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Yarns BC, Zhu TA, Najafian Jazi A. Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach. Am J Geriatr Psychiatry 2022; 30:1342-1350. [PMID: 35999127 DOI: 10.1016/j.jagp.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients' pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA.
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
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Zhou Z, Hui ES, Kranz GS, Chang JR, de Luca K, Pinto SM, Chan WW, Yau SY, Chau BK, Samartzis D, Jensen MP, Wong AYL. Potential mechanisms underlying the accelerated cognitive decline in people with chronic low back pain: A scoping review. Ageing Res Rev 2022; 82:101767. [PMID: 36280211 DOI: 10.1016/j.arr.2022.101767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/13/2022] [Accepted: 10/20/2022] [Indexed: 01/31/2023]
Abstract
A growing body of evidence has shown that people with chronic low back pain (CLBP) demonstrate significantly greater declines in multiple cognitive domains than people who do not have CLBP. Given the high prevalence of CLBP in the ever-growing aging population that may be more vulnerable to cognitive decline, it is important to understand the mechanisms underlying the accelerated cognitive decline observed in this population, so that proper preventive or treatment approaches can be developed and implemented. The current scoping review summarizes what is known regarding the potential mechanisms underlying suboptimal cognitive performance and cognitive decline in people with CLBP and discusses future research directions. Five potential mechanisms were identified based on the findings from 34 included studies: (1) altered activity in the cortex and neural networks; (2) grey matter atrophy; (3) microglial activation and neuroinflammation; (4) comorbidities associated with CLBP; and (5) gut microbiota dysbiosis. Future studies should deepen the understanding of mechanisms underlying this association so that proper prevention and treatment strategies can be developed.
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Affiliation(s)
- Zhixing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Edward S Hui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Jeremy R Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Katie de Luca
- School of Health, Medical and Applied Sciences, CQ University, Brisbane, Australia
| | - Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Winnie Wy Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Suk-Yu Yau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Bolton Kh Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Centre, Chicago, IL, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China.
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53
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Cao J, Liu X, Liu JX, Zhao S, Guo YX, Wang GY, Wang XL. Inhibition of glutamatergic neurons in layer II/III of the medial prefrontal cortex alleviates paclitaxel-induced neuropathic pain and anxiety. Eur J Pharmacol 2022; 936:175351. [DOI: 10.1016/j.ejphar.2022.175351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022]
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Preliminary study: quantification of chronic pain from physiological data. Pain Rep 2022; 7:e1039. [PMID: 36213596 PMCID: PMC9534370 DOI: 10.1097/pr9.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Preliminary evidence suggests that physiological variables collected with our low-cost pain meter are correlated with chronic pain, both for individuals and populations. Introduction: It is unknown if physiological changes associated with chronic pain could be measured with inexpensive physiological sensors. Recently, acute pain and laboratory-induced pain have been quantified with physiological sensors. Objectives: To investigate the extent to which chronic pain can be quantified with physiological sensors. Methods: Data were collected from chronic pain sufferers who subjectively rated their pain on a 0 to 10 visual analogue scale, using our recently developed pain meter. Physiological variables, including pulse, temperature, and motion signals, were measured at head, neck, wrist, and finger with multiple sensors. To quantify pain, features were first extracted from 10-second windows. Linear models with recursive feature elimination were fit for each subject. A random forest regression model was used for pain score prediction for the population-level model. Results: Predictive performance was assessed using leave-one-recording-out cross-validation and nonparametric permutation testing. For individual-level models, 5 of 12 subjects yielded intraclass correlation coefficients between actual and predicted pain scores of 0.46 to 0.75. For the population-level model, the random forest method yielded an intraclass correlation coefficient of 0.58. Bland–Altman analysis shows that our model tends to overestimate the lower end of the pain scores and underestimate the higher end. Conclusion: This is the first demonstration that physiological data can be correlated with chronic pain, both for individuals and populations. Further research and more extensive data will be required to assess whether this approach could be used as a “chronic pain meter” to assess the level of chronic pain in patients.
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Relief of chronic pain associated with increase in midline frontal theta power. Pain Rep 2022; 7:e1040. [PMID: 36247110 PMCID: PMC9555895 DOI: 10.1097/pr9.0000000000001040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Unique electroencephalogram signatures of relief from chronic pain demonstrate theta power increase in the midline frontal cortex. Introduction: Objectives: Methods: Results: Conclusion:
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Pricope CV, Tamba BI, Stanciu GD, Cuciureanu M, Neagu AN, Creanga-Murariu I, Dobrovat BI, Uritu CM, Filipiuc SI, Pricope BM, Alexa-Stratulat T. The Roles of Imaging Biomarkers in the Management of Chronic Neuropathic Pain. Int J Mol Sci 2022; 23:13038. [PMID: 36361821 PMCID: PMC9657736 DOI: 10.3390/ijms232113038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 08/04/2023] Open
Abstract
Chronic neuropathic pain (CNP) affects around 10% of the general population and has a significant social, emotional, and economic impact. Current diagnosis techniques rely mainly on patient-reported outcomes and symptoms, which leads to significant diagnostic heterogeneity and subsequent challenges in management and assessment of outcomes. As such, it is necessary to review the approach to a pathology that occurs so frequently, with such burdensome and complex implications. Recent research has shown that imaging methods can detect subtle neuroplastic changes in the central and peripheral nervous system, which can be correlated with neuropathic symptoms and may serve as potential markers. The aim of this paper is to review available imaging methods used for diagnosing and assessing therapeutic efficacy in CNP for both the preclinical and clinical setting. Of course, further research is required to standardize and improve detection accuracy, but available data indicate that imaging is a valuable tool that can impact the management of CNP.
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Affiliation(s)
- Cosmin Vasilica Pricope
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bogdan Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Gabriela Dumitrita Stanciu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Magdalena Cuciureanu
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Anca Narcisa Neagu
- Laboratory of Animal Histology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Carol I bvd. No. 22, 700505 Iasi, Romania
| | - Ioana Creanga-Murariu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bogdan-Ionut Dobrovat
- Department of Radiology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
| | - Cristina Mariana Uritu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Silviu Iulian Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bianca-Mariana Pricope
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Medical Oncology-Radiotherapy Department, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
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Bucolo M, Rance M, Nees F, Ruttorf M, Stella G, Monarca N, Andoh J, Flor H. Cortical networks underlying successful control of nociceptive processing using real-time fMRI. FRONTIERS IN PAIN RESEARCH 2022; 3:969867. [PMID: 36353700 PMCID: PMC9637825 DOI: 10.3389/fpain.2022.969867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Real-time fMRI (rt-fMRI) enables self-regulation of neural activity in localized brain regions through neurofeedback. Previous studies showed successful up- and down-regulation of neural activity in the anterior cingulate cortex (ACC) and the insula (Ins) during nociceptive stimulation. Such self-regulation capacity is, however, variable across subjects, possibly related to the ability of cognitive top-down control of pain. Moreover, how specific brain areas interact to enable successful regulation of nociceptive processing and neurofeedback-based brain modulation is not well understood. A connectivity analysis framework in the frequency domain was used to examine the up- or down-regulation in the ACC and Ins and pain intensity and unpleasantness ratings were assessed. We found that successful up- and down-regulation was mediated by the ACC and by its functional connectivity with the Ins and secondary somatosensory cortex. There was no significant relationship between successful up- or downregulation and pain ratings. These findings demonstrate functional interactions between brain areas involved in nociceptive processing during regulation of ACC and Ins activity, and the relevance of the frequency domain connectivity analysis for real-time fMRI. Moreover, despite successful neural regulation, there was no change in pain ratings, suggesting that pain is a complex perception, which may be more difficult to modify than other sensory or emotional processes.
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Affiliation(s)
- Maide Bucolo
- Department of Electrical Electronic and Computer Engineering, University of Catania, Catania, Italy
| | - Mariela Rance
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Sociology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Michaela Ruttorf
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Giovanna Stella
- Department of Electrical Electronic and Computer Engineering, University of Catania, Catania, Italy
- Correspondence: Giovanna Stella
| | - Nicolò Monarca
- Department of Electrical Electronic and Computer Engineering, University of Catania, Catania, Italy
| | - Jamila Andoh
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Department of Electrical Electronic and Computer Engineering, University of Catania, Catania, Italy
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Cunningham NR, Nahman-Averbuch H, Lee GR, King CD, Coghill RC. Amygdalar functional connectivity during resting and evoked pain in youth with functional abdominal pain disorders. Pain 2022; 163:2031-2043. [PMID: 35472070 PMCID: PMC9329503 DOI: 10.1097/j.pain.0000000000002601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]
Abstract
ABSTRACT Pediatric functional abdominal pain disorders (FAPD) are highly prevalent, difficult to diagnose, and challenging to treat. The brain systems supporting FAPD remain poorly understood. This investigation examined the neuromechanisms of FAPD during a well-tolerated visceral pain induction task, the water load symptom provocation task (WL-SPT). Youth between the ages of 11 and 17 years participated. Functional connectivity (FC) was examined through the blood oxygenation level-dependent effect using the left and right amygdala (AMY) as seed regions. Relationships of the time courses within these seeds with voxels across the whole brain were evaluated. Arterial spin labeling was used to assess regional brain activation by examining cerebral blood flow. Increased FC between the left AMY with regions associated with nociceptive processing (eg, thalamus) and right AMY FC changes with areas associated with cognitive functioning (dorsolateral prefrontal cortex) and the default mode network (DMN; parietal lobe) were observed in youth with FAPD after the WL-SPT. These changes were related to changes in pain unpleasantness. Amygdala FC changes post-WL-SPT were also related to changes in pain intensity. Amygdala FC with the DMN in youth with FAPD also differed from healthy controls. Global cerebral blood flow changes were also noted between FAPD and healthy controls, but no significant differences in grey matter were detected either between groups or during the WL-SPT in youth with FAPD. Findings confirm youth with FAPD undergo changes in brain systems that could support the development of biomarkers to enhance understanding of the mechanisms of pain and treatment response.
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Affiliation(s)
- Natoshia R Cunningham
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Hadas Nahman-Averbuch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Anesthesiology, Washington University Pain Center and Division of Clinical and Translational Research, Washington University in St Louis School of Medicine, St Louis, MO, United States
| | - Gregory R Lee
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Radiology, University of Cincinnati, Cincinnati, OH, United States
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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59
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Mackey S, Gilam G, Darnall B, Goldin P, Kong JT, Law C, Heirich M, Karayannis N, Kao MC, Tian L, Manber R, Gross J. Mindfulness-Based Stress Reduction, Cognitive Behavioral Therapy, and Acupuncture in Chronic Low Back Pain: Protocol for Two Linked Randomized Controlled Trials. JMIR Res Protoc 2022; 11:e37823. [PMID: 36166279 PMCID: PMC9555327 DOI: 10.2196/37823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nonpharmacologic mind-body therapies have demonstrated efficacy in low back pain. However, the mechanisms underlying these therapies remain to be fully elucidated. OBJECTIVE In response to these knowledge gaps, the Stanford Center for Low Back Pain-a collaborative, National Institutes of Health P01-funded, multidisciplinary research center-was established to investigate the common and distinct biobehavioral mechanisms of three mind-body therapies for chronic low back pain: cognitive behavioral therapy (CBT) that is used to treat pain, mindfulness-based stress reduction (MBSR), and electroacupuncture. Here, we describe the design and implementation of the center structure and the associated randomized controlled trials for characterizing the mechanisms of chronic low back pain treatments. METHODS The multidisciplinary center is running two randomized controlled trials that share common resources for recruitment, enrollment, study execution, and data acquisition. We expect to recruit over 300 chronic low back pain participants across two projects and across different treatment arms within each project. The first project will examine pain-CBT compared with MBSR and a wait-list control group. The second project will examine real versus sham electroacupuncture. We will use behavioral, psychophysical, physical measure, and neuroimaging techniques to characterize the central pain modulatory and emotion regulatory systems in chronic low back pain at baseline and longitudinally. We will characterize how these interventions impact these systems, characterize the longitudinal treatment effects, and identify predictors of treatment efficacy. RESULTS Participant recruitment began on March 17, 2015, and will end in March 2023. Recruitment was halted in March 2020 due to COVID-19 and resumed in December 2021. CONCLUSIONS This center uses a comprehensive approach to study chronic low back pain. Findings are expected to significantly advance our understanding in (1) the baseline and longitudinal mechanisms of chronic low back pain, (2) the common and distinctive mechanisms of three mind-body therapies, and (3) predictors of treatment response, thereby informing future delivery of nonpharmacologic chronic low back pain treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT02503475; https://clinicaltrials.gov/ct2/show/NCT02503475. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37823.
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Affiliation(s)
- Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Gadi Gilam
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Beth Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Jiang-Ti Kong
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Christine Law
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Marissa Heirich
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Nicholas Karayannis
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Ming-Chih Kao
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - James Gross
- Department of Psychology, Stanford University, Palo Alto, CA, United States
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60
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Fusaro M, Bufacchi RJ, Nicolardi V, Provenzano L. The analgesic power of pleasant touch in individuals with chronic pain: Recent findings and new insights. Front Integr Neurosci 2022; 16:956510. [PMID: 36176327 PMCID: PMC9513358 DOI: 10.3389/fnint.2022.956510] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
This mini-review covers recent works on the study of pleasant touch in patients with chronic pain (CP) and its potential use as a treatment. While experiments have demonstrated that pleasant touch, through the activation of CT-afferents and the brain regions involved in its affective value, might reduce the unpleasantness and intensity of induced pain, the interaction between pleasant touch and CP remains under-examined. Some experiments show that CP might disrupt the positive aspects of receiving pleasant touch, while in other studies the perception of pleasantness is preserved. Moreover, only a few attempts have been made to test whether touch can have a modulatory effect on CP, but these results also remain inconclusive. Indeed, while one recent study demonstrated that CT-touch can diminish CP after a short stimulation, another study suggested that pleasant touch might not be sufficient. Future studies should further investigate the psychological and neural interplay between pleasant touch and CP. In the conclusion of this mini-review, we propose a new tool we have recently developed using immersive virtual reality (IVR).
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61
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Krimmel SR, Keaser ML, Speis D, Haythornthwaite JA, Seminowicz DA. Migraine disability, pain catastrophizing, and headache severity are associated with evoked pain and targeted by mind-body therapy. Pain 2022; 163:e1030-e1037. [PMID: 35297801 PMCID: PMC9288557 DOI: 10.1097/j.pain.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Meta-analysis suggests that migraine patients are no more sensitive to experimentally evoked pain than healthy control subjects. At the same time, studies have linked some migraine symptoms to quantitative sensory testing (QST) profiles. Unfortunately, previous studies associating migraine symptoms and QST have important methodological shortcomings, stemming from small sample sizes, and frequent use of univariate statistics for multivariate research questions. In the current study, we seek to address these limitations by using a large sample of episodic migraine patients (n = 103) and a multivariate analysis that associates pain ratings from many thermal intensities simultaneously with 12 clinical measures ranging from headache frequency to sleep abnormalities. We identified a single dimension of association between thermal QST and migraine symptoms that relates to pain ratings for all stimulus intensities and a subset of migraine symptoms relating to disability (Headache Impact Test 6 and Brief Pain Inventory interference), catastrophizing (Pain Catastrophizing Scale), and pain severity (average headache pain, Brief Pain Inventory severity, and Short-Form McGill Pain Questionnaire 2). Headache frequency, allodynia, affect, and sleep disturbances were unrelated to this dimension. Consistent with previous research, we did not observe any difference in QST ratings between migraine patients and healthy control subjects. Additionally, we found that the linear combination of symptoms related to QST was modified by the mind-body therapy enhanced mindfulness-based stress reduction (MBSR+). These results suggest that QST has a selective relationship with pain symptoms even in the absence of between-subjects differences between chronic pain patients and healthy control subjects.
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Affiliation(s)
- Samuel R. Krimmel
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland School of
Medicine, Baltimore, MD, 21201 USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Darrah Speis
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
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62
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Brain-specific genes contribute to chronic but not to acute back pain. Pain Rep 2022; 7:e1018. [PMID: 35975136 PMCID: PMC9371560 DOI: 10.1097/pr9.0000000000001018] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Back pain is the leading cause of disability worldwide. Although most back pain cases are acute, 20% of acute pain patients experience chronic back pain symptoms. It is unclear whether acute pain and chronic pain have similar or distinct underlying genetic mechanisms. Objectives To characterize the molecular and cellular pathways contributing to acute and chronic pain states. Methods Cross-sectional observational genome-wide association study. Results A total of 375,158 individuals from the UK Biobank cohort were included in the discovery of genome-wide association study. Of those, 70,633 (19%) and 32,209 (9%) individuals met the definition of chronic and acute back pain, respectively. A total of 355 single nucleotide polymorphism grouped into 13 loci reached the genome-wide significance threshold (5x10-8) for chronic back pain, but none for acute. Of these, 7 loci were replicated in the Nord-Trøndelag Health Study (HUNT) cohort (19,760 chronic low back pain cases and 28,674 pain-free controls). Single nucleotide polymorphism heritability was 4.6% (P=1.4x10-78) for chronic back pain and 0.81% (P=1.4x10-8) for acute back pain. Similar differences in heritability estimates between acute and chronic back pain were found in the HUNT cohort: 3.4% (P=0.0011) and 0.6% (P=0.851), respectively. Pathway analyses, tissue-specific heritability enrichment analyses, and epigenetic characterization suggest a substantial genetic contribution to chronic but not acute back pain from the loci predominantly expressed in the central nervous system. Conclusion Chronic back pain is substantially more heritable than acute back pain. This heritability is mostly attributed to genes expressed in the brain.
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Medrano-Escalada Y, Plaza-Manzano G, Fernández-de-las-Peñas C, Valera-Calero JA. Structural, Functional and Neurochemical Cortical Brain Changes Associated with Chronic Low Back Pain. Tomography 2022; 8:2153-2163. [PMID: 36136876 PMCID: PMC9498382 DOI: 10.3390/tomography8050180] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/19/2022] Open
Abstract
Chronic low back pain (CLBP) is one of the most prevalent musculoskeletal disorders, being one of the leading contributors to disability worldwide and involving an important economic and social burden. Up to 90% of CLBP is non-specific (not associated with specific injuries), with a chronicity expectation estimated at 10%. Currently, motivational and emotional central circuits are being investigated due to their role in CLBP persistency and chronification. Therefore, this narrative review aimed to summarize the evidence regarding the cortical brain changes described for proposing novel multidisciplinary approaches. Novel advances in neuroimaging techniques demonstrated structural (e.g., decrease in the grey matter located at the dorsolateral prefrontal cortex), functional (e.g., connectivity impairments in those areas involved in pain processing), and neurochemical changes (e.g., decrease in cerebral metabolites). In addition, significant changes were found in the primary somatosensory and motor cortex, contributing to the alteration of low back muscles activation and function.
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Affiliation(s)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-913-941-545
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
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Masoumbeigi M, Alam NR, Kordi R, Rostami M, Afzali M, Yadollahi M, Rahimiforoushani A, Jafari AH, Hashemi H, Kavousi M. rTMS Pain Reduction Effectiveness in Non-specific Chronic Low Back Pain Patients using rs-fMRI Functional Connectivity. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bassez I, Van de Steen F, Hackl S, Jahn P, Mayr A, Marinazzo D, Schulz E. Investigation on how dynamic effective connectivity patterns encode the fluctuating pain intensity in chronic migraine. NEUROBIOLOGY OF PAIN 2022; 12:100100. [PMID: 36051490 PMCID: PMC9424568 DOI: 10.1016/j.ynpai.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022]
Abstract
Chronic migraine is characterised by persistent headaches for >15 days per month; the intensity of the pain is fluctuating over time. Here, we explored the dynamic interplay of connectivity patterns between regions known to be related to pain processing and their relation to the ongoing dynamic pain experience. We recorded EEG from 80 sessions (20 chronic migraine patients in 4 separate sessions of 25 min). The patients were asked to continuously rate the intensity of their endogenous headache. On different time-windows, a dynamic causal model (DCM) of cross spectral responses was inverted to estimate connectivity strengths. For each patient and session, the evolving dynamics of effective connectivity were related to pain intensities and to pain intensity changes by using a Bayesian linear model. Hierarchical Bayesian modelling was further used to examine which connectivity-pain relations are consistent across sessions and across patients. The results reflect the multi-facetted clinical picture of the disease. Across all sessions, each patient with chronic migraine exhibited a distinct pattern of pain intensity-related cortical connectivity. The diversity of the individual findings are accompanied by inconsistent relations between the connectivity parameters and pain intensity or pain intensity changes at group level. This suggests a rejection of the idea of a common neuronal core problem for chronic migraine.
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Baran TM, Lin FV, Geha P. Functional brain mapping in patients with chronic back pain shows age-related differences. Pain 2022; 163:e917-e926. [PMID: 34799532 DOI: 10.1097/j.pain.0000000000002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Low back pain is the most common pain condition and cause for disability in older adults. Older adults suffering from low back pain are more disabled than their healthy peers, are more predisposed to frailty, and tend to be undertreated. The cause of increased prevalence and severity of this chronic pain condition in older adults is unknown. Here, we draw on accumulating data demonstrating a critical role for brain limbic and sensory circuitries in the emergence and experience of chronic low back pain (CLBP) and the availability of resting-state brain activity data collected at different sites to study how brain activity patterns predictive of CLBP differ between age groups. We apply a data-driven multivariate searchlight analysis to amplitude of low-frequency fluctuation brain maps to classify patients with CLBP with >70% accuracy. We observe that the brain activity pattern including the paracingulate gyrus, insula/secondary somatosensory area, inferior frontal, temporal, and fusiform gyrus predicted CLBP. When separated by age groups, brain patterns predictive of older patients with CLBP showed extensive involvement of limbic brain areas including the ventromedial prefrontal cortex, the nucleus accumbens, and hippocampus, whereas only anterior insula paracingulate and fusiform gyrus predicted CLBP in the younger patients. In addition, we validated the relationships between back pain intensity ratings and CLBP brain activity patterns in an independent data set not included in our initial patterns' identification. Our results are the first to directly address how aging affects the neural signature of CLBP and point to an increased role of limbic brain areas in older patients with CLBP.
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Affiliation(s)
- Timothy M Baran
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Feng V Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
| | - Paul Geha
- Department of Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
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Schlitt F, Schmidt K, Merz CJ, Wolf OT, Kleine-Borgmann J, Elsenbruch S, Wiech K, Forkmann K, Bingel U. Impaired pain-related threat and safety learning in patients with chronic back pain. Pain 2022; 163:1560-1570. [PMID: 35135995 PMCID: PMC9341232 DOI: 10.1097/j.pain.0000000000002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
ABSTRACT Pain-related learning mechanisms likely play a key role in the development and maintenance of chronic pain. Previous smaller-scale studies have suggested impaired pain-related learning in patients with chronic pain, but results are mixed, and chronic back pain (CBP) particularly has been poorly studied. In a differential conditioning paradigm with painful heat as unconditioned stimuli, we examined pain-related acquisition and extinction learning in 62 patients with CBP and 61 pain-free healthy male and female volunteers using valence and contingency ratings and skin conductance responses. Valence ratings indicate significantly reduced threat and safety learning in patients with CBP, whereas no significant differences were observed in contingency awareness and physiological responding. Moreover, threat learning in this group was more impaired the longer patients had been in pain. State anxiety was linked to increased safety learning in healthy volunteers but enhanced threat learning in the patient group. Our findings corroborate previous evidence of altered pain-related threat and safety learning in patients with chronic pain. Longitudinal studies exploring pain-related learning in (sub)acute and chronic pain are needed to further unravel the role of aberrant pain-related learning in the development and maintenance of chronic pain.
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Affiliation(s)
- Frederik Schlitt
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Christian J. Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T. Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Katja Wiech
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Katarina Forkmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
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Park SH, Baker AK, Krishna V, Mackey SC, Martucci KT. Altered resting-state functional connectivity within corticostriatal and subcortical-striatal circuits in chronic pain. Sci Rep 2022; 12:12683. [PMID: 35879602 PMCID: PMC9314446 DOI: 10.1038/s41598-022-16835-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
Brain corticostriatal circuits are important for understanding chronic pain and highly relevant to motivation and cognitive processes. It has been demonstrated that in patients with chronic back pain, altered nucleus accumbens (NAcc)-medial prefrontal cortex (MPFC) circuit fMRI-based activity is predictive of patient outcome. We evaluated the NAcc-MPFC circuit in patients with another chronic pain condition, fibromyalgia, to extend these important findings. First, we compared fMRI-based NAcc-MPFC resting-state functional connectivity in patients with fibromyalgia (N = 32) vs. healthy controls (N = 37). Compared to controls, the NAcc-MPFC circuit's connectivity was significantly reduced in fibromyalgia. In addition, within the fibromyalgia group, NAcc-MPFC connectivity was significantly correlated with trait anxiety. Our expanded connectivity analysis of the NAcc to subcortical brain regions showed reduced connectivity of the right NAcc with mesolimbic circuit regions (putamen, thalamus, and ventral pallidum) in fibromyalgia. Lastly, in an exploratory analysis comparing our fibromyalgia and healthy control cohorts to a separate publicly available dataset from patients with chronic back pain, we identified reduced NAcc-MPFC connectivity across both the patient groups with unique alterations in NAcc-mesolimbic connectivity. Together, expanding upon prior observed alterations in brain corticostriatal circuits, our results provide novel evidence of altered corticostriatal and mesolimbic circuits in chronic pain.
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Affiliation(s)
- Su Hyoun Park
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Anne K Baker
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Vinit Krishna
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Katherine T Martucci
- Department of Anesthesiology, Duke University Medical Center, Durham, USA.
- Duke Center for Translational Pain Medicine, Durham, USA.
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA.
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Ninneman JV, Gretzon NP, Stegner AJ, Lindheimer JB, Falvo MJ, Wylie GR, Dougherty RJ, Almassi NE, Van Riper SM, Boruch AE, Dean DC, Koltyn KF, Cook DB. Pain, But Not Physical Activity, Is Associated with Gray Matter Volume Differences in Gulf War Veterans with Chronic Pain. J Neurosci 2022; 42:5605-5616. [PMID: 35697521 PMCID: PMC9295831 DOI: 10.1523/jneurosci.2394-21.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 01/16/2023] Open
Abstract
Chronic musculoskeletal pain (CMP) is a significant burden for Persian Gulf War Veterans (GWVs), yet the causes are poorly understood. Brain structure abnormalities are observed in GWVs, however relationships with modifiable lifestyle factors such as physical activity (PA) are unknown. We evaluated gray matter volumes and associations with symptoms, PA, and sedentary time in GWVs with and without CMP. Ninety-eight GWVs (10 females) with CMP and 56 GWVs (7 females) controls completed T1-weighted magnetic resonance imaging, pain and fatigue symptom questionnaires, and PA measurement via actigraphy. Regional gray matter volumes were analyzed using voxel-based morphometry and were compared across groups using analysis of covariance (ANCOVA). Separate multiple linear regression models were used to test associations between PA intensities, sedentary time, symptoms, and gray matter volumes. Familywise cluster error rates were used to control for multiple comparisons (α = 0.05). GWVs with CMP reported greater pain and fatigue symptoms, worse mood, and engaged in less moderate-to-vigorous PA and more sedentary time than healthy GWVs (all p values < 0.05). GWVs with CMP had smaller gray matter volumes in the bilateral insula and larger volumes in the frontal pole (p < 0.05adjusted). Gray matter volumes in the left insula were associated with pain symptoms (r partial = 0.26, -0.29; p < 0.05adjusted). No significant associations were observed for either PA or sedentary time (p > 0.05adjusted). GWVs with CMP had smaller gray matter volumes within a critical brain region of the descending pain processing network and larger volumes within brain regions associated with pain sensation and affective processing, which may reflect pain chronification.SIGNIFICANCE STATEMENT The pathophysiology of chronic pain in Gulf War veterans is understudied and not well understood. In a large sample of Gulf War veterans, we report veterans with chronic musculoskeletal pain have smaller gray matter volumes in brain regions associated with pain regulation and larger volumes in regions associated with pain sensitivity compared with otherwise healthy Gulf War veterans. Gray matter volumes in regions of pain regulation were significantly associated with pain symptoms and encompassed the observed group brain volume differences. These results are suggestive of deficient pain modulation that may contribute to pain chronification.
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Affiliation(s)
- Jacob V Ninneman
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Nicholas P Gretzon
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Michael J Falvo
- War Related Illness and Injury Study Center, U.S. Department of Veterans Affairs, Veterans Affairs New Jersey Health Care System, East Orange, New Jersey 07018
- New Jersey Medical School, Rutgers University, Newark, New Jersey 08854
| | - Glenn R Wylie
- War Related Illness and Injury Study Center, U.S. Department of Veterans Affairs, Veterans Affairs New Jersey Health Care System, East Orange, New Jersey 07018
- Kessler Foundation, West Orange, New Jersey 07052
- New Jersey Medical School, Rutgers University, Newark, New Jersey 08854
| | - Ryan J Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287
| | - Neda E Almassi
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Stephanie M Van Riper
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94301
| | - Alexander E Boruch
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Douglas C Dean
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, 53706
| | - Kelli F Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin 53706
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Hazra S, Handa G, Nayak P, Sahu S, Sarkar K, Venkataraman S. A Dysfunctional Descending Pain Modulation System in Chronic Nonspecific Low Back Pain: A Systematic Review and ALE Meta-Analysis. Neurol India 2022; 70:1344-1360. [PMID: 36076626 DOI: 10.4103/0028-3886.355137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Pain, a physiological protective mechanism, turns into a complex dynamic neural response when it becomes chronic. The role of neuroplastic brain changes is more evident than the peripheral factors in the maintenance, modulation and amplification of chronic low back pain (cLBP). In this background, we summarise the brain changes in cLBP in a coordinate-based activation likelihood estimation (ALE) meta-analysis of previous functional magnetic resonance imaging (fMRI) studies. Databases ('PubMed', 'Scopus' and 'Sleuth') were searched till May 2022 and the activity pattern was noted under the 'without stimulation' and 'with stimulation' groups. A total of 312 studies were selected after removing duplicates. Seventeen (553 cLBP patients, 192 activation foci) studies were fulfilled the eligibility criteria and included in the 'without stimulation' group. Twelve statistically significant clusters are localized in the prefrontal cortex, primary somatosensory cortex, primary motor cortex, parietal cortex, anterior cingulate cortex, caudate, putamen, globus pallidus amygdala, occipital lobe, temporal lobe and associated white matter in this group. Ten studies (353 cLBP patients, 125 activation foci) were selected in the' with stimulation' groups. In this group, seven statistically significant clusters were found in the frontal cortex, orbitofrontal cortex, premotor cortex, parietal cortex, claustrum and insula. These statistically significant clusters indicate a probable imbalance in GABAergic modulation of brain circuits and dysfunction in the descending pain modulation system. This disparity in the pain neuro-matrix is the source of spontaneous and persisting pain in cLBP.
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Affiliation(s)
- Sandipan Hazra
- Department of Physical Medicine and Rehabilitation, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Gita Handa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Prasunpriya Nayak
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samantak Sahu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kaushik Sarkar
- Department of Electronics and Communication Engineering, Narula Institute of Technology, Kolkata, West Bengal, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
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Ni X, Zhang J, Sun M, Wang L, Xu T, Zeng Q, Wang X, Wang Z, Liao H, Hu Y, Gao Q, Zhao L. Abnormal Dynamics of Functional Connectivity Density Associated With Chronic Neck Pain. Front Mol Neurosci 2022; 15:880228. [PMID: 35845606 PMCID: PMC9277509 DOI: 10.3389/fnmol.2022.880228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic neck pain (CNP) is highly prevalent and complicated, associated with limited movement, and accompanied by shoulder pain and other clinical manifestations such as dizziness, anxiety, and insomnia. Brain structural and functional abnormalities often occur in patients with CNP. However, knowledge of the brain’s functional organization and temporal dynamics in CNP patients is limited. Dynamic functional connectivity density (dFCD) can reflect the ability of brain areas or voxels to integrate information, and could become neuroimaging markers for objectively reflecting pain to a certain extent. Therefore, this study compared the dFCD between CNP patients and healthy controls (HCs) and investigated potential associations of the abnormal density variability in dynamic functional connectivity with pain characteristics in CNP patients. Methods: Resting functional magnetic resonance imaging was performed for 89 CNP patients and 57 HCs. After preprocessing resting-state fMRI images by the Data Processing and Analysis of Brain Imaging toolbox, the sliding window method was applied to investigate dFCD changes in CNP patients and HCs using the DynamicBC toolbox. Then we quantified dFCD variability using their standard deviation. Based on the pain-associated factors collected from the case report form of CNP patients, the mean dFCD variability values of each dFCD from region of interest were extracted to calculate Pearson’s correlation coefficient to study the potential correlation between dFCD abnormal variability and pain. Results: Compared with HCs, the dFCD values of the anterior cingulate cortex, occipital lobe, temporal lobe, and cerebellum were statistically different in patients with CNP. Subsequent correlation analysis showed that the variable dFCD in the related brain region was correlative with the course of the disease and clinical symptoms, such as pain and depression, in patients with CNP. Conclusion: Dynamic functional alterations were observed in the brain regions of CNP patients, and the dFCD of these brain regions could become neuroimaging markers for objectively reflecting pain to a certain extent. This suggests that chronic pain may cause changes in pain processing and emotional feedback and highlights the link between dynamic neural communication in brain regions and disease conditions, deepening our understanding of chronic pain diseases, and guiding clinical practice.
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Affiliation(s)
- Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiabao Zhang
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linjia Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Xu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zeng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziwen Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaqiang Liao
- Department of Imaging, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yimei Hu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Ling Zhao ; Qing Gao ; Yimei Hu
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Ling Zhao ; Qing Gao ; Yimei Hu
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Ling Zhao ; Qing Gao ; Yimei Hu
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Li Z, Zhao L, Ji J, Ma B, Zhao Z, Wu M, Zheng W, Zhang Z. Temporal Grading Index of Functional Network Topology Predicts Pain Perception of Patients With Chronic Back Pain. Front Neurol 2022; 13:899254. [PMID: 35756935 PMCID: PMC9226296 DOI: 10.3389/fneur.2022.899254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic back pain (CBP) is a maladaptive health problem affecting the brain function and behavior of the patient. Accumulating evidence has shown that CBP may alter the organization of functional brain networks; however, whether the severity of CBP is associated with changes in dynamics of functional network topology remains unclear. Here, we generated dynamic functional networks based on resting-state functional magnetic resonance imaging (rs-fMRI) of 34 patients with CBP and 34 age-matched healthy controls (HC) in the OpenPain database via a sliding window approach, and extracted nodal degree, clustering coefficient (CC), and participation coefficient (PC) of all windows as features to characterize changes of network topology at temporal scale. A novel feature, named temporal grading index (TGI), was proposed to quantify the temporal deviation of each network property of a patient with CBP to the normal oscillation of the HCs. The TGI of the three features achieved outstanding performance in predicting pain intensity on three commonly used regression models (i.e., SVR, Lasso, and elastic net) through a 5-fold cross-validation strategy, with the minimum mean square error of 0.25 ± 0.05; and the TGI was not related to depression symptoms of the patients. Furthermore, compared to the HCs, brain regions that contributed most to prediction showed significantly higher CC and lower PC across time windows in the CBP cohort. These results highlighted spatiotemporal changes in functional network topology in patients with CBP, which might serve as a valuable biomarker for assessing the sensation of pain in the brain and may facilitate the development of CBP management/therapy approaches.
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Affiliation(s)
- Zhonghua Li
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Leilei Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Jing Ji
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Ben Ma
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Miao Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Weihao Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Zhe Zhang
- Institute of Brain Science, Hangzhou Normal University, Hangzhou, China.,School of Physics, Hangzhou Normal University, Hangzhou, China
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73
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Chae Y, Park HJ, Lee IS. Pain modalities in the body and brain: Current knowledge and future perspectives. Neurosci Biobehav Rev 2022; 139:104744. [PMID: 35716877 DOI: 10.1016/j.neubiorev.2022.104744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/29/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022]
Abstract
Development and validation of pain biomarkers has become a major issue in pain research. Recent advances in multimodal data acquisition have allowed researchers to gather multivariate and multilevel whole-body measurements in patients with pain conditions, and data analysis techniques such as machine learning have led to novel findings in neural biomarkers for pain. Most studies have focused on the development of a biomarker to predict the severity of pain with high precision and high specificity, however, a similar approach to discriminate different modalities of pain is lacking. Identification of more accurate and specific pain biomarkers will require an in-depth understanding of the modality specificity of pain. In this review, we summarize early and recent findings on the modality specificity of pain in the brain, with a focus on distinct neural activity patterns between chronic clinical and acute experimental pain, direct, social, and vicarious pain, and somatic and visceral pain. We also suggest future directions to improve our current strategy of pain management using our knowledge of modality-specific aspects of pain.
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Affiliation(s)
- Younbyoung Chae
- College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea; Acupuncture & Meridian Science Research Center, Kyung Hee University, Seoul, the Republic of Korea
| | - Hi-Joon Park
- College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea; Acupuncture & Meridian Science Research Center, Kyung Hee University, Seoul, the Republic of Korea
| | - In-Seon Lee
- College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea; Acupuncture & Meridian Science Research Center, Kyung Hee University, Seoul, the Republic of Korea.
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74
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Future Treatment of Neuropathic Pain in Spinal Cord Injury: The Challenges of Nanomedicine, Supplements or Opportunities? Biomedicines 2022; 10:biomedicines10061373. [PMID: 35740395 PMCID: PMC9219608 DOI: 10.3390/biomedicines10061373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/28/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
Neuropathic pain (NP) is a common chronic condition that severely affects patients with spinal cord injuries (SCI). It impairs the overall quality of life and is considered difficult to treat. Currently, clinical management of NP is often limited to drug therapy, primarily with opioid analgesics that have limited therapeutic efficacy. The persistence and intractability of NP following SCI and the potential health risks associated with opioids necessitate improved treatment approaches. Nanomedicine has gained increasing attention in recent years for its potential to improve therapeutic efficacy while minimizing toxicity by providing sensitive and targeted treatments that overcome the limitations of conventional pain medications. The current perspective begins with a brief discussion of the pathophysiological mechanisms underlying NP and the current pain treatment for SCI. We discuss the most frequently used nanomaterials in pain diagnosis and treatment as well as recent and ongoing efforts to effectively treat pain by proactively mediating pain signals following SCI. Although nanomedicine is a rapidly growing field, its application to NP in SCI is still limited. Therefore, additional work is required to improve the current treatment of NP following SCI.
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75
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Presto P, Neugebauer V. Sex Differences in CGRP Regulation and Function in the Amygdala in a Rat Model of Neuropathic Pain. Front Mol Neurosci 2022; 15:928587. [PMID: 35726298 PMCID: PMC9206543 DOI: 10.3389/fnmol.2022.928587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
The amygdala has emerged as a key player in the emotional response to pain and pain modulation. The lateral and capsular regions of the central nucleus of the amygdala (CeA) represent the “nociceptive amygdala” due to their high content of neurons that process pain-related information. These CeA divisions are the targets of the spino-parabrachio-amygdaloid pain pathway, which is the predominant source of calcitonin gene-related peptide (CGRP) within the amygdala. Changes in lateral and capsular CeA neurons have previously been observed in pain models, and synaptic plasticity in these areas has been linked to pain-related behavior. CGRP has been demonstrated to play an important role in peripheral and spinal mechanisms, and in pain-related amygdala plasticity in male rats in an acute arthritis pain model. However, the role of CGRP in chronic neuropathic pain-related amygdala function and behaviors remains to be determined for both male and female rats. Here we tested the hypothesis that the CGRP1 receptor is involved in neuropathic pain-related amygdala activity, and that blockade of this receptor can inhibit neuropathic pain behaviors in both sexes. CGRP mRNA expression levels in the CeA of male rats were upregulated at the acute stage of the spinal nerve ligation (SNL) model of neuropathic pain, whereas female rats had significantly higher CGRP and CGRP receptor component expression at the chronic stage. A CGRP1 receptor antagonist (CGRP 8-37) administered into the CeA in chronic neuropathic rats reduced mechanical hypersensitivity (von Frey and paw compression tests) in both sexes but showed female-predominant effects on emotional-affective responses (ultrasonic vocalizations) and anxiety-like behaviors (open field test). CGRP 8-37 inhibited the activity of CeA output neurons assessed with calcium imaging in brain slices from chronic neuropathic pain rats. Together, these findings may suggest that CGRP1 receptors in the CeA are involved in neuropathic pain-related amygdala activity and contribute to sensory aspects in both sexes but to emotional-affective pain responses predominantly in females. The sexually dimorphic function of CGRP in the amygdala would make CGRP1 receptors a potential therapeutic target for neuropathic pain relief, particularly in females in chronic pain conditions.
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Affiliation(s)
- Peyton Presto
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Volker Neugebauer
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- *Correspondence: Volker Neugebauer
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76
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Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. FRONTIERS IN PAIN RESEARCH 2022; 3:896276. [PMID: 35721658 PMCID: PMC9201034 DOI: 10.3389/fpain.2022.896276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.
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Affiliation(s)
- Sara E. Berger
- Responsible and Inclusive Technologies Research, Exploratory Sciences Division, IBM Thomas J. Watson Research Center, Yorktown Heights, NY, United States
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77
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Zhou X, Zhu Y, Wang Z, Lin Z, Zhu D, Xie C, Calcutt NA, Guan Y. Rate-Dependent Depression: A Predictor of the Therapeutic Efficacy in Treating Painful Diabetic Peripheral Neuropathy. Diabetes 2022; 71:1272-1281. [PMID: 35234842 DOI: 10.2337/db21-0960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
We investigated the application of rate-dependent depression (RDD) of the Hoffmann (H) wave as a predictor of treatment efficacy in patients with painful diabetic peripheral neuropathy (DPN). General medical information, scales, and nerve conduction data were collected from 73 healthy subjects, 50 subjects with type 2 diabetes and painless DPN, and 71 subjects with type 2 diabetes and painful DPN. The left tibial nerve was stimulated, and RDD was calculated by the decline in amplitude of the third H wave relative to the first one. Gabapentin treatment was initiated after baseline evaluation, and the RDD and visual analog scale (VAS) score were both evaluated regularly during the 2-week study period. At baseline, the painful DPN group exhibited significant RDD impairment across all stimulation frequencies. Gabapentin treatment significantly reduced the VAS score and restored RDD during the 2-week observation period. RDD was found to be an independent factor of minimal VAS score improvement, such that the benefit increased by 1.27 times per 1% decrease in the RDD value. In conclusion, this study demonstrates that diabetes-induced loss of RDD can be modified by gabapentin and suggests that RDD may be valuable for predicting the initial efficacy of gabapentin therapy in patients with painful DPN.
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Affiliation(s)
- Xiajun Zhou
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Zhu
- Department of Neurology, Shanghai International Medical Center, Shanghai, China
| | - Ze Wang
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi Lin
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Desheng Zhu
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chong Xie
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nigel A Calcutt
- Department of Pathology, University of California, San Diego, San Diego, CA
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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78
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Abdus-Saboor I, Luo W. Measuring Mouse Somatosensory Reflexive Behaviors with High-speed Videography, Statistical Modeling, and Machine Learning. NEUROMETHODS 2022; 178:441-456. [PMID: 35783537 PMCID: PMC9249079 DOI: 10.1007/978-1-0716-2039-7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Objectively measuring and interpreting an animal's sensory experience remains a challenging task. This is particularly true when using preclinical rodent models to study pain mechanisms and screen for potential new pain treatment reagents. How to determine their pain states in a precise and unbiased manner is a hurdle that the field will need to overcome. Here, we describe our efforts to measure mouse somatosensory reflexive behaviors with greatly improved precision by high-speed video imaging. We describe how coupling sub-second ethograms of reflexive behaviors with a statistical reduction method and supervised machine learning can be used to create a more objective quantitative mouse "pain scale." Our goal is to provide the readers with a protocol of how to integrate some of the new tools described here with currently used mechanical somatosensory assays, while discussing the advantages and limitations of this new approach.
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Affiliation(s)
- Ishmail Abdus-Saboor
- Department of Biology, University of Pennsylvania, 3740 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Wenqin Luo
- Department of Neuroscience, University of Pennsylvania, 3610 Hamilton Walk, Philadelphia, PA, 19104, USA
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79
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Lee JY, You T, Lee CH, Im GH, Seo H, Woo CW, Kim SG. Role of anterior cingulate cortex inputs to periaqueductal gray for pain avoidance. Curr Biol 2022; 32:2834-2847.e5. [PMID: 35609604 DOI: 10.1016/j.cub.2022.04.090] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 12/13/2022]
Abstract
Although pain-related excessive fear is known to be a key factor in chronic pain disability, which involves the anterior cingulate cortex (ACC), little is known about the downstream circuits of the ACC for fear avoidance in pain processing. Using behavioral experiments and functional magnetic resonance imaging with optogenetics at 15.2 T, we demonstrate that the ACC is a part of the abnormal circuit changes in chronic pain and its downstream circuits are closely related to modulating sensorimotor integration and generating active movement rather than carrying sensory information. The projection from the ACC to the dorsolateral and lateral parts of the periaqueductal gray (dl/lPAG) especially enhances both reflexive and active avoidance behavior toward pain. Collectively, our results indicate that increased signals from the ACC to the dl/lPAG might be critical for excessive fear avoidance in chronic pain disability.
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Affiliation(s)
- Jeong-Yun Lee
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea.
| | - Taeyi You
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Choong-Hee Lee
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea
| | - Geun Ho Im
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea
| | - Heewon Seo
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Chemistry and Biochemistry, Oberlin College, Oberlin, OH 44704, USA
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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80
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Brain Network Changes in Lumbar Disc Herniation Induced Chronic Nerve Roots Compression Syndromes. Neural Plast 2022; 2022:7912410. [PMID: 35607420 PMCID: PMC9124092 DOI: 10.1155/2022/7912410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/04/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Lumbar disc herniation (LDH) induced nerve compression syndromes have been a prevalent problem with complex neural mechanisms. Changes in distributed brain areas are involved in the occurrence and persistence of syndromes. The present study aimed to investigate the changes of brain functional network in LDH patients with chronic sciatica using graph theory analysis. A total of thirty LDH adults presenting L4 and/or L5 root (s) compression syndromes (LDH group) and thirty age-, sex-, BMI- and education-matched healthy control (HC group) were recruited for functional MRI scan. Whole-brain functional network was constructed for each participant using Pearson's correlation. Global and nodal properties were calculated and compared between two groups, including small-worldness index, clustering coefficient, characteristic path length, degree centrality (DC), betweenness centrality (BC) and nodal efficiency. Both LDH and HC groups showed small-world architecture in the functional network of brain. However, LDH group showed that nodal centralities (DC, BC and nodal efficiency) increased in opercular part of inferior frontal gyrus; and decreased in orbital part of inferior frontal gyrus, lingual cortex and inferior occipital gyrus. The DC and efficiency in the right inferior occipital gyrus were negatively related with the Oswestry Disability Index in LDH group. In conclusion, the LDH-related chronic sciatica syndromes may induce regional brain alterations involving self-referential, emotional responses and pain regulation functions. But the whole-brain small-world architecture was not significantly disturbed. It may provide new insights into LDH patients with radicular symptoms from new perspectives.
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81
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Strigo IA, Spadoni AD, Simmons AN. Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling. FRONTIERS IN PAIN RESEARCH 2022; 3:871961. [PMID: 35620636 PMCID: PMC9127988 DOI: 10.3389/fpain.2022.871961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/07/2022] [Indexed: 01/19/2023] Open
Abstract
Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.
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Affiliation(s)
- Irina A. Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Andrea D. Spadoni
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Alan N. Simmons
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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82
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Goldway N, Petro NM, Ablin J, Keil A, Ben Simon E, Zamir Y, Weizman L, Greental A, Hendler T, Sharon H. Abnormal Visual Evoked Responses to Emotional Cues Correspond to Diagnosis and Disease Severity in Fibromyalgia. Front Behav Neurosci 2022; 16:852133. [PMID: 35600994 PMCID: PMC9116473 DOI: 10.3389/fnbeh.2022.852133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Chronic pain disorders are often associated with cognitive-emotional dysregulation. However, the relations between such dysregulation, underlying brain processes, and clinical symptom constellations, remain unclear. Here, we aimed to characterize the abnormalities in cognitive-emotional processing involved in fibromyalgia syndrome (FMS) and their relation to disease severity. Methods Fifty-eight participants, 39 FMS patients (35F), and 19 healthy control subjects (16F) performed an EEG-based paradigm assessing attention allocation by extracting steady-state visually evoked potentials (ssVEP) in response to affective distractors presented during a cognitive task. Patients were also evaluated for pain severity, sleep quality, depression, and anxiety. Results EEG ssVEP measurement indicated that, compared to healthy controls, FMS patients displayed impaired affective discrimination, and sustained attention to negative distractors. Moreover, patients displayed decreased task-related fronto-occipital EEG connectivity. Lack of adaptive attentional discrimination, measured via EEG, was predictive of pain severity, while impairments in fronto-occipital connectivity were predictive of impaired sleep. Conclusions FMS patients display maladaptive affective attention modulation, which predicts disease symptoms. These findings support the centrality of cognitive-emotional dysregulation in the pathophysiology of chronic pain.
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Affiliation(s)
- Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Psychology, New York University, New York, NY, United States
| | - Nathan M. Petro
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jacob Ablin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Internal Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
| | - Andreas Keil
- Department of Psychology, Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL, United States
| | - Eti Ben Simon
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Yoav Zamir
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Libat Weizman
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ayam Greental
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Haggai Sharon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
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83
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Tonic pain alters functional connectivity of the descending pain modulatory network involving amygdala, periaqueductal gray, parabrachial nucleus and anterior cingulate cortex. Neuroimage 2022; 256:119278. [PMID: 35523367 PMCID: PMC9250649 DOI: 10.1016/j.neuroimage.2022.119278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC accompanying tonic pain in pain-free persons are rare. A network we term the Descending Pain Modulatory Network (DPMN) is implicated in healthy and pathologic pain modulation. Here, we evaluate the effect of tonic pain on FC of specific nodes of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN). METHODS In 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. functional MRI measured resting BOLD signal during pain-free rest with a 32°C thermode and then tonic pain where participants experienced a previously warm temperature combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity during both states. We hypothesized tonic pain would diminish FC dyads within the DPMN. RESULTS Of all hypothesized FC dyads, only PAG and subgenual ACC was weakly altered during pain (F=3.34; p=0.074; pain-free>pain d=0.25). After pain induction sACC-PAG FC became positively correlated with pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During pain, this connection's FC was diminished (paired t=-3.17; p=0.0026). In whole-brain analyses, during pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During pain, FC between left AMYG and right inferior temporal gyrus negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC with right claustrum; right primary visual cortex and right temporo-occipitoparietal junction Conclusion: We demonstrate sACC-PAG tonic pain FC positively correlates with experienced pain and resting right PBN-PAG FC correlates with subsequent pain and is diminished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which correlate with subsequently experienced pain intensity. Our findings suggest specific connectivity patterns within the DPMN at rest are associated with subsequently experienced pain and modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation or biomarkers to guide interventions.
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84
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Moscato S, Cortelli P, Chiari L. Physiological responses to pain in cancer patients: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106682. [PMID: 35172252 DOI: 10.1016/j.cmpb.2022.106682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Pain is one of the most debilitating symptoms in persons with cancer. Still, its assessment is often neglected both by patients and healthcare professionals. There is increasing interest in conducting pain assessment and monitoring via physiological signals that promise to overcome the limitations of state-of-the-art pain assessment tools. This systematic review aims to evaluate existing experimental studies to identify the most promising methods and results for objectively quantifying cancer patients' pain experience. METHODS Four electronic databases (Pubmed, Compendex, Scopus, Web of Science) were systematically searched for articles published up to October 2020. RESULTS Fourteen studies (528 participants) were included in the review. The selected studies analyzed seven physiological signals. Blood pressure and ECG were the most used signals. Sixteen physiological parameters showed significant changes in association with pain. The studies were fairly consistent in stating that heart rate, the low-frequency to high-frequency component ratio (LF/HF), and systolic blood pressure positively correlate with the pain. CONCLUSIONS Current evidence supports the hypothesis that physiological signals can help objectively quantify, at least in part, cancer patients' pain experience. While there is much more to be done to obtain a reliable pain assessment method, this review takes an essential first step by highlighting issues that should be taken into account in future research: use of a wearable device for pervasive recording in a real-world context, implementation of a big-data approach possibly supported by AI, including multiple stratification factors (e.g., cancer site and stage, source of pain, demographic and psychosocial data), and better-defined recording procedures. Improved methods and algorithms could then become valuable add-ons in taking charge of cancer patients.
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Affiliation(s)
- Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy.
| | - Pietro Cortelli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, UOC Clinica Neurologica NeuroMet, Ospedale Bellaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy; Health Sciences and Technologies, Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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85
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Jabakhanji R, Vigotsky AD, Bielefeld J, Huang L, Baliki MN, Iannetti G, Apkarian AV. Limits of decoding mental states with fMRI. Cortex 2022; 149:101-122. [PMID: 35219121 PMCID: PMC9238276 DOI: 10.1016/j.cortex.2021.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
A growing number of studies claim to decode mental states using multi-voxel decoders of brain activity. It has been proposed that the fixed, fine-grained, multi-voxel patterns in these decoders are necessary for discriminating between and identifying mental states. Here, we present evidence that the efficacy of these decoders might be overstated. Across various tasks, decoder patterns were spatially imprecise, as decoder performance was unaffected by spatial smoothing; 90% redundant, as selecting a random 10% of a decoder's constituent voxels recovered full decoder performance; and performed similarly to brain activity maps used as decoders. We distinguish decoder performance in discriminating between mental states from performance in identifying a given mental state, and show that even when discrimination performance is adequate, identification can be poor. Finally, we demonstrate that simple and intuitive similarity metrics explain 91% and 62% of discrimination performance within- and across-subjects, respectively. These findings indicate that currently used across-subject decoders of mental states are superfluous and inappropriate for decision-making.
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Affiliation(s)
- Rami Jabakhanji
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Andrew D Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Marwan N Baliki
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Shirley Ryan AbilityLab, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Giandomenico Iannetti
- Division of Biosciences, University College London, London, UK; Neuroscience and Behaviour Laboratory, Italian Institute of Technology, Rome, Italy
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA.
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86
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Fang Y, Chen C, Zhong Q, Wang L, Gui Z, Zhu J, Manyande A, Xu F, Wang J, Zhang Z. Influence of Cerebral Glucose Metabolism by Chronic Pain-Mediated Cognitive Impairment in Adolescent Rats. Mol Neurobiol 2022; 59:3635-3648. [PMID: 35355195 DOI: 10.1007/s12035-022-02816-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Chronic pain during adolescence can lead to mental health disorders in adulthood, but the underlying mechanism is still unclear. Furthermore, the homeostasis of cerebral glucose metabolism and neurotransmitter metabolic kinetics are closely associated with cognitive development and pain progression. The present study investigated changes in cognitive function and glucose metabolism in adult rats, which had experienced chronic pain during their adolescence. Here, spared nerve injury (SNI) surgery was conducted in 4-week-old male rats. Mechanical nociceptive reflex thresholds were analyzed, and SNI chronic pain (SNI-CP) animals were screened. Based on animal behavioral tests (open field, three-chambered social, novel object recognition and the Y maze), the SNI-CP animals showed learning and memory impairment and anxiety-like behaviors, compared to SNI no chronic pain (SNI-NCP) animals. The cerebral glucose metabolism in the prefrontal cortex and hippocampus of adult SNI-CP animals was decreased with positron emission tomography/computed tomography. GABA2 and Glu4 levels in the metabolic kinetics study were significantly decreased in the hippocampus, frontal cortex, and temporal cortex, and the expression of GLUT3 and GLUT4 was also significantly downregulated in the prefrontal cortex and hippocampus of adult rats in the SNI-CP group. These findings suggest that the rats which suffered chronic pain during adolescence have lower cerebral glucose metabolism in the cortex and hippocampus, which could be related to cognitive function during the development of the central nervous system.
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Affiliation(s)
- Yuanyuan Fang
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Chang Chen
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Qi Zhong
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Lirong Wang
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Zhu Gui
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, Hubei, 430071, People's Republic of China
| | - Jinpiao Zhu
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, Hubei, 430071, People's Republic of China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, Brentford, TW8 9GA, Middlesex, UK
| | - Fuqiang Xu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, Hubei, 430071, People's Republic of China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, Hubei, 430071, People's Republic of China.
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, People's Republic of China.
- University of Chinese Academy of Sciences, Beijing, 100049, People's Republic of China.
| | - Zongze Zhang
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China.
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87
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Medeiros P, Medeiros AC, Coimbra JPC, de Paiva Teixeira LEP, Salgado-Rohner CJ, da Silva JA, Coimbra NC, de Freitas RL. Physical, Emotional, and Social Pain During COVID-19 Pandemic-Related Social Isolation. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8886700 DOI: 10.1007/s43076-022-00149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The socio-emotional condition during the COVID-19 pandemic subsidises the (re)modulation of interactive neural circuits underlying risk assessment behaviour at the physical, emotional, and social levels. Experiences of social isolation, exclusion, or affective loss are generally considered some of the most “painful” things that people endure. The threats of social disconnection are processed by some of the same neural structures that process basic threats to survival. The lack of social connection can be “painful” due to an overlap in the neural circuitry responsible for both physical and emotional pain related to feelings of social rejection. Indeed, many of us go to great lengths to avoid situations that may engender these experiences. Accordingly, this work focuses on pandemic times; the somatisation mentioned above seeks the interconnection and/or interdependence between neural systems related to emotional and cognitive processes such that a person involved in an aversive social environment becomes aware of himself, others, and the threatening situation experienced and takes steps to avoid daily psychological and neuropsychiatric effects. Social distancing during isolation evokes the formation of social distress, increasing the intensity of learned fear that people acquire, consequently enhancing emotional and social pain.
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Affiliation(s)
- Priscila Medeiros
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
| | - Ana Carolina Medeiros
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
| | - Jade Pisssamiglio Cysne Coimbra
- Pontificial Catholic University of Campinas (PUC-Campinas), Prof Dr Euryclides de Jesus Zerbini Str., 1516, Parque Rural Fazenda Santa Cândida, Campinas, São Paulo, 13087-571 Brazil
| | | | - Carlos José Salgado-Rohner
- NeuroSmart Lab, International School of Economics and Administrative Sciences, Universidad de La Sabana, Chia, Colombia
| | - José Aparecido da Silva
- Laboratory of Psychophysics, Perception, Psychometrics, and Pain, Department of Psychology, Ribeirão Preto School of Philosophy, Sciences and Literature of the University of São Paulo (FFCLRP-USP), São Paulo, Ribeirão Preto 14049-901 Brazil
| | - Norberto Cysne Coimbra
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
| | - Renato Leonardo de Freitas
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
- Biomedical Sciences Institute, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Str., 700, Alfenas, Minas Gerais 37130-000 Brazil
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88
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At the Intersection of Anger, Chronic Pain, and the Brain: A Mini-Review. Neurosci Biobehav Rev 2022; 135:104558. [PMID: 35122780 DOI: 10.1016/j.neubiorev.2022.104558] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 01/30/2023]
Abstract
Chronic pain remains one of the most persistent healthcare challenges in the world. To advance pain treatment, experts have recently introduced research-driven subtypes of chronic pain based on proposed underlying mechanisms. Nociplastic pain (e.g., nonspecific chronic low back or fibromyalgia) is one such subtype which may involve a greater etiologic role for brain plasticity, painful emotions induced by life stress and trauma, and unhealthy emotion regulation. In particular, correlational and behavioral data link anger and the ways anger is regulated with the presence and severity of nociplastic pain. Functional neuroimaging studies also suggest nociplastic pain and healthy anger regulation demonstrate inverse patterns of activity in the medial prefrontal cortex and amygdala; thus, improving anger regulation could normalize activity in these regions. In this Mini-Review, we summarize these findings and propose a unified, biobehavioral model called the Anger, Brain, and Nociplastic Pain (AB-NP) Model, which can be tested in future research and may advance pain care by informing new treatments that address anger, anger regulation, and brain plasticity for nociplastic pain.
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89
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Zhang Z, Gewandter JS, Geha P. Brain Imaging Biomarkers for Chronic Pain. Front Neurol 2022; 12:734821. [PMID: 35046881 PMCID: PMC8763372 DOI: 10.3389/fneur.2021.734821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering chronic pain is associated with psychiatric and medical co-morbidities, notably substance misuse, and a huge a societal cost amounting to hundreds of billions of dollars annually in medical cost, lost wages, and productivity. Chronic pain does not have a cure or quantitative diagnostic or prognostic tools. In this manuscript we provide evidence that this situation is about to change. We first start by summarizing our current understanding of the role of the brain in the pathogenesis of chronic pain. We particularly focus on the concept of learning in the emergence of chronic pain, and the implication of the limbic brain circuitry and dopaminergic signaling, which underly emotional learning and decision making, in this process. Next, we summarize data from our labs and from other groups on the latest brain imaging findings in different chronic pain conditions focusing on results with significant potential for translation into clinical applications. The gaps in the study of chronic pain and brain imaging are highlighted in throughout the overview. Finally, we conclude by discussing the costs and benefits of using brain biomarkers of chronic pain and compare to other potential markers.
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Affiliation(s)
- Zhengwu Zhang
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer S Gewandter
- Anesthesiology and Perioperative Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Paul Geha
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Del Monte Neuroscience Institute, University of Rochester, Rochester, NY, United States
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90
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Araya EI, Carvalho EC, Andreatini R, Zamponi GW, Chichorro JG. Trigeminal neuropathic pain causes changes in affective processing of pain in rats. Mol Pain 2022; 18:17448069211057750. [PMID: 35042377 PMCID: PMC8777332 DOI: 10.1177/17448069211057750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Trigeminal neuropathic pain has been modeled in rodents through the constriction of the
infraorbital nerve (CCI-ION). Sensory alterations, including spontaneous pain, and thermal
and mechanical hyperalgesia are well characterized, but there is a notable lack of
evidence about the affective pain component in this model. Evaluation of the emotional
component of pain in rats has been proposed as a way to optimize potential translational
value of non-clinical studies. In rats, 22 and 50 kHz ultrasonic vocalizations (USVs) are
considered well-established measures of negative and positive emotional states,
respectively. Thus, this study tested the hypothesis that trigeminal neuropathic pain
would result, in addition to the sensory alterations, in a decrease of 50 kHz USV, which
may be related to altered function of brain areas involved in emotional pain processing.
CCI-ION surgery was performed on 60-day-old male Wistar rats. 15 days after surgery, von
Frey filaments were applied to detect mechanical hyperalgesia, and USV was recorded. At
the same timepoint, systemic treatment with d,l-amphetamine (1 mg/kg) allowed
investigation of the involvement of the dopaminergic system in USV emission. Finally,
brain tissue was collected to assess the change in tyrosine hydroxylase (TH) expression in
the nucleus accumbens (NAc) and c-Fos expression in brain areas involved in emotional pain
processing, including the prefrontal cortex (PFC), amygdala, and NAc. The results showed
that CCI-ION rats presented mechanical hyperalgesia and a significant reduction of
environmental-induced 50 kHz USV. Amphetamine caused a marked increase in 50 kHz USV
emission in CCI-ION rats. In addition, TH expression was lower in constricted animals and
c-Fos analysis revealed an increase in neuronal activation. Taken together, these data
indicate that CCI-ION causes a reduction in the emission of environmental-induced
appetitive calls concomitantly with facial mechanical hyperalgesia and that both changes
may be related to a reduction in the mesolimbic dopaminergic activity.
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Affiliation(s)
- Erika I Araya
- Department of Pharmacology, Biological Sciences Building, 232174Federal University of Parana, Curitiba, Brazil
| | - Eduardo C Carvalho
- Department of Pharmacology, Biological Sciences Building, 232174Federal University of Parana, Curitiba, Brazil
| | - Roberto Andreatini
- Department of Pharmacology, Biological Sciences Building, 232174Federal University of Parana, Curitiba, Brazil
| | - Gerald W Zamponi
- Department of Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, 70401University of Calgary, Calgary, AB, Canada
| | - Juliana G Chichorro
- Department of Pharmacology, Biological Sciences Building, 232174Federal University of Parana, Curitiba, Brazil
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91
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Association of plasma tryptophan concentration with periaqueductal gray matter functional connectivity in migraine patients. Sci Rep 2022; 12:739. [PMID: 35031640 PMCID: PMC8760301 DOI: 10.1038/s41598-021-04647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/14/2021] [Indexed: 01/16/2023] Open
Abstract
Altered periaqueductal gray matter (PAG) functional connectivity contributes to brain hyperexcitability in migraine. Although tryptophan modulates neurotransmission in PAG projections through its metabolic pathways, the effect of plasma tryptophan on PAG functional connectivity (PAG-FC) in migraine has not been investigated yet. In this study, using a matched case-control design PAG-FC was measured during a resting-state functional magnetic resonance imaging session in migraine without aura patients (n = 27) and healthy controls (n = 27), and its relationship with plasma tryptophan concentration (TRP) was assessed. In addition, correlations of PAG-FC with age at migraine onset, migraine frequency, trait-anxiety and depressive symptoms were tested and the effect of TRP on these correlations was explored. Our results demonstrated that migraineurs had higher TRP compared to controls. In addition, altered PAG-FC in regions responsible for fear-cascade and pain modulation correlated with TRP only in migraineurs. There was no significant correlation in controls. It suggests increased sensitivity to TRP in migraine patients compared to controls. Trait-anxiety and depressive symptoms correlated with PAG-FC in migraine patients, and these correlations were modulated by TRP in regions responsible for emotional aspects of pain processing, but TRP did not interfere with processes that contribute to migraine attack generation or attack frequency.
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92
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Deak B, Eggert T, Mayr A, Stankewitz A, Filippopulos F, Jahn P, Witkovsky V, Straube A, Schulz E. Intrinsic Network Activity Reflects the Fluctuating Experience of Tonic Pain. Cereb Cortex 2022; 32:4098-4109. [PMID: 35024821 DOI: 10.1093/cercor/bhab468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Although we know sensation is continuous, research on long-lasting and continuously changing stimuli is scarce and the dynamic nature of ongoing cortical processing is largely neglected. In a longitudinal study, 38 participants across four sessions were asked to continuously rate the intensity of an applied tonic heat pain for 20 min. Using group-independent component analysis and dual regression, we extracted the subjects' time courses of intrinsic network activity. The relationship between the dynamic fluctuation of network activity with the varying time courses of three pain processing entities was computed: pain intensity, the direction of pain intensity changes, and temperature. We were able to dissociate the spatio-temporal patterns of objective (temperature) and subjective (pain intensity/changes of pain intensity) aspects of pain processing in the human brain. We found two somatosensory networks with distinct functions: one network that encodes the small fluctuations in temperature and consists mainly of bilateral primary somatosensory cortex (SI), and a second right-lateralized network that encodes the intensity of the subjective experience of pain consisting of SI, secondary somatosensory cortex, the posterior cingulate cortex, and the thalamus. We revealed the somatosensory dynamics that build up toward a current subjective percept of pain. The timing suggests a cascade of subsequent processing steps toward the current pain percept.
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Affiliation(s)
- Bettina Deak
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Thomas Eggert
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Astrid Mayr
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.,Department of Radiology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Filipp Filippopulos
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Pauline Jahn
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, 841 04 Bratislava, Slovak Republic
| | - Andreas Straube
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Enrico Schulz
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.,Department of Medical Psychology, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
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93
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Hua D, Li S, Li S, Wang X, Wang Y, Xie Z, Zhao Y, Zhang J, Luo A. Gut Microbiome and Plasma Metabolome Signatures in Middle-Aged Mice With Cognitive Dysfunction Induced by Chronic Neuropathic Pain. Front Mol Neurosci 2022; 14:806700. [PMID: 35058749 PMCID: PMC8763791 DOI: 10.3389/fnmol.2021.806700] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022] Open
Abstract
Patients with chronic neuropathic pain (CNP) often complain about their terrible memory, especially the speed of information processing. Accumulating evidence suggests a possible link between gut microbiota and pain processing as well as cognitive function via the microbiota-gut-brain axis. This study aimed at exploring the fecal microbiome and plasma metabolite profiles in middle-aged spared nerve injury (SNI) mice model with cognitive dysfunction (CD) induced by CNP. The hierarchical cluster analysis of performance in the Morris water maze test was used to classify SNI mice with CD or without CD [i.e., non-CD (NCD)] phenotype. 16S rRNA sequencing revealed a lower diversity of gut bacteria in SNI mice, and the increase of Actinobacteria, Proteus, and Bifidobacterium might contribute to the cognitive impairment in the CNP condition. The plasma metabolome analysis showed that the endocannabinoid (eCB) system, disturbances of lipids, and amino acid metabolism might be the dominant signatures of CD mice. The fecal microbiota transplantation of the Sham (not CD) group improved allodynia and cognitive performance in pseudo-germ-free mice via normalizing the mRNA expression of eCB receptors, such as cn1r, cn2r, and htr1a, reflecting the effects of gut bacteria on metabolic activity. Collectively, the findings of this study suggest that the modulation of gut microbiota and eCB signaling may serve as therapeutic targets for cognitive deficits in patients with CNP.
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94
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Abstract
The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.
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Affiliation(s)
- Andrew P Binks
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States; Faculty of Health Sciences, Virginia Tech, Blacksburg, VA, United States.
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Lenoir D, Willaert W, Ickmans K, Bernaers L, Nijs J, Malfliet A, Danneels L, Leysen L, De Pauw R, Cagnie B, Coppieters I, Meeus M. Are Reports of Pain, Disability, Quality of Life, Psychological Factors, and Central Sensitization Related to Outcomes of Quantitative Sensory Testing in Patients Suffering From Chronic Whiplash Associated Disorders? Clin J Pain 2021; 38:159-172. [PMID: 34939972 DOI: 10.1097/ajp.0000000000001013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic whiplash associated disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. OBJECTIVE Investigating the relationships between self-reported pain, disability, quality of life, psychological factors, and symptoms of CS; and electrical-based quantitative sensory testing (QST) outcomes in CWAD patients. Secondly, to investigate the differences in QST between CWAD patients and pain-free controls. METHODS Seventy-two individuals with CWAD and 55 pain-free controls underwent electrical stimuli-based QST. Detection and pain thresholds (EPT), temporal summation (TS), and conditioned pain modulation were examined. Spearman correlation and linear mixed models analyses were performed to assess, respectively, the hypothesized associations and group differences in QST. RESULTS The Pain Catastrophizing magnification subscale correlated with the left wrist EPT (r=-0.332; P=0.004), and the Pain Anxiety Symptom Scale-20 with the left wrist (r=-0.325; P=0.005) and ankle (r=-0.330; P=0.005) EPT. TS at the ankle correlated with the CS inventory (r=0.303; P=0.010), Short Form 36 pain subscale (r=-0.325; P=0.005), and Illness Perception Questionnaire revised consequences subscale (r=0.325; P=0.005). EPTs left (P=0.011) and right wrist (P=0.023) were lower in the CWAD group, but conditioned pain modulation and TS did not differ between groups. CONCLUSION QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in individuals with CWAD, but no differences in endogenous pain facilitation nor inhibition.
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Affiliation(s)
- Dorine Lenoir
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Bijzonder Onderzoeksfonds Gent (BOF), Ghent
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, Brussels, Belgium
| | - Lisa Bernaers
- Department of Rehabilitation Sciences, Ghent University
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy
- University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion International Research Group, www.paininmotion.be
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | | | - Laurence Leysen
- Pain in Motion International Research Group, www.paininmotion.be
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Ghent University
| | | | - Iris Coppieters
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | - Mira Meeus
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Faculty of Medicine and Health Science, Department of Rehabilitation Sciences and Physiotherapy-MOVANT Research Group, University of Antwerp, Antwerp
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96
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Mayr A, Jahn P, Stankewitz A, Deak B, Winkler A, Witkovsky V, Eren O, Straube A, Schulz E. Patients with chronic pain exhibit individually unique cortical signatures of pain encoding. Hum Brain Mapp 2021; 43:1676-1693. [PMID: 34921467 PMCID: PMC8886665 DOI: 10.1002/hbm.25750] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Abstract
Chronic pain is characterised by an ongoing and fluctuating intensity over time. Here, we investigated how the trajectory of the patients' endogenous pain is encoded in the brain. In repeated functional MRI (fMRI) sessions, 20 patients with chronic back pain and 20 patients with chronic migraine were asked to continuously rate the intensity of their endogenous pain. Linear mixed effects models were used to disentangle cortical processes related to pain intensity and to pain intensity changes. At group level, we found that the intensity of pain in patients with chronic back pain is encoded in the anterior insular cortex, the frontal operculum, and the pons; the change of pain in chronic back pain and chronic migraine patients is mainly encoded in the anterior insular cortex. At the individual level, we identified a more complex picture where each patient exhibited their own signature of endogenous pain encoding. The diversity of the individual cortical signatures of chronic pain encoding results bridge between clinical observations and neuroimaging; they add to the understanding of chronic pain as a complex and multifaceted disease.
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Affiliation(s)
- Astrid Mayr
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pauline Jahn
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bettina Deak
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anderson Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Ozan Eren
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
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97
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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98
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Valdes-Hernandez PA, Montesino-Goicolea S, Hoyos L, Porges EC, Huo Z, Ebner NC, Woods AJ, Cohen R, Riley JL, Fillingim RB, Cruz-Almeida Y. Resting-state functional connectivity patterns are associated with worst pain duration in community-dwelling older adults. Pain Rep 2021; 6:e978. [PMID: 34901680 PMCID: PMC8660002 DOI: 10.1097/pr9.0000000000000978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An individual's chronic pain history is associated with brain morphometric alterations; but little is known about the association between pain history and brain function. OBJECTIVES This cross-sectional study aimed at determining how worst musculoskeletal pain intensity (WPINT) moderated the association between worst musculoskeletal pain duration (WPDUR) and brain resting-state magnetic resonance imaging functional connectivity (RSFC) in community-dwelling older adults (60-94 years, 75% females, 97% right-handed). METHODS Resting-state magnetic resonance imaging functional connectivity between region of interests was linearly regressed on WPDUR and WPINT. Predictions were compared with a control group's average RSFC (61-85 years, 47% females, 95% right-handed). RESULTS Three significant patterns emerged: (1) the positive association between WPDUR and RSFC between the medial prefrontal cortex, in the anterior salience network (SN), and bilateral lateral Brodmann area 6, in the visuospatial network (VSN), in participants with more severe chronic pain, resulting in abnormally lower RSFC for shorter WPDUR; (2) the negative association between WPDUR and RSFC between right VSN occipitotemporal cortex (lateral BA37 and visual V5) and bilateral VSN lateral Brodmann area 6, independently of WPINT, resulting in abnormally higher and lower RSFC for shorter and longer WPDUR, respectively; and (3) the positive association between WPDUR and the left hemisphere's salience network-default mode network connectivity (between the hippocampus and both dorsal insula and ventral or opercular BA44), independently of WPINT, resulting in abnormally higher RSFC for longer WPDUR. CONCLUSION Musculoskeletal effects on brain functional networks of general healthy individuals could accumulate until being observable at older ages. Results invite to examinations of these effects' impact on function and memory.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Lorraine Hoyos
- University of Central Florida, Department of Clinical Sciences, Orlando, Florida, USA
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Natalie C. Ebner
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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99
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Provencher B, Northon S, Piché M. Segmental Chiropractic Spinal Manipulation Does not Reduce Pain Amplification and the Associated Pain-Related Brain Activity in a Capsaicin-Heat Pain Model. FRONTIERS IN PAIN RESEARCH 2021; 2:733727. [PMID: 35295444 PMCID: PMC8915690 DOI: 10.3389/fpain.2021.733727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Musculoskeletal injuries lead to sensitization of nociceptors and primary hyperalgesia (hypersensitivity to painful stimuli). This occurs with back injuries, which are associated with acute pain and increased pain sensitivity at the site of injury. In some cases, back pain persists and leads to central sensitization and chronic pain. Thus, reducing primary hyperalgesia to prevent central sensitization may limit the transition from acute to chronic back pain. It has been shown that spinal manipulation (SM) reduces experimental and clinical pain, but the effect of SM on primary hyperalgesia and hypersensitivity to painful stimuli remains unclear. The goal of the present study was to investigate the effect of SM on pain hypersensitivity using a capsaicin-heat pain model. Laser stimulation was used to evoke heat pain and the associated brain activity, which were measured to assess their modulation by SM. Eighty healthy participants were recruited and randomly assigned to one of the four experimental groups: inert cream and no intervention; capsaicin cream and no intervention; capsaicin cream and SM at T7; capsaicin cream and placebo. Inert or capsaicin cream (1%) was applied to the T9 area. SM or placebo were performed 25 min after cream application. A series of laser stimuli were delivered on the area of cream application (1) before cream application, (2) after cream application but before SM or placebo, and (3) after SM or placebo. Capsaicin cream induced a significant increase in laser pain (p < 0.001) and laser-evoked potential amplitude (p < 0.001). However, SM did not decrease the amplification of laser pain or laser-evoked potentials by capsaicin. These results indicate that segmental SM does not reduce pain hypersensitivity and the associated pain-related brain activity in a capsaicin-heat pain model.
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Affiliation(s)
- Benjamin Provencher
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Stéphane Northon
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mathieu Piché
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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100
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Chen ZS. Decoding pain from brain activity. J Neural Eng 2021; 18. [PMID: 34608868 DOI: 10.1088/1741-2552/ac28d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022]
Abstract
Pain is a dynamic, complex and multidimensional experience. The identification of pain from brain activity as neural readout may effectively provide a neural code for pain, and further provide useful information for pain diagnosis and treatment. Advances in neuroimaging and large-scale electrophysiology have enabled us to examine neural activity with improved spatial and temporal resolution, providing opportunities to decode pain in humans and freely behaving animals. This topical review provides a systematical overview of state-of-the-art methods for decoding pain from brain signals, with special emphasis on electrophysiological and neuroimaging modalities. We show how pain decoding analyses can help pain diagnosis and discovery of neurobiomarkers for chronic pain. Finally, we discuss the challenges in the research field and point to several important future research directions.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, Department of Neuroscience and Physiology, Neuroscience Institute, Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY 10016, United States of America
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