions. Our data support the hypothesis that the NCS-R total scores are related to cortical processing of nociception and may constitute an appropriate behavioral tool to assess, monitor, and treat possible pain in brain-damaged noncommunicative patients with disorders of consciousness. Future studies using event-related functional magnetic resonance imaging should investigate the correlation between NCS-R scores and brain activation in response to noxious stimulation at the single-subject level.
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55
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Lowén MB, Mayer EA, Sjöberg M, Tillisch K, Naliboff B, Labus J, Lundberg P, Ström M, Engström M, Walter SA. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther 2013; 37:1184-97. [PMID: 23617618 PMCID: PMC4084976 DOI: 10.1111/apt.12319] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/10/2013] [Accepted: 04/01/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy can reduce IBS symptoms, but the mechanisms underlying this therapeutic effect remain unknown. AIM To determine the effect of hypnotherapy and educational intervention on brain responses to cued rectal distensions in IBS patients. METHODS Forty-four women with moderate-to-severe IBS and 20 healthy controls (HCs) were included. Blood oxygen level dependent (BOLD) signals were measured by functional Magnetic Resonance Imaging (fMRI) during expectation and delivery of high- (45 mmHg) and low-intensity (15 mmHg) rectal distensions. Twenty-five patients were assigned to hypnotherapy (HYP) and 16 to educational intervention (EDU). Thirty-one patients completed treatments and posttreatment fMRI. RESULTS Similar symptom reduction was achieved in both groups. Clinically successful treatment (all responders) was associated with significant BOLD attenuation during high-intensity distension in the dorsal and ventral anterior insula (cluster size 142, P = 0.006, and cluster size 101, P = 0.005 respectively). Moreover HYP responders demonstrated a pre-post treatment BOLD attenuation in posterior insula (cluster sizes 59, P = 0.05) while EDU responders had a BOLD attenuation in prefrontal cortex (cluster size 60, P = 0.05). Pre-post differences for expectation conditions were almost exclusively seen in the HYP group. Following treatment, the brain response to distension was similar to that observed in HCs, suggesting that the treatment had a normalising effect on the central processing abnormality of visceral signals in IBS. CONCLUSIONS The abnormal processing and enhanced perception of visceral stimuli in IBS can be normalised by psychological interventions. Symptom improvement in the treatment groups may be mediated by different brain mechanisms. CLINICAL TRIAL NUMBER NCT01815164.
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Affiliation(s)
- Mats B.O. Lowén
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - Emeran A. Mayer
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | | | - Kirsten Tillisch
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Bruce Naliboff
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jennifer Labus
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Lundberg
- Center for Medical Image Science and Visualization, CMIV; Radiation Physics, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University; Department of Radiation Physics UHL, County Council of Östergötland, Linköping, Sweden Center for Medical Image Science and Visualization, CMIV; Radiology, Department of Medical and Health Sciences, Faculty of Health Sciences Linköping University; Department of Radiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Magnus Ström
- Department of Clinical and Experimental Medicine/Gastroenterology, Linköping University, Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - Maria Engström
- Department of Medical and Health Sciences (IMH)/Radiology, Linköping University, Sweden, Center for Medical Image Science and Visualization (CMIV) Linköping University, Sweden
| | - Susanna A. Walter
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
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Mutschler I, Reinbold C, Wankerl J, Seifritz E, Ball T. Structural basis of empathy and the domain general region in the anterior insular cortex. Front Hum Neurosci 2013; 7:177. [PMID: 23675334 PMCID: PMC3648769 DOI: 10.3389/fnhum.2013.00177] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/20/2013] [Indexed: 01/10/2023] Open
Abstract
Empathy is key for healthy social functioning and individual differences in empathy have strong implications for manifold domains of social behavior. Empathy comprises of emotional and cognitive components and may also be closely linked to sensorimotor processes, which go along with the motivation and behavior to respond compassionately to another person's feelings. There is growing evidence for local plastic change in the structure of the healthy adult human brain in response to environmental demands or intrinsic factors. Here we have investigated changes in brain structure resulting from or predisposing to empathy. Structural MRI data of 101 healthy adult females was analyzed. Empathy in fictitious as well as real-life situations was assessed using a validated self-evaluation measure. Furthermore, empathy-related structural effects were also put into the context of a functional map of the anterior insular cortex (AIC) determined by activation likelihood estimate (ALE) meta-analysis of previous functional imaging studies. We found that gray matter (GM) density in the left dorsal AIC correlates with empathy and that this area overlaps with the domain general region (DGR) of the anterior insula that is situated in-between functional systems involved in emotion-cognition, pain, and motor tasks as determined by our meta-analysis. Thus, we propose that this insular region where we find structural differences depending on individual empathy may play a crucial role in modulating the efficiency of neural integration underlying emotional, cognitive, and sensorimotor information which is essential for global empathy.
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Affiliation(s)
- Isabella Mutschler
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel Basel, Switzerland ; Department of Psychiatry, University of California San Diego (UCSD) La Jolla, California, USA
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Huber A, Lui F, Porro CA. Hypnotic susceptibility modulates brain activity related to experimental placebo analgesia. Pain 2013; 154:1509-1518. [PMID: 23664683 DOI: 10.1016/j.pain.2013.03.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/08/2013] [Accepted: 03/22/2013] [Indexed: 12/19/2022]
Abstract
Identifying personality traits and neural signatures that predict placebo responsiveness is important, both on theoretical and practical grounds. In the present functional magnetic resonance imaging (fMRI) study, we performed multiple-regression interaction analysis to investigate whether hypnotic susceptibility (HS), a cognitive trait referring to the responsiveness to suggestions, explains interindividual differences in the neural mechanisms related to conditioned placebo analgesia in healthy volunteers. HS was not related to the overall strength of placebo analgesia. However, we found several HS-related differences in the patterns of fMRI activity and seed-based functional connectivity that accompanied placebo analgesia. Specifically, in subjects with higher HS, the placebo response was related to increased anticipatory activity in a right dorsolateral prefrontal cortex focus, and to reduced functional connectivity of that focus with brain regions related to emotional and evaluative pain processing (anterior mid-cingulate cortex/medial prefrontal cortex); an opposite pattern of fMRI activity and functional connectivity was found in subjects with lower HS. During pain perception, activity in the regions reflecting attention/arousal (bilateral anterior thalamus/left caudate) and self-related processing (left precuneus and bilateral posterior temporal foci) was negatively related to the strength of the analgesic placebo response in subjects with higher HS, but not in subjects with lower HS. These findings highlight HS influences on brain circuits related to the placebo analgesic effects. More generally, they demonstrate that different neural mechanisms can be involved in placebo responsiveness, depending on individual cognitive traits.
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Affiliation(s)
- Alexa Huber
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena I-41125, Italy
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58
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Hypnotic modulation of pain perception and of brain activity triggered by nociceptive laser stimuli. Cortex 2013; 49:446-62. [DOI: 10.1016/j.cortex.2012.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/09/2012] [Accepted: 02/15/2012] [Indexed: 11/18/2022]
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Hoeft F, Gabrieli JD, Whitfield-Gabrieli S, Haas BW, Bammer R, Menon V, Spiegel D. Functional brain basis of hypnotizability. ARCHIVES OF GENERAL PSYCHIATRY 2012; 69:1064-72. [PMID: 23026956 PMCID: PMC4365296 DOI: 10.1001/archgenpsychiatry.2011.2190] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Focused hypnotic concentration is a model for brain control over sensation and behavior. Pain and anxiety can be effectively alleviated by hypnotic suggestion, which modulates activity in brain regions associated with focused attention, but the specific neural network underlying this phenomenon is not known. OBJECTIVE To investigate the brain basis of hypnotizability. DESIGN Cross-sectional, in vivo neuroimaging study performed from November 2005 through July 2006. SETTING Academic medical center at Stanford University School of Medicine. PATIENTS Twelve adults with high and 12 adults with low hypnotizability. MAIN OUTCOME MEASURES Functional magnetic resonance imaging to measure functional connectivity networks at rest, including default-mode, salience, and executive-control networks; structural T1 magnetic resonance imaging to measure regional gray and white matter volumes; and diffusion tensor imaging to measure white matter microstructural integrity. RESULTS High compared with low hypnotizable individuals had greater functional connectivity between the left dorsolateral prefrontal cortex, an executive-control region of the brain, and the salience network composed of the dorsal anterior cingulate cortex, anterior insula, amygdala, and ventral striatum, involved in detecting, integrating, and filtering relevant somatic, autonomic, and emotional information using independent component analysis. Seed-based analysis confirmed elevated functional coupling between the dorsal anterior cingulate cortex and the dorsolateral prefrontal cortex in high compared with low hypnotizable individuals. These functional differences were not due to any variation in brain structure in these regions, including regional gray and white matter volumes and white matter microstructure. CONCLUSIONS Our results provide novel evidence that altered functional connectivity in the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex may underlie hypnotizability. Future studies focusing on how these functional networks change and interact during hypnosis are warranted.
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Affiliation(s)
- Fumiko Hoeft
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5795
- Center for Interdisciplinary Brain Sciences Research (CIBSR), Stanford University School of Medicine, Stanford CA 94305-5795
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA 94143
| | - John D.E. Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Brian W. Haas
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5795
- Center for Interdisciplinary Brain Sciences Research (CIBSR), Stanford University School of Medicine, Stanford CA 94305-5795
| | - Roland Bammer
- Department of Radiology, Stanford University School of Medicine, Stanford CA 94305
| | - Vinod Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5795
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5795
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60
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Lifshitz M, Campbell NK, Raz A. Varieties of attention in hypnosis and meditation. Conscious Cogn 2012; 21:1582-5. [DOI: 10.1016/j.concog.2012.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 12/13/2022]
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61
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Arsalidou M, Duerden EG, Taylor MJ. The centre of the brain: topographical model of motor, cognitive, affective, and somatosensory functions of the basal ganglia. Hum Brain Mapp 2012; 34:3031-54. [PMID: 22711692 DOI: 10.1002/hbm.22124] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/09/2012] [Accepted: 04/20/2012] [Indexed: 01/11/2023] Open
Abstract
The basal ganglia have traditionally been viewed as motor processing nuclei; however, functional neuroimaging evidence has implicated these structures in more complex cognitive and affective processes that are fundamental for a range of human activities. Using quantitative meta-analysis methods we assessed the functional subdivisions of basal ganglia nuclei in relation to motor (body and eye movements), cognitive (working-memory and executive), affective (emotion and reward) and somatosensory functions in healthy participants. We document affective processes in the anterior parts of the caudate head with the most overlap within the left hemisphere. Cognitive processes showed the most widespread response, whereas motor processes occupied more central structures. On the basis of these demonstrated functional roles of the basal ganglia, we provide a new comprehensive topographical model of these nuclei and insight into how they are linked to a wide range of behaviors.
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Affiliation(s)
- Marie Arsalidou
- Diagnostic Imaging and Research Institute, Hospital for Sick Children, Toronto, Canada
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Naglatzki RP, Schlamann M, Gasser T, Ladd ME, Sure U, Forsting M, Gizewski ER. Cerebral somatic pain modulation during autogenic training in fMRI. Eur J Pain 2012; 16:1293-301. [PMID: 22461412 DOI: 10.1002/j.1532-2149.2012.00138.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) studies are increasingly employed in different conscious states. Autogenic training (AT) is a common clinically used relaxation method. The purpose of this study was to investigate the cerebral modulation of pain activity patterns due to AT and to correlate the effects to the degree of experience with AT and strength of stimuli. METHODS Thirteen volunteers familiar with AT were studied with fMRI during painful electrical stimulation in a block design alternating between resting state and electrical stimulation, both without AT and while employing the same paradigm when utilizing their AT abilities. The subjective rating of painful stimulation and success in modulation during AT was assessed. RESULTS During painful electrical stimulation without AT, fMRI revealed activation of midcingulate, right secondary sensory, right supplementary motor, and insular cortices, the right thalamus and left caudate nucleus. In contrast, utilizing AT only activation of left insular and supplementary motor cortices was revealed. The paired t-test revealed pain-related activation in the midcingulate, posterior cingulate and left anterior insular cortices for the condition without AT, and activation in the left ventrolateral prefrontal cortex under AT. Activation of the posterior cingulate cortex and thalamus correlated with the amplitude of electrical stimulation. CONCLUSIONS This study revealed an effect on cerebral pain processing while performing AT. This might represent the cerebral correlate of different painful stimulus processing by subjects who are trained in performing relaxation techniques. However, due to the absence of a control group, further studies are needed to confirm this theory.
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Affiliation(s)
- R P Naglatzki
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Germany
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63
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Gard T, Hölzel BK, Sack AT, Hempel H, Lazar SW, Vaitl D, Ott U. Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cereb Cortex 2011; 22:2692-702. [PMID: 22172578 DOI: 10.1093/cercor/bhr352] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Pain can be modulated by several cognitive techniques, typically involving increased cognitive control and decreased sensory processing. Recently, it has been demonstrated that pain can also be attenuated by mindfulness. Here, we investigate the underlying brain mechanisms by which the state of mindfulness reduces pain. Mindfulness practitioners and controls received unpleasant electric stimuli in the functional magnetic resonance imaging scanner during a mindfulness and a control condition. Mindfulness practitioners, but not controls, were able to reduce pain unpleasantness by 22% and anticipatory anxiety by 29% during a mindful state. In the brain, this reduction was associated with decreased activation in the lateral prefrontal cortex and increased activation in the right posterior insula during stimulation and increased rostral anterior cingulate cortex activation during the anticipation of pain. These findings reveal a unique mechanism of pain modulation, comprising increased sensory processing and decreased cognitive control, and are in sharp contrast to established pain modulation mechanisms.
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Affiliation(s)
- Tim Gard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
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64
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Assessment of consciousness with electrophysiological and neurological imaging techniques. Curr Opin Crit Care 2011; 17:146-51. [PMID: 21206267 DOI: 10.1097/mcc.0b013e328343476d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Brain MRI (diffusion tensor imaging and spectroscopy) and functional neuroimaging (PET, functional MRI, EEG and evoked potential studies) are changing our understanding of patients with disorders of consciousness encountered after coma such as the 'vegetative' or minimally conscious states. RECENT FINDINGS Increasing evidence from functional neuroimaging and electrophysiology demonstrates some residual cognitive processing in a subgroup of patients who clinically fail to show any response to commands, leading to the recent proposal of 'unresponsive wakefulness syndrome' as an alternative name for patients previously coined 'vegetative' or 'apallic'. SUMMARY Consciousness can be viewed as the emergent property of the collective behavior of widespread thalamocortical frontoparietal network connectivity. Data from physiological, pharmacological and pathological alterations of consciousness provide evidence in favor of this hypothesis. Increasing our understanding of the neural correlates of consciousness is helping clinicians to do a better job in terms of diagnosis, prognosis and finally treatment and drug development for these severely brain-damaged patients. The current challenge remains to continue translating this research from the bench to the bedside. Only well controlled large multicentric neuroimaging and electrophysiology studies will enable to identify which paraclinical diagnostic or prognostic test is necessary for our routine evidence-based assessment of individuals with disorders of consciousness.
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Knudsen L, Petersen GL, Nørskov KN, Vase L, Finnerup N, Jensen TS, Svensson P. Review of neuroimaging studies related to pain modulation. Scand J Pain 2011; 2:108-120. [DOI: 10.1016/j.sjpain.2011.05.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/18/2011] [Indexed: 12/28/2022]
Abstract
Abstract
Background and purpose: A noxious stimulus does not necessarily cause pain. Nociceptive signals arising from a noxious stimulus are subject to modulation via endogenous inhibitory and facilitatory mechanisms as they travel from the periphery to the dorsal horn or brainstem and on to higher brain sites. Research on the neural structures underlying endogenous pain modulation has largely been restricted to animal research due to the invasiveness of such studies (e.g., spinal cord transection, brain lesioning, brain site stimulation). Neuroimaging techniques (e.g., magnetoencephalography (MEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI)) provide non-invasive means to study neural structures in humans. The aim is to provide a narrative review of neuroimaging studies related to human pain control mechanisms.
Methods: The approach taken is to summarise specific pain modulation mechanisms within the somatosensory (diffuse noxious inhibitory controls, acupuncture, movement), affective (depression, anxiety, catastrophizing, stress) and cognitive (anticipation/placebo, attention/distraction, hypnosis)domains with emphasis on the contribution of neuroimaging studies.
Results and conclusions: Findings from imaging studies are complex reflecting activation or deactivation in numerous brain areas. Despite this, neuroimaging techniques have clarified supraspinal sites involved in a number of pain control mechanisms. The periaqueductal grey (PAG) is one area that has consistently been shown to be activated across the majority of pain mechanisms. Activity in the rostral ventromedial medulla known to relay descending modulation from the PAG, has also been observed both during acupuncture analgesia and anxiety-induced hyperalgesia. Other brain areas that appear to be involved in a number of mechanisms are the anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex and nucleus accumbens, but their exact role is less clear.
Implications: Neuroimaging studies have provided essential information about the pain modulatory pathways under normal conditions, but much is still to be determined. Understanding the mechanisms of pain control is important for understanding the mechanisms that contribute to failed pain control in chronic pain. Applying fMRI outside the brain, such as in the trigeminal nucleus caudalis of the spinotrigeminal pathway and in the dorsal horn of the spinal cord, and coupling brain activity with activity at these sites may help improve our understanding of the function of brain sites and shed light on functional connectivity in the pain pathway.
© 2011 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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Affiliation(s)
- Lone Knudsen
- Danish Pain Research Center , Aarhus University Hospital Nørrebrogade 44, Building 1A , 8000 Aarhus C , Denmark
| | - Gitte Laue Petersen
- School of Psychology , Aarhus University, Jens Chr. Skous Vej 4 , 8000 Aarhus C , Denmark
| | | | - Lene Vase
- School of Psychology , Aarhus University, Jens Chr. Skous Vej 4 , 8000 Aarhus C , Denmark
| | - Nanna Finnerup
- Danish Pain Research Center , Aarhus University Hospital Nørrebrogade 44, Building 1A , 8000 Aarhus C , Denmark
- Center for Functionally Integrative Neuroscience, MindLab , Aarhus University Hospital, Nørrebrogade 44, Building 10G , 8000 Aarhus C , Denmark
| | - Troels Staehelin Jensen
- Danish Pain Research Center , Aarhus University Hospital Nørrebrogade 44, Building 1A , 8000 Aarhus C , Denmark
- Center for Functionally Integrative Neuroscience, MindLab , Aarhus University Hospital, Nørrebrogade 44, Building 10G , 8000 Aarhus C , Denmark
| | - Peter Svensson
- Center for Functionally Integrative Neuroscience, MindLab , Aarhus University Hospital, Nørrebrogade 44, Building 10G , 8000 Aarhus C , Denmark
- Department of Clinical Oral Physiology, School of Dentistry , Aarhus University, Vennelyst Boulevard 9 , 8000 Aarhus C , Denmark
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Demertzi A, Soddu A, Faymonville ME, Bahri MA, Gosseries O, Vanhaudenhuyse A, Phillips C, Maquet P, Noirhomme Q, Luxen A, Laureys S. Hypnotic modulation of resting state fMRI default mode and extrinsic network connectivity. PROGRESS IN BRAIN RESEARCH 2011; 193:309-22. [PMID: 21854971 DOI: 10.1016/b978-0-444-53839-0.00020-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to self-related processes) and an anticorrelated "extrinsic" system (encompassing lateral frontoparietal areas and modulated via external sensory stimulation). In order to better determine the functional contribution of these networks to conscious awareness, we here sought to transiently modulate their relationship by means of hypnosis. We used independent component analysis (ICA) on resting state fMRI acquisitions during normal wakefulness, under hypnotic state, and during a control condition of autobiographical mental imagery. As compared to mental imagery, hypnosis-induced modulation of resting state fMRI networks resulted in a reduced "extrinsic" lateral frontoparietal cortical connectivity, possibly reflecting a decreased sensory awareness. The default mode network showed an increased connectivity in bilateral angular and middle frontal gyri, whereas its posterior midline and parahippocampal structures decreased their connectivity during hypnosis, supposedly related to an altered "self" awareness and posthypnotic amnesia. In our view, fMRI resting state studies of physiological (e.g., sleep or hypnosis), pharmacological (e.g., sedation or anesthesia), and pathological modulation (e.g., coma or related states) of "intrinsic" default mode and anticorrelated "extrinsic" sensory networks, and their interaction with other cerebral networks, will further improve our understanding of the neural correlates of subjective awareness.
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Affiliation(s)
- A Demertzi
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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Effect of hypnotic pain modulation on brain activity in patients with temporomandibular disorder pain. Pain 2010; 151:825-833. [DOI: 10.1016/j.pain.2010.09.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 11/23/2022]
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Gray MA, Minati L, Paoletti G, Critchley HD. Baroreceptor activation attenuates attentional effects on pain-evoked potentials. Pain 2010; 151:853-861. [PMID: 20965656 PMCID: PMC3038268 DOI: 10.1016/j.pain.2010.09.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 08/16/2010] [Accepted: 09/22/2010] [Indexed: 01/03/2023]
Abstract
Focused attention typically enhances neural nociceptive responses, reflected electroencephalographically as increased amplitude of pain-evoked event-related potentials (ERPs). Additionally, pain-evoked ERPs are attenuated by hypertension and baroreceptor activity, through as yet unclear mechanisms. There is indirect evidence that these two effects may interact, suggesting that baroreceptor-related modulation of nociception is more than a low-level gating phenomenon. To address this hypothesis, we explored in a group of healthy participants the combined effects of cue-induced expectancy and baroreceptor activity on the amplitude of pain-evoked ERPs. Brief nociceptive skin stimuli were delivered during a simple visual task; half were preceded by a visual forewarning cue, and half were unpredictable. Nociceptive stimuli were timed to coincide either with systole (maximum activation of cardiac baroreceptors) or with diastole (minimum baroreceptor activation). We observed a strong interaction between expectancy and cardiac timing for the amplitude of the P2 ERP component; no effects were observed for the N2 component. Cued stimuli were associated with larger P2 amplitude, but this effect was abolished for stimuli presented during baroreceptor activation. No cardiac timing effect was observed for un-cued stimuli. Taken together, these findings suggest a close integration of cognitive-affective aspects of expectancy and baroreceptor influences on pain, and as such may cast further light on mechanisms underlying mental and physiological contributions to clinical pain.
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Affiliation(s)
- Marcus A. Gray
- Clinical Imaging Sciences Centre (CISC), Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, East Sussex, BN1 9RR, UK
- Experimental Neuropsychology Research Unit, School of Psychology and Psychiatry, Monash University 3800, Australia
| | - Ludovico Minati
- Clinical Imaging Sciences Centre (CISC), Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, East Sussex, BN1 9RR, UK
- Scientific Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | | | - Hugo D. Critchley
- Clinical Imaging Sciences Centre (CISC), Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, East Sussex, BN1 9RR, UK
- Sussex Partnership Foundation (NHS) Trust, Sussex, UK
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[Ambulatory Essure implant placement sterilization procedure for women: prospective study comparing general anesthesia versus hypnosis combined with sedation]. ACTA ACUST UNITED AC 2010; 29:889-96. [PMID: 21112724 DOI: 10.1016/j.annfar.2010.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 10/15/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE implant placement Essure, sterilization procedure for women, were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA). STUDY DESIGN prospective and comparative group study. PATIENTS AND METHODS two groups of twelve patients were matched and compared based on the choice of anesthetic technique: hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol, sevoflurane and remifentanil. The assessment of anxiety and pain based on a visual analogy scale (0-10) and use of analgesics were studied in the recovery room and at discharge of hospital. The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test). RESULTS all patients were operated. The two groups are statistically comparable. The preoperative anxiety before premedication is lower in the HYP group (p<0.05). No conversion to general anaesthesia is necessary in the HYP group, but five patients were using sedatives drugs but doses are very low compared to general anaesthesia. The analgesic consumption was equivalent in both groups. CONCLUSION we conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure implant. The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical, providing psychological benefits to the patient.
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Vanhaudenhuyse A, Demertzi A, Schabus M, Noirhomme Q, Bredart S, Boly M, Phillips C, Soddu A, Luxen A, Moonen G, Laureys S. Two distinct neuronal networks mediate the awareness of environment and of self. J Cogn Neurosci 2010; 23:570-8. [PMID: 20515407 DOI: 10.1162/jocn.2010.21488] [Citation(s) in RCA: 269] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evidence from functional neuroimaging studies on resting state suggests that there are two distinct anticorrelated cortical systems that mediate conscious awareness: an "extrinsic" system that encompasses lateral fronto-parietal areas and has been linked with processes of external input (external awareness), and an "intrinsic" system which encompasses mainly medial brain areas and has been associated with internal processes (internal awareness). The aim of our study was to explore the neural correlates of resting state by providing behavioral and neuroimaging data from healthy volunteers. With no a priori assumptions, we first determined behaviorally the relationship between external and internal awareness in 31 subjects. We found a significant anticorrelation between external and internal awareness with a mean switching frequency of 0.05 Hz (range: 0.01-0.1 Hz). Interestingly, this frequency is similar to BOLD fMRI slow oscillations. We then evaluated 22 healthy volunteers in an fMRI paradigm looking for brain areas where BOLD activity correlated with "internal" and "external" scores. Activation of precuneus/posterior cingulate, anterior cingulate/mesiofrontal cortices, and parahippocampal areas ("intrinsic system") was linearly linked to intensity of internal awareness, whereas activation of lateral fronto-parietal cortices ("extrinsic system") was linearly associated with intensity of external awareness.
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Lane RD, Wager TD. The new field of Brain-Body Medicine: what have we learned and where are we headed? Neuroimage 2009; 47:1135-40. [PMID: 19524045 DOI: 10.1016/j.neuroimage.2009.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Demertzi A, Schnakers C, Ledoux D, Chatelle C, Bruno MA, Vanhaudenhuyse A, Boly M, Moonen G, Laureys S. Different beliefs about pain perception in the vegetative and minimally conscious states: a European survey of medical and paramedical professionals. PROGRESS IN BRAIN RESEARCH 2009; 177:329-38. [PMID: 19818911 DOI: 10.1016/s0079-6123(09)17722-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Pain management in severely brain-damaged patients constitutes a clinical and ethical stake. At the bedside, assessing the presence of pain and suffering is challenging due to both patients' physical condition and inherent limitations of clinical assessment. Neuroimaging studies support the existence of distinct cerebral responses to noxious stimulation in brain death, vegetative state, and minimally conscious state. We here provide results from a European survey on 2059 medical and paramedical professionals' beliefs on possible pain perception in patients with disorders of consciousness. To the question "Do you think that patients in a vegetative state can feel pain?," 68% of the interviewed paramedical caregivers (n=538) and 56% of medical doctors (n=1166) answered "yes" (no data on exact profession in 17% of total sample). Logistic regression analysis showed that paramedical professionals, religious caregivers, and older caregivers reported more often that vegetative patients may experience pain. Following professional background, religion was the highest predictor of caregivers' opinion: 64% of religious (n=1009; 850 Christians) versus 52% of nonreligious respondents (n=830) answered positively (missing data on religion in 11% of total sample). To the question "Do you think that patients in a minimally conscious state can feel pain?" nearly all interviewed caregivers answered "yes" (96% of the medical doctors and 97% of the paramedical caregivers). Women and religious caregivers reported more often that minimally conscious patients may experience pain. These results are discussed in terms of existing definitions of pain and suffering, the remaining uncertainty on the clinical assessment of pain as a subjective first-person experience and recent functional neuroimaging findings on nociceptive processing in disorders of consciousness. In our view, more research is needed to increase our understanding of residual sensation in vegetative and minimally conscious patients and to propose evidence-based medical guidelines for the management of possible pain perception and suffering in these vulnerable patient populations.
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Affiliation(s)
- A Demertzi
- Coma Science Group, Cyclotron Research Center and Neurology Department, University of Liège, Liège, Belgium
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