101
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Clinical and Neurophysiological Effects of Botulinum Neurotoxin Type A in Chronic Migraine. Toxins (Basel) 2021; 13:toxins13060392. [PMID: 34072379 PMCID: PMC8229748 DOI: 10.3390/toxins13060392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic pain syndromes present a subversion of both functional and structural nociceptive networks. We used transcranial magnetic stimulation (TMS) to evaluate changes in cortical excitability and plasticity in patients with chronic migraine (CM) treated with botulinum neurotoxin type A (BoNT/A). We enrolled 11 patients with episodic migraine (EM) and 11 affected by CM. Baseline characteristics for both groups were recorded using single- and paired-pulse TMS protocols. The same TMS protocol was repeated in CM patients after four cycles of BoNT/A completed in one year. At baseline, compared with EM patients, patients with CM had a lower threshold in both hemispheres (right hemisphere: 46% ± 7.8 vs. 52% ± 4.28, p = 0.03; left hemisphere: 52% ± 4.28 vs. 53.54% ± 6.58, p = 0.02). In EM, paired-pulse stimulation elicited a physiologically shaped response, whereas in CM, physiological intracortical inhibition (ICI) between 1 and 3 ms intervals was absent at baseline. On the contrary, increasing intracortical facilitation (ICF) was observed for all interstimulus intervals (ISIs). In CM, cortical excitability was partially reduced after BoNT/A treatment, along with a significant decrease observed in MIDAS score (from 20.7 to 9.8; p = 0.008). The lower motor threshold in CM reflects a higher cortical hyperexcitability. The lack of physiological ICI in CM could indicate sensitisation of the trigeminovascular system. Although reduced, this type of response is still observable after treatment, despite a marked clinical improvement. Our study suggests a long-term alteration of cortical plasticity due to chronic pain.
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102
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Elina KC, Oh BH, Islam J, Kim S, Park YS. Activation of CamKIIα expressing neurons on ventrolateral periaqueductal gray improves behavioral hypersensitivity and thalamic discharge in a trigeminal neuralgia rat model. J Headache Pain 2021; 22:47. [PMID: 34044756 PMCID: PMC8161973 DOI: 10.1186/s10194-021-01257-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preceding studies have reported the association of chronic neuropathic orofacial pain with altered ongoing function in the ventrolateral periaqueductal gray (vlPAG). However, its role in trigeminal neuralgia (TN) lacks attention. We here reported the aspect that vlPAG neurons play in TN nociceptive processing by employing excitatory neuron-specific optogenetic approaches. METHODS TN was generated via unilateral infraorbital nerve chronic constriction in Sprague Dawley rats which induced mechanical and thermal pain sensitivity in air puff and acetone test, respectively. Channelrhodopsin conjugated virus with CamKIIα promoter was used to specifically activate the excitatory vlPAG neuronal population by optogenetic stimulation and in vivo microdialysis was done to determine its effect on the excitatory-inhibitory balance. In vivo extracellular recordings from ventral posteromedial (VPM) thalamus were assessed in response to vlPAG optogenetic stimulation. Depending on the experimental terms, unpaired student's t test and two-way analysis of variance (ANOVA) were used for statistical analysis. RESULTS We observed that optogenetic activation of vlPAG subgroup neurons markedly improved pain hypersensitivity in reflexive behavior tests which was also evident on microdialysis analysis with increase glutamate concentration during stimulation period. Decreased mean firing and burst rates were evident in VPM thalamic electrophysiological recordings during the stimulation period. Overall, our results suggest the optogenetic activation of vlPAG excitatory neurons in a TN rat model has pain ameliorating effect. CONCLUSIONS This article presents the prospect of pain modulation in trigeminal pain pathway via optogenetic activation of vlPAG excitatory neurons in rat model. This outlook could potentially assist vlPAG insight and its optogenetic approach in trigeminal neuropathic pain which aid clinicians endeavoring towards enhanced pain relief therapy in trigeminal neuralgia patients.
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Affiliation(s)
- K C Elina
- Department of Neuroscience, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Byeong Ho Oh
- Department of Neuroscience, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jaisan Islam
- Department of Neuroscience, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Soochong Kim
- Department of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Young Seok Park
- Department of Neuroscience, College of Medicine, Chungbuk National University, Cheongju, South Korea.
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea.
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103
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Brain imaging signature of neuropathic pain phenotypes in small-fiber neuropathy: altered thalamic connectome and its associations with skin nerve degeneration. Pain 2021; 162:1387-1399. [PMID: 33239524 DOI: 10.1097/j.pain.0000000000002155] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT Small-fiber neuropathy (SFN) has been traditionally considered as a pure disorder of the peripheral nervous system, characterized by neuropathic pain and degeneration of small-diameter nerve fibers in the skin. Previous functional magnetic resonance imaging studies revealed abnormal activations of pain networks, but the structural basis underlying such maladaptive functional alterations remains elusive. We applied diffusion tensor imaging to explore the influences of SFN on brain microstructures. Forty-one patients with pathology-proven SFN with reduced skin innervation were recruited. White matter connectivity with the thalamus as the seed was assessed using probabilistic tractography of diffusion tensor imaging. Patients with SFN had reduced thalamic connectivity with the insular cortex and the sensorimotor areas, including the postcentral and precentral gyri. Furthermore, the degree of skin nerve degeneration, measured by intraepidermal nerve fiber density, was associated with the reduction of connectivity between the thalamus and pain-related areas according to different neuropathic pain phenotypes, specifically, the frontal, cingulate, motor, and limbic areas for burning, electrical shocks, tingling, mechanical allodynia, and numbness. Despite altered white matter connectivity, there was no change in white matter integrity assessed with fractional anisotropy. Our findings indicate that alterations in structural connectivity may serve as a biomarker of maladaptive brain plasticity that contributes to neuropathic pain after peripheral nerve degeneration.
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104
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Innes KE, Sambamoorthi U. The Association of Osteoarthritis and Related Pain Burden to Incident Alzheimer's Disease and Related Dementias: A Retrospective Cohort Study of U.S. Medicare Beneficiaries. J Alzheimers Dis 2021; 75:789-805. [PMID: 32333589 DOI: 10.3233/jad-191311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Emerging evidence suggests osteoarthritis (OA) and related symptom burden may increase risk for Alzheimer's disease and related dementias (ADRD). However, longitudinal studies are sparse, and none have examined the potential mediating effects of mood or sleep disorders. OBJECTIVE To determine the association of OA and related pain to incident ADRD in U.S. elders. METHODS In this retrospective cohort study, we used baseline and two-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey files (11 pooled cohorts, 2001-2013). The study sample comprised 16,934 community-dwelling adults≥65 years, ADRD-free at baseline and enrolled in fee-for-service Medicare. Logistic regression was used to assess the association of OA and related pain (back, neck, joint, neuropathic) to incident ADRD, explore the mediating inlfuence of mood and insomnia-related sleep disorders, and (sensitivity analyses) account for potential survival bias. RESULTS Overall, 25.5% of beneficiaries had OA at baseline (21.0% with OA and pain); 1149 elders (5.7%) were subsequently diagnosed with ADRD. Compared to beneficiaries without OA, those with OA were significantly more likely to receive a diagnosis of incident ADRD after adjustment for sociodemographics, lifestyle characteristics, comorbidities, and medications (adjusted odds ratio (AOR) = 1.23 (95% confidence interval (CI) 1.06, 1.42). Elders with OA and pain at baseline were significantly more likely to be diagnosed with incident ADRD than were those without OA or pain (AOR = 1.31, CI 1.08, 1.58). Sensitivity analyses yielded similar findings. Inclusion of depression/anxiety, but not sleep disorders, substantially attenuated these associations. CONCLUSION Findings of this study suggest that: OA is associated with elevated ADRD risk, this association is particularly pronounced in those with OA and pain, and mood disorders may partially mediate this relationship.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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105
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Kumaradev S, Fayosse A, Dugravot A, Dumurgier J, Roux C, Kivimäki M, Singh-Manoux A, Sabia S. Timeline of pain before dementia diagnosis: a 27-year follow-up study. Pain 2021; 162:1578-1585. [PMID: 33003109 PMCID: PMC7985036 DOI: 10.1097/j.pain.0000000000002080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study examines the importance of length of follow-up on the association between pain and incident dementia. Further objective was to characterize pain trajectories in the 27 years preceding dementia diagnosis and compare them with those among persons free of dementia during the same period. Pain intensity and pain interference (averaged as total pain) were measured on 9 occasions (1991-2016) using the Short-Form 36 Questionnaire amongst 9046 (women = 31.4%) dementia-free adults aged 40 to 64 years in 1991; 567 dementia cases were recorded between 1991 and 2019. Cox regression was used to assess the association between pain measures at different time points and incident dementia and mixed models to assess pain trajectories preceding dementia diagnosis or end point for dementia-free participants. Results from Cox regression showed moderate/severe compared with mild/no total pain, pain intensity, and pain interference not to be associated with dementia when the mean follow-up was 25.0, 19.6, 14.5, or 10.0 years. These associations were evident for a mean follow-up of 6.2 years: for total pain (hazard ratio = 1.72; 95% confidence intervals = 1.28-2.33), pain intensity (1.41; 1.04-1.92), and pain interference (1.80; 1.30-2.49). These associations were stronger when the mean follow-up for incidence of dementia was 3.2 years. Twenty-seven-year pain trajectories differed between dementia cases and noncases with small differences in total pain and pain interference evident 16 years before dementia diagnosis (difference in the total pain score = 1.4, 95% confidence intervals = 0.1-2.7) and rapidly increasing closer to diagnosis. In conclusion, these findings suggest that pain is a correlate or prodromal symptom rather than a cause of dementia.
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Affiliation(s)
- Sushmithadev Kumaradev
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aurore Fayosse
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aline Dugravot
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Julien Dumurgier
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Christian Roux
- Inserm 1153, Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université de Paris, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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106
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Huang S, Zhang Z, Gambeta E, Xu SC, Thomas C, Godfrey N, Chen L, M'Dahoma S, Borgland SL, Zamponi GW. Dopamine Inputs from the Ventral Tegmental Area into the Medial Prefrontal Cortex Modulate Neuropathic Pain-Associated Behaviors in Mice. Cell Rep 2021; 31:107812. [PMID: 32579938 DOI: 10.1016/j.celrep.2020.107812] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/06/2020] [Accepted: 06/03/2020] [Indexed: 02/08/2023] Open
Abstract
The medial prefrontal cortex (mPFC) is a brain region involved in the affective components of pain and undergoes plasticity during the development of chronic pain. Dopamine (DA) is a key neuromodulator in the mesocortical circuit and modulates working memory and aversion. Although DA inputs into the mPFC are known to modulate plasticity, whether and how these inputs affect pain remains incompletely understood. By using optogenetics, we find that phasic activation of DA inputs from the ventral tegmental area (VTA) into the mPFC reduce mechanical hypersensitivity during neuropathic pain states. Mice with neuropathic pain exhibit a preference for contexts paired with photostimulation of DA terminals in the mPFC. Fiber photometry-based calcium imaging reveals that DA increases the activity of mPFC neurons projecting to the ventrolateral periaqueductal gray (vlPAG). Together, our findings indicate an important role of mPFC DA signaling in pain modulation.
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Affiliation(s)
- Shuo Huang
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Zizhen Zhang
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Eder Gambeta
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Shi Chen Xu
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Catherine Thomas
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nathan Godfrey
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Lina Chen
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Said M'Dahoma
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Stephanie L Borgland
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Gerald W Zamponi
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
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107
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Sevel L, Boissoneault J, Alappattu M, Bishop M, Robinson M. Training endogenous pain modulation: a preliminary investigation of neural adaptation following repeated exposure to clinically-relevant pain. Brain Imaging Behav 2021; 14:881-896. [PMID: 30617786 DOI: 10.1007/s11682-018-0033-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Analgesic treatments that aim to eliminate pain display marginal success in relieving chronic pain and may increase pain vulnerability. Repeated exposure to pain may result in increased pain modulation via engagement of anti-nociceptive brain regions. It was hypothesized that repeated exposure to delayed onset muscle soreness (DOMS) would result in increased pain modulatory capacity (PMC) via functional neural adaptation. 23 healthy participants completed Baseline and Follow Up resting-state fMRI and quantitative sensory testing (QST) visits 40 days apart. Participants were randomized to two groups: A Repeated DOMS Group (RD Group) that received four, weekly DOMS inductions and a Control Group that received one baseline induction. Daily pain ratings were collected for seven days post-induction, as were quantitative sensory testing (QST) metrics at baseline and Follow Up. Regional functional connectivity (FC) was estimated among areas involved in pain modulation. Seed and network FC was estimated among areas involved in pain modulation and sensory processing. Changes in FC were compared between groups. The RD Group displayed significant reductions in post-DOMS pain ratings and significant changes in thermal QST measures. RD Group participants displayed greater adaptation in nucleus accumbens-medial prefrontal cortex (NAc-mPFC) FC and in sensorimotor network (SMN) connectivity with the dorsomedial, ventromedial, and rostromedial prefrontal cortices. Changes in SMN-PFC connectivity correlated with reductions in post-DOMS affective distress. Results suggest that repeated exposure to clinically-relevant pain results in adaptations among brain regions involved in pain modulation. Repeated exposure to clinically-relevant pain may serve as a mechanism to increase PMC via inhibition of emotional valuation of painful stimuli.
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Affiliation(s)
- Landrew Sevel
- Osher Center for Integrative Medicine at Vanderbilt, Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Suite 380, 3401 West End Avenue, Nashville, TN, 37203, USA.
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Meryl Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Mark Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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108
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain 2021; 25:1429-1448. [PMID: 33786932 DOI: 10.1002/ejp.1773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022]
Abstract
Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation (SM) on a variety of peripheral, spinal and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain-relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by SM. SIGNIFICANCE: Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non-specific effects to pain relief by spinal manipulative therapy.
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Affiliation(s)
- Carlos Gevers-Montoro
- 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.,Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Benjamin Provencher
- 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
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Mathieu Piché
- 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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109
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Dunbar EK, Saloman JL, Phillips AE, Whitcomb DC. Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors. J Pain Res 2021; 14:773-784. [PMID: 33762844 PMCID: PMC7982558 DOI: 10.2147/jpr.s274276] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/20/2021] [Indexed: 12/24/2022] Open
Abstract
Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.
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Affiliation(s)
- Ellyn K Dunbar
- Departments of Human Genetics and Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jami L Saloman
- Departments of Neurobiology and Medicine, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anna Evans Phillips
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - David C Whitcomb
- Departments of Human Genetics, Cell Biology and Molecular Physiology, and Medicine, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, PA, USA
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110
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Wyse J, Lovejoy J, Holloway J, Morasco BJ, Dobscha SK, Hagedorn H, Lovejoy TI. Patients' perceptions of the pathways linking chronic pain with problematic substance use. Pain 2021; 162:787-793. [PMID: 32947546 PMCID: PMC7886942 DOI: 10.1097/j.pain.0000000000002077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Approximately one-half of patients with substance use disorders (SUDs) experience chronic pain. Yet, how patients perceive the relationship between their substance use and chronic pain remains poorly understood. We sought to identify how patients with comorbid SUD and chronic pain describe the relationship between, and mechanisms linking, these conditions. We conducted qualitative interviews with 34 patients engaged in SUD treatment who were also diagnosed with chronic pain. Interviews were transcribed verbatim and coded by both primary and secondary coders. Qualitative content analysis guided coding and analysis. Patient interviews revealed 3 primary pathways. One group of participants described SUD as developing independently from their experiences of chronic pain. A second group of participants described turning to substances to self-manage or cope with the physical and emotional aspects of chronic pain. A third group of participants described encounters with opioid medications as the causal agent initiating a SUD. Our findings build on research that has identified chronic pain and SUD as developmentally similar and mutually reinforcing, by revealing the ways in which patients themselves understand and experience the interconnections between their substance use and chronic pain.
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Affiliation(s)
- Jessica Wyse
- School of Public Health, Oregon Health & Science University
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | | | - Julia Holloway
- College of Health and Behavioral Sciences, Chapman University
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry, Oregon Health & Science University
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry, Oregon Health & Science University
| | - Hildi Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System
- Department of Psychiatry, University of Minnesota School of Medicine
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry, Oregon Health & Science University
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111
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Aberrant plasticity in musculoskeletal pain: a failure of homeostatic control? Exp Brain Res 2021; 239:1317-1326. [PMID: 33635391 DOI: 10.1007/s00221-021-06062-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Aberrant synaptic plasticity is hypothesised to underpin chronic pain. Yet, synaptic plasticity regulated by homeostatic mechanisms have received limited attention in pain. We investigated homeostatic plasticity in the human primary motor cortex (M1) of 21 healthy individuals in response to experimentally induced muscle pain for several days. Experimental pain was induced by injecting nerve growth factor into the muscle belly of the right extensor carpi radialis brevis muscle. Pain and disability were monitored until day 21. Homeostatic plasticity was induced on day 0, 2, 4, 6, and 14 in the left M1 using anodal transcranial direct stimulation (tDCS) applied for 7 and 5 min, separated by a 3-min rest period. Motor-evoked potentials (MEP) to transcranial magnetic stimulation assessed the homeostatic response. On days 0 and 14, MEPs increased following the first block of tDCS (p < 0.004), and decreased following the second block of tDCS (p < 0.001), consistent with a normal homeostatic response. However, on days 2 (p = 0.07) and 4 (p = 0.7), the decrease in MEPs after the second block of tDCS was attenuated, representing an impaired homeostatic response. Findings demonstrate altered homeostatic plasticity in the M1 with the greatest alteration observed after 4 days of sustained pain. This study provides longitudinal insight into homeostatic plasticity in response to the development, maintenance, and resolution of pain over the course of 14 days.
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112
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Teixeira PEP, Pacheco-Barrios K, Gunduz ME, Gianlorenço AC, Castelo-Branco L, Fregni F. Understanding intracortical excitability in phantom limb pain: A multivariate analysis from a multicenter randomized clinical trial. Neurophysiol Clin 2021; 51:161-173. [PMID: 33648819 DOI: 10.1016/j.neucli.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore associations of intracortical excitability with clinical characteristics in a large sample of subjects with phantom limb pain (PLP). METHODS Ancillary study using baseline and longitudinal data from a large multicenter randomized trial that investigated the effects of non-invasive brain stimulation combined with sensorimotor training on PLP. Multivariate regression modeling analyses were used to investigate the association of intracortical excitability, measured by percentages of intracortical inhibition (ICI) and facilitation (ICF) with clinical variables. RESULTS Ninety-eight subjects were included. Phantom sensation of itching was positively associated with ICI changes and at baseline in the affected hemisphere (contralateral to PLP). However, in the non-affected hemisphere (ipsilateral to PLP), the phantom sensation of warmth and PLP intensity were negatively associated with ICI (both models). For the ICF, PLP intensity (baseline model only) and age (longitudinal model) were negatively associated, while time since amputation and amputation level (both for longitudinal model only) were positively associated in the affected hemisphere. Additionally, use of antidepressants led to lower ICF in the non-affected hemisphere for the baseline model while higher amputation level also led to less changes in the ICF. CONCLUSION Results revealed clear associations of clinical variables and cortical excitability in a large chronic pain sample. ICI and ICF changes appear not to be mainly explained by PLP intensity. Instead, other variables associated with duration of neuroplasticity changes (such as age and duration of amputation) and compensatory mechanisms (such as itching and phantom limb sensation) seem to be more important in explaining these variables.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; MGH Institute of Health Professions, Boston, MA, USA; Instituto Wilson Mello, Campinas, SP, Brazil.
| | - Kevin Pacheco-Barrios
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Muhammed Enes Gunduz
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Laboratory of neuroscience, Department of Physical Therapy, Federal University of Sao Carlos, SP, Brazil
| | - Luis Castelo-Branco
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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113
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Intracortical Localization of a Promising Pain Biomarker. J Neurosci 2021; 40:9549-9551. [PMID: 33298597 DOI: 10.1523/jneurosci.1520-20.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
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114
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Midavaine É, Côté J, Marchand S, Sarret P. Glial and neuroimmune cell choreography in sexually dimorphic pain signaling. Neurosci Biobehav Rev 2021; 125:168-192. [PMID: 33582232 DOI: 10.1016/j.neubiorev.2021.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/03/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Abstract
Chronic pain is a major global health issue that affects all populations regardless of sex, age, ethnicity/race, or country of origin, leading to persistent physical and emotional distress and to the loss of patients' autonomy and quality of life. Despite tremendous efforts in the elucidation of the mechanisms contributing to the pathogenesis of chronic pain, the identification of new potential pain targets, and the development of novel analgesics, the pharmacological treatment options available for pain management remain limited, and most novel pain medications have failed to achieve advanced clinical development, leaving many patients with unbearable and undermanaged pain. Sex-specific susceptibility to chronic pain conditions as well as sex differences in pain sensitivity, pain tolerance and analgesic efficacy are increasingly recognized in the literature and have thus prompted scientists to seek mechanistic explanations. Hence, recent findings have highlighted that the signaling mechanisms underlying pain hypersensitivity are sexually dimorphic, which sheds light on the importance of conducting preclinical and clinical pain research on both sexes and of developing sex-specific pain medications. This review thus focuses on the clinical and preclinical evidence supporting the existence of sex differences in pain neurobiology. Attention is drawn to the sexually dimorphic role of glial and immune cells, which are both recognized as key players in neuroglial maladaptive plasticity at the origin of the transition from acute pain to chronic pathological pain. Growing evidence notably attributes to microglial cells a pivotal role in the sexually dimorphic pain phenotype and in the sexually dimorphic analgesic efficacy of opioids. This review also summarizes the recent advances in understanding the pathobiology underpinning the development of pain hypersensitivity in both males and females in different types of pain conditions, with particular emphasis on the mechanistic signaling pathways driving sexually dimorphic pain responses.
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Affiliation(s)
- Élora Midavaine
- Department of Pharmacology-Physiology, Institut de pharmacologie de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada.
| | - Jérôme Côté
- Department of Pharmacology-Physiology, Institut de pharmacologie de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
| | - Serge Marchand
- Department of Pharmacology-Physiology, Institut de pharmacologie de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada
| | - Philippe Sarret
- Department of Pharmacology-Physiology, Institut de pharmacologie de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada.
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115
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Wang C, Liu Y, Dun W, Zhang T, Yang J, Wang K, Mu J, Zhang M, Liu J. Effects of repeated menstrual pain on empathic neural responses in women with primary dysmenorrhea across the menstrual cycle. Hum Brain Mapp 2021; 42:345-356. [PMID: 33030796 PMCID: PMC7775997 DOI: 10.1002/hbm.25226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
Primary dysmenorrhea (PDM) is cyclic menstrual pain in the absence of pelvic anomalies, and it is thought to be a sex-hormone related disorder. Existing study has focused on the effects of menstrual cramps on brain function and structure, ignoring the psychological changes associated with menstrual pain. Here we examined whether pain empathy in PDM differs from healthy controls (HC) using task-based functional magnetic resonance imaging (fMRI). Fifty-seven PDM women and 53 matched HC were recruited, and data were collected at the luteal and menstruation phases, respectively. During fMRI scans, participants viewed pictures displaying exposure to painful situations and pictures without any pain cues and assessed the level of pain experienced by the person in the picture. Regarding the main effect of the pain pictures, our results showed that compared to viewing neutral pictures, viewing pain pictures caused significantly higher activation in the anterior insula (AI), anterior cingulate cortex, and the left inferior parietal lobule; and only the right AI exhibited a significant interaction effect (group × picture). Post-hoc analyses confirmed that, relative to neutral pictures, the right AI failed to be activated in PDM women viewing painsss pictures. Additionally, there was no significant interaction effect between the luteal and menstruation phases. It suggests that intermittent pain can lead to abnormal empathy in PDM women, which does not vary with the pain or pain-free phase. Our study may deepen the understanding of the relationship between recurrent spontaneous pain and empathy in a clinical disorder characterized by cyclic episodes of pain.
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Affiliation(s)
- Chen Wang
- Center for Brain Imaging, School of Life Science and TechnologyXidian UniversityXi'anChina
- Engineering Research Center of Molecular & Neuroimaging,Ministry of EducationXi'anChina
| | - Yang Liu
- Center for Brain Imaging, School of Life Science and TechnologyXidian UniversityXi'anChina
- Engineering Research Center of Molecular & Neuroimaging,Ministry of EducationXi'anChina
| | - Wanghuan Dun
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Tian Zhang
- Center for Brain Imaging, School of Life Science and TechnologyXidian UniversityXi'anChina
- Engineering Research Center of Molecular & Neuroimaging,Ministry of EducationXi'anChina
| | - Jing Yang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ke Wang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and TechnologyXidian UniversityXi'anChina
- Engineering Research Center of Molecular & Neuroimaging,Ministry of EducationXi'anChina
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and TechnologyXidian UniversityXi'anChina
- Engineering Research Center of Molecular & Neuroimaging,Ministry of EducationXi'anChina
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Modeling neural and self-reported factors of affective distress in the relationship between pain and working memory in healthy individuals. Neuropsychologia 2021; 153:107766. [PMID: 33503490 DOI: 10.1016/j.neuropsychologia.2021.107766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/20/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022]
Abstract
The relationship between pain and cognition has primarily been investigated in patients with chronic pain and healthy participants undergoing experimental pain. Recently, there has been interest in understanding the disruptive effects of non-experimental pain in otherwise healthy individuals. Recent studies suggest that healthy individuals reporting pain also demonstrate decrements in working memory (WM) performance, however factors contributing to this relationship remain poorly understood. The present study examined the association between pain and WM in a large community-based sample of healthy individuals and investigated whether self-reported affective distress and medial frontal cortex activity might help to explain this relationship. To address these research questions, a large publicly available dataset from the Human Connectome Project (N = 416) was sourced and structural equation modeling was utilized to examine relationships between pain intensity experienced over the past 7 days, self-reported affective distress, performance on a WM (n-back) task, and task-related activation in the medial frontal cortex. Examining participants who reported non-zero pain intensity in the past 7 days (n = 228), we found a direct negative association between pain intensity and performance on the WM n-back task, consistent with prior findings. Self-reported affective distress was not associated with WM performance. Additionally, pain intensity was indirectly associated with WM performance via WM task-related activity in the ventromedial prefrontal cortex (vmPFC). Our findings suggest that pain experienced in everyday life by otherwise healthy individuals may directly impact WM performance. Furthermore, WM task-related increases in vmPFC activity may be a factor contributing to this relationship.
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117
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Kong J, Huang Y, Liu J, Yu S, Ming C, Chen H, Wilson G, Harvey WF, Li W, Wang C. Altered functional connectivity between hypothalamus and limbic system in fibromyalgia. Mol Brain 2021; 14:17. [PMID: 33472674 PMCID: PMC7816461 DOI: 10.1186/s13041-020-00705-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
The hypothalamus links the nervous system to the endocrine system and plays a crucial role in maintaining the human body's homeostasis. This study aims to investigate the resting state functional connectivity (rsFC) changes of the hypothalamus in fibromyalgia patients. 24 Fibromyalgia patients and 24 matched healthy controls (HCs) were recruited. Resting state fMRI data were collected from the fibromyalgia patients and HC's. Fibromyalgia patients went through a second scan after 12 weeks of Tai Chi mind-body intervention. Data analysis showed that fibromyalgia patients displayed less medial hypothalamus (MH) rsFC with the thalamus and amygdala when compared to the functional connectivity in the HCs. After the Tai Chi mind-body intervention, fibromyalgia patients showed increased MH rsFC with the thalamus and amygdala accompanied by clinical improvement. Effective connectivity analysis showed disrupted MH and thalamus interaction in the fibromyalgia patients, which was altered by mind-body exercise. Our findings suggest that fibromyalgia is associated with altered functional connectivity within the diencephalon and limbic system. Elucidating the roles of the diencephalon and limbic system in the pathophysiology and development of fibromyalgia may facilitate the development of a new biomarker and effective treatment methods for this prevalent disorder.Trial Registration ClinicalTrials.gov, NCT02407665. Registered: 3 April 2015, https://clinicaltrials.gov/ct2/show/NCT02407665?term=NCT02407665&draw=2&rank=1.
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Affiliation(s)
- Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jiao Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Siyi Yu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Cheng Ming
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Helen Chen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center / Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Wen Li
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center / Tufts University School of Medicine, Boston, MA, 02111, USA.
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118
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Zhuang X, Huang L, Gu Y, Wang L, Zhang R, Zhang M, Li F, Shi Y, Mo Y, Dai Q, Wei C, Wang J. The anterior cingulate cortex projection to the dorsomedial striatum modulates hyperalgesia in a chronic constriction injury mouse model. Arch Med Sci 2021; 17:1388-1399. [PMID: 34522268 PMCID: PMC8425248 DOI: 10.5114/aoms.2019.85202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/26/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to study the role of the anterior cingulate cortex (ACC)-dorsal midbrain striatum (DMS) in neuropathic pain in mice. MATERIAL AND METHODS Optogenetics has been increasingly used in neuroscience research to selectively and precisely control the activity of a defined group of central neurons to determine their roles in behavioral functions in animals. The most important opsins are blue-sensitive ChR2 and yellow-sensitive NpHR. Calcium-calmodulin dependent protein kinase Iiα (CaMKIIα) is mostly expressed in the pyramidal excitatory neurons. Mice were injected with AAV2/9-CamKII-ChR2-mCherry, AAV2/9-CamKII-eNpHR3.0-GFP or AAV2/9-CamKII-mCherry virus in the ACC region, and the optical fiber implantation was performed in the ACC or DMS region. Mice were then followed up for 2 to 8 weeks and behavioral tests were carried out in the presence or absence of the blue/yellow light (473 nm/589 nm). Pain behavioral tests with or without the blue/yellow light at the same time were performed on the third and the seventh day after the chronic constriction injury of sciatic nerve model (CCI) was established. The pain thresholds of left and right hind limbs of mice in all groups were measured. RESULTS No matter whether activating the neurons in ACC or DMS, compared with normal mice in the ChR2-off-right group, and the mCherry-on-right group, the thermal pain threshold and mechanical pain threshold of the normal mice in the ChR2-on-right group were significantly lower. When inhibiting the neurons in the ACC or DMS, on day 3 and day 7 after CCI operation, the thermal pain threshold and mechanical pain threshold of the CCI mice of the NpHR-on-right group were significantly higher compared with the NpHR-off-right and mCherry-on-right groups. CONCLUSIONS The anterior cingulate cortex-dorsal midbrain striatum may be involved in the regulation of neuropathic pain in mice.
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Affiliation(s)
- Xiuxiu Zhuang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Luping Huang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Yixiao Gu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Lu Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Rong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Minyuan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Fei Li
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Yiyi Shi
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Yunchang Mo
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Qinxue Dai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Chaoyi Wei
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Junlu Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
- Wencheng Country People’s Hospital, Wenzhou, Zhejiang, China
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119
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Yan M, Chen J, Liu F, Li H, Huang R, Tang Y, Zhao J, Guo W. Disrupted Regional Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest. Front Psychiatry 2021; 12:636820. [PMID: 34122171 PMCID: PMC8187583 DOI: 10.3389/fpsyt.2021.636820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Gastrointestinal (GI) symptoms are prominent in patients with major depressive disorder (MDD). Previous studies have reported brain structural and functional changes in both MDD and digestive system diseases but it remains unclear whether MDD patients with GI symptoms have brain imaging changes. Methods: We recruited 35 MDD patients with GI symptoms, 17 MDD patients without GI symptoms and 28 age-, gender-, and education-matched healthy controls. All participants were scanned by resting-state functional magnetic resonance imaging (fMRI). Imaging data were analyzed with regional homogeneity (ReHo). Results: The GI group showed higher total HRSD-17 scores, anxiety/somatization, weight loss, and sleep disturbance scores compared to the non-GI group. We found increased ReHo in the right inferior parietal gyrus (IPL), bilateral supplementary motor area (SMA), bilateral cerebellum Crus II, left inferior frontal gyrus (IFG), and bilateral superior medial frontal cortex (SMFC) and decreased ReHo in the right posterior cingulate cortex (PCC), bilateral cuneus, and left middle occipital gyrus (MOG) in patients with GI symptoms relative to the HCs. The GI group showed higher ReHo values in the bilateral precuneus than the non-GI group. Conclusion: MDD patients with GI symptoms showed a greater severity of symptoms than MDD patients without GI symptoms, particularly in terms of anxiety/somatization, weight loss, and sleep disturbances. Increased activity in the default-mode network might be associated with GI symptoms in MDD patients.
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Affiliation(s)
- Meiqi Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Renzhi Huang
- Hunan Key Laboratory of Children's Psychological Development and Brain Cognitive Science, Changsha, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
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120
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Huang CH, Lin MC, Hsieh CL. Acupuncture Treatment Reduces Incidence of Parkinson's Disease in Patients With Depression: A Population-Based Retrospective Cohort Study in Taiwan. Front Aging Neurosci 2020; 12:591640. [PMID: 33343332 PMCID: PMC7746549 DOI: 10.3389/fnagi.2020.591640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022] Open
Abstract
Depression is a risk factor for subsequent Parkinson's disease (PD). Some patients with depression undergo acupuncture treatment because of other diseases in Taiwan. Therefore, the present study used data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the incidence of PD in patients having depression with and without acupuncture treatment. We conducted a retrospective study of a matched cohort of 48,981 patients with newly diagnosed depression between 2000 and 2012 who were selected from the NHIRD. The 1:1 propensity score method was utilized to match an equal number of patients (N = 9,189) in the acupuncture and non-acupuncture cohorts. We employed Cox proportional hazard models to evaluate the risk of PD. The cumulative incidence of PD in both cohorts was estimated using the Kaplan–Meier method, and the difference was examined through a log-rank test. Patients with depression who received acupuncture treatment demonstrated a lower risk of PD [adjusted hazard ratio (aHR) = 0.39, 95% confidence interval = 0.31–0.49] than those who did not undergo acupuncture treatment, after adjusting for age, sex, insurance amount, geographic region, urbanization levels, comorbidities, and drugs. The cumulative incidence of PD was significantly lower in the acupuncture cohort than in the non-acupuncture cohort (log-rank test, p < 0.001). The database did not indicate the severity of depression and acupoints. The results suggest that acupuncture treatment significantly reduced the development of PD in patients with depression; however, a future study should be conducted to provide more objective evidence.
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Affiliation(s)
- Cheng-Hao Huang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
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121
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Stomp M, d’Ingeo S, Henry S, Lesimple C, Cousillas H, Hausberger M. EEG individual power profiles correlate with tension along spine in horses. PLoS One 2020; 15:e0243970. [PMID: 33315932 PMCID: PMC7735639 DOI: 10.1371/journal.pone.0243970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
Assessing chronic pain is a challenge given its subjective dimension. In humans, resting state electroencephalography (EEG) is a promising tool although the results of various studies are contradictory. Spontaneous chronic pain is understudied in animals but could be of the highest interest for a comparative study. Riding horses show a very high prevalence of back disorders thought to be associated with chronic pain. Moreover, horses with known back problems show cognitive alterations, such as a lower attentional engagement. Therefore, we hypothesized that the individual EEG power profiles resting state (i.e. quiet standing) of different horses could reflect the state of their back, that we measured using static sEMG, a tool first promoted to assess lower back pain in human patients. Results show that 1) EEG profiles are highly stable at the intra-individual level, 2) horses with elevated back tension showed resting state EEG profiles characterized by more fast (beta and gamma) and less slow (theta and alpha) waves. The proportion of theta waves was particularly negatively correlated with muscular tension along the spine. Moreover, elevated back tension was positively correlated with the frequency of stereotypic behaviours (an "addictive- like" repetitive behavior) performed by the horses in their stall. Resting state quantitative EEG appears therefore as a very promising tool that may allow to assess individual subjective chronic pain experience, beyond more objective measures of tension. These results open new lines of research for a multi-species comparative approach and might reveal very important in the context of animal welfare.
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Affiliation(s)
- Mathilde Stomp
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| | - Serenella d’Ingeo
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
- Department of Veterinary Medicine, Section of Animal Physiology and Behaviour, University of Bari “Aldo Moro”, Bari, Italy
| | - Séverine Henry
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| | - Clémence Lesimple
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| | - Hugo Cousillas
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
| | - Martine Hausberger
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine)—UMR 6552, Paimpont, France
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Innes KE, Sambamoorthi U. The Potential Contribution of Chronic Pain and Common Chronic Pain Conditions to Subsequent Cognitive Decline, New Onset Cognitive Impairment, and Incident Dementia: A Systematic Review and Conceptual Model for Future Research. J Alzheimers Dis 2020; 78:1177-1195. [PMID: 33252087 DOI: 10.3233/jad-200960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Growing evidence suggests that chronic pain and certain chronic pain conditions may increase risk for cognitive decline and dementia. OBJECTIVE In this systematic review, we critically evaluate available evidence regarding the association of chronic pain and specific common chronic pain conditions to subsequent decline in cognitive function, new onset cognitive impairment (CI), and incident Alzheimer's disease and related dementias (ADRD); outline major gaps in the literature; and provide a preliminary conceptual model illustrating potential pathways linking pain to cognitive change. METHODS To identify qualifying studies, we searched seven scientific databases and scanned bibliographies of identified articles and relevant review papers. Sixteen studies met our inclusion criteria (2 matched case-control, 10 retrospective cohort, 2 prospective cohort), including 11 regarding the association of osteoarthritis (N = 4), fibromyalgia (N = 1), or headache/migraine (N = 6) to incident ADRD (N = 10) and/or its subtypes (N = 6), and 5 investigating the relation of chronic pain symptoms to subsequent cognitive decline (N = 2), CI (N = 1), and/or ADRD (N = 3). RESULTS Studies yielded consistent evidence for a positive association of osteoarthritis and migraines/headaches to incident ADRD; however, findings regarding dementia subtypes were mixed. Emerging evidence also suggests chronic pain symptoms may accelerate cognitive decline and increase risk for memory impairment and ADRD, although findings and measures varied considerably across studies. CONCLUSION While existing studies support a link between chronic pain and ADRD risk, conclusions are limited by substantial study heterogeneity, limited investigation of certain pain conditions, and methodological and other concerns characterizing most investigations to date. Additional rigorous, long-term prospective studies are needed to elucidate the effects of chronic pain and specific chronic pain conditions on cognitive decline and conversion to ADRD, and to clarify the influence of potential confounding and mediating factors.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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Huang J, Li Y, Xie H, Yang S, Jiang C, Sun W, Li D, Liao Y, Ba X, Xiao L. Abnormal Intrinsic Brain Activity and Neuroimaging-Based fMRI Classification in Patients With Herpes Zoster and Postherpetic Neuralgia. Front Neurol 2020; 11:532110. [PMID: 33192967 PMCID: PMC7642867 DOI: 10.3389/fneur.2020.532110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/01/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Neuroimaging studies on neuropathic pain have discovered abnormalities in brain structure and function. However, the brain pattern changes from herpes zoster (HZ) to postherpetic neuralgia (PHN) remain unclear. The present study aimed to compare the brain activity between HZ and PHN patients and explore the potential neural mechanisms underlying cognitive impairment in neuropathic pain patients. Methods: Resting-state functional magnetic resonance imaging (MRI) was carried out among 28 right-handed HZ patients, 24 right-handed PHN patients, and 20 healthy controls (HC), using a 3T MRI system. The amplitude of low-frequency fluctuation (ALFF) was analyzed to detect the brain activity of the patients. Correlations between ALFF and clinical pain scales were assessed in two groups of patients. Differences in brain activity between groups were examined and used in a support vector machine (SVM) algorithm for the subjects' classification. Results: Spontaneous brain activity was reduced in both patient groups. Compared with HC, patients from both groups had decreased ALFF in the precuneus, posterior cingulate cortex, and middle temporal gyrus. Meanwhile, the neural activities of angular gyrus and middle frontal gyrus were lowered in HZ and PHN patients, respectively. Reduced ALFF in these regions was associated with clinical pain scales in PHN patients only. Using SVM algorithm, the decreased brain activity in these regions allowed for the classification of neuropathic pain patients (HZ and PHN) and HC. Moreover, HZ and PHN patients are also roughly classified by the same model. Conclusion: Our study indicated that mean ALFF values in these pain-related regions can be used as a functional MRI-based biomarker for the classification of subjects with different pain conditions. Altered brain activity might contribute to PHN-induced pain.
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Affiliation(s)
- Jiabin Huang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Huijun Xie
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Shaomin Yang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Changyu Jiang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Wuping Sun
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Disen Li
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yuliang Liao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xiyuan Ba
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Lizu Xiao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Rocha HA, Marks J, Woods AJ, Staud R, Sibille K, Keil A. Re-test reliability and internal consistency of EEG alpha-band oscillations in older adults with chronic knee pain. Clin Neurophysiol 2020; 131:2630-2640. [PMID: 32947197 PMCID: PMC7815204 DOI: 10.1016/j.clinph.2020.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/18/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Chronic pain studies investigating the ability to detect sensory processing differences related to thalamic gating using electroencephalographic (EEG) alpha have yielded conflicting results. Alpha's basic psychometric properties in pain populations requires further study. The present study reports on the test-retest reliability and internal consistency of EEG alpha power in older adults with chronic knee pain. METHODS Repeated EEG alpha power measurements were taken of older adults (N = 31) with chronic knee pain across two sessions separated by a ten-day period associated with a pilot clinical trial study. Recordings included resting periods (eyes open and eyes closed) as well as periods involving a pain management activity. RESULTS Most single alpha-power measures and all within-participant averages of alpha obtained within a session showed high internal consistency (Cronbach's α > 0.7) and satisfactory-to-excellent re-test reliability (Pearson's rs > 0.6) of both alpha power and alpha blocking (eyes closed minus eyes open) across repeated conditions. CONCLUSIONS EEG alpha power seems mostly reliable and consistent, particularly when participants' eyes are closed, after a period of habituation, and when alpha measures are averaged as within-participant estimates. SIGNIFICANCE This analysis suggests that within-subject averages of EEG alpha are the most reliable for developing indices of chronic knee pain.
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Affiliation(s)
- Harold A Rocha
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA; Department of Psychology, University of Florida, FL, USA.
| | - John Marks
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, FL, USA
| | - Roland Staud
- Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Kimberly Sibille
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Andreas Keil
- Department of Psychology, University of Florida, FL, USA
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125
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Kaido M, Inoue S, Kawashima M, Ishida R, Nakamura S, Tsubota K. Role of transient receptor potential melastatin 8 activity in menthol-induced cold sensitivity and its qualitative perception in dry eye. Ocul Surf 2020; 19:307-312. [PMID: 33127598 DOI: 10.1016/j.jtos.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the role of transient receptor potential melastatin 8 (TRPM8) activity in menthol-induced cold sensitivity and its qualitative perception in patients with dry eye (DE). METHODS This prospective, cross-sectional, comparative study included 52 eyes of 52 subjects (mean age: 66.8 ± 9.2 years; range: 44-86) with a tear break-up time (TBUT) of ≤5 s. The participants were classified into three groups: 17 patients with DE symptoms and keratoconjunctival (KC) staining scores of ≥3 points (positive KC-DE group), 18 patients with DE symptoms and KC staining scores of <3 points (negative KC-DE group), and 17 individuals with KC staining scores of <3 points and no symptoms (non-DE control group). The menthol-induced cool sensation (M-cool) and TBUT were measured after administration of 2 μl of 1.0 mM menthol eye drops. Furthermore, participants answered a questionnaire regarding their stimulus perception (pleasant, unpleasant, or neither). RESULTS M-cool values were similar in the three groups. TBUT significantly increased in the negative KC-DE and control groups (P < 0.05) and remained unchanged in the positive KC-DE group (P > 0.05) after menthol administration. DE patients reported the sensation as pleasant or unpleasant, whereas most control participants were indifferent (P < 0.05). CONCLUSIONS While M-cold sensitivity was similar in DE and control groups, its qualitative perception differed between these groups. Thus, TRPM8 activation at the peripheral level alone may not be sufficient to account for the manifestation of discomfort symptoms associated with DE.
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Affiliation(s)
- Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Wada Eye Clinic, Chiba, Japan; Ishida Eye Clinic, Shizuoka, Japan.
| | - Sachiko Inoue
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Haneginomori Eye Clinic, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Reiko Ishida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Ishida Eye Clinic, Shizuoka, Japan
| | - Shigeru Nakamura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Tsubota Laboratory, Inc., Tokyo, Japan
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126
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Deficits in ascending and descending pain modulation pathways in patients with postherpetic neuralgia. Neuroimage 2020; 221:117186. [DOI: 10.1016/j.neuroimage.2020.117186] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/18/2020] [Accepted: 07/19/2020] [Indexed: 01/19/2023] Open
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Jackson JB, O'Daly O, Makovac E, Medina S, Rubio ADL, McMahon SB, Williams SCR, Howard MA. Noxious pressure stimulation demonstrates robust, reliable estimates of brain activity and self-reported pain. Neuroimage 2020; 221:117178. [PMID: 32707236 PMCID: PMC7762811 DOI: 10.1016/j.neuroimage.2020.117178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Functional neuroimaging techniques have provided great insight in the field of pain. Utilising these techniques, we have characterised pain-induced responses in the brain and improved our understanding of key pain-related phenomena. Despite the utility of these methods, there remains a need to assess the test retest reliability of pain modulated blood-oxygen-level-dependant (BOLD) MR signal across repeated sessions. This is especially the case for more novel yet increasingly implemented stimulation modalities, such as noxious pressure, and it is acutely important for multi-session studies considering treatment efficacy. In the present investigation, BOLD signal responses were estimated for noxious-pressure stimulation in a group of healthy participants, across two separate sessions. Test retest reliability of functional magnetic resonance imaging (fMRI) data and self-reported visual analogue scale measures were determined by the intra-class correlation coefficient. High levels of reliability were observed in several key brain regions known to underpin the pain experience, including in the thalamus, insula, somatosensory cortices, and inferior frontal regions, alongside "excellent" reliability of self-reported pain measures. These data demonstrate that BOLD-fMRI derived signals are a valuable tool for quantifying noxious responses pertaining to pressure stimulation. We further recommend the implementation of pressure as a stimulation modality in experimental applications.
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Affiliation(s)
- Jade B Jackson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Owen O'Daly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Elena Makovac
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sonia Medina
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Stephen B McMahon
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Matthew A Howard
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
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128
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Zhang S, Zhornitsky S, Wang W, Dhingra I, Le TM, Li CSR. Cue-elicited functional connectivity of the periaqueductal gray and tonic cocaine craving. Drug Alcohol Depend 2020; 216:108240. [PMID: 32853997 PMCID: PMC7606798 DOI: 10.1016/j.drugalcdep.2020.108240] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Withdrawal from chronic cocaine use leads to anxiety and dysphoria that may perpetuate habitual drug use. The pain circuit is widely implicated in the processing and manifestations of negative emotions. Numerous studies have focused on characterizing reward circuit dysfunction but relatively little is known about the pain circuit response during cocaine withdrawal. METHODS Here we examined the activity and connectivity of the periaqueductal gray (PAG), a hub of the pain circuit, during cocaine cue exposure in 52 recently abstinent cocaine dependent participants (CD, 42 men). Imaging data were processed with published routines, and the results were evaluated at a corrected threshold. RESULTS CD showed higher activation of the PAG and connectivity of the PAG with the ventromedial prefrontal cortex (vmPFC) during cocaine as compared to neutral cue exposure. PAG-vmPFC connectivity was positively and negatively correlated with tonic cocaine craving, as assessed by the Cocaine Craving Questionnaire, in male and female CD, respectively, and the sex difference was confirmed by a slope test. Granger causality analyses showed that the PAG Granger caused vmPFC time series in men and the reverse was true in women, substantiating sex differences in the directional interactions of the PAG and vmPFC. CONCLUSION The findings provide the first evidence in humans implicating the PAG circuit in cocaine withdrawal and cocaine craving and advance our understanding of the role of the pain circuit and negative reinforcement in sustaining habitual drug use in cocaine addiction.
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Affiliation(s)
- Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Isha Dhingra
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Thang M. Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Neuroscience, Yale University School of Medicine, New Haven, CT,Interdepartmental Neuroscience Program, Yale University, New Haven, CT
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129
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Park BY, Lee JJ, Kim HJ, Woo CW, Park H. A neuroimaging marker for predicting longitudinal changes in pain intensity of subacute back pain based on large-scale brain network interactions. Sci Rep 2020; 10:17392. [PMID: 33060726 PMCID: PMC7567066 DOI: 10.1038/s41598-020-74217-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022] Open
Abstract
Identification of predictive neuroimaging markers of pain intensity changes is a crucial issue to better understand macroscopic neural mechanisms of pain. Although a single connection between the medial prefrontal cortex and nucleus accumbens has been suggested as a powerful marker, how the complex interactions on a large-scale brain network can serve as the markers is underexplored. Here, we aimed to identify a set of functional connections predictive of longitudinal changes in pain intensity using large-scale brain networks. We re-analyzed previously published resting-state functional magnetic resonance imaging data of 49 subacute back pain (SBP) patients. We built a network-level model that predicts changes in pain intensity over one year by combining independent component analysis and a penalized regression framework. Connections involving top-down pain modulation, multisensory integration, and mesocorticolimbic circuits were identified as predictive markers for pain intensity changes. Pearson’s correlations between actual and predicted pain scores were r = 0.33–0.72, and group classification results between SBP patients with persisting pain and recovering patients, in terms of area under the curve (AUC), were 0.89/0.75/0.75 for visits four/three/two, thus outperforming the previous work (AUC 0.83/0.73/0.67). This study identified functional connections important for longitudinal changes in pain intensity in SBP patients, providing provisional markers to predict future pain using large-scale brain networks.
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Affiliation(s)
- Bo-Yong Park
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jae-Joong Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hong Ji Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea. .,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea.
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130
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Mota-Rojas D, Olmos-Hernández A, Verduzco-Mendoza A, Hernández E, Martínez-Burnes J, Whittaker AL. The Utility of Grimace Scales for Practical Pain Assessment in Laboratory Animals. Animals (Basel) 2020; 10:ani10101838. [PMID: 33050267 PMCID: PMC7600890 DOI: 10.3390/ani10101838] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Grimace scales for laboratory animals were first reported ten years ago. Yet, despite their promise as pain assessment tools it appears that they have not been implemented widely in animal research establishments for clinical pain assessment. We discuss potential reasons for this based on the knowledge gained to date on their use and suggest avenues for further research, which might improve uptake of their use in laboratory animal medicine. Abstract Animals’ facial expressions are widely used as a readout for emotion. Scientific interest in the facial expressions of laboratory animals has centered primarily on negative experiences, such as pain, experienced as a result of scientific research procedures. Recent attempts to standardize evaluation of facial expressions associated with pain in laboratory animals has culminated in the development of “grimace scales”. The prevention or relief of pain in laboratory animals is a fundamental requirement for in vivo research to satisfy community expectations. However, to date it appears that the grimace scales have not seen widespread implementation as clinical pain assessment techniques in biomedical research. In this review, we discuss some of the barriers to implementation of the scales in clinical laboratory animal medicine, progress made in automation of collection, and suggest avenues for future research.
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Affiliation(s)
- Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Xochimilco Campus, Ciudad de México 04960, CDMX, Mexico;
| | - Adriana Olmos-Hernández
- Division of Biotechnology—Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Tlalpan 14389, CDMX, Mexico; (A.O.-H.); (A.V.-M.)
| | - Antonio Verduzco-Mendoza
- Division of Biotechnology—Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Tlalpan 14389, CDMX, Mexico; (A.O.-H.); (A.V.-M.)
| | - Elein Hernández
- Department of Clinical Studies and Surgery, Facultad de Estudios Superiores Cuautiltán UNAM, Cuautitlán Izcalli 54714, Estado de México, Mexico;
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Cd Victoria 87000, Tamaulipas, Mexico;
| | - Alexandra L. Whittaker
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, SA 5116, Australia
- Correspondence:
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131
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Physical or Cognitive Exertion Does Not Influence Cortical Movement Preparation for Rapid Arm Movements. Motor Control 2020; 24:473-498. [DOI: 10.1123/mc.2019-0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022]
Abstract
The contribution of central factors to movement preparation (e.g., the contingent negative variation [CNV]) and the influence of fatigue on such factors are still unclear, even though executive cognitive functions are regarded as key elements in motor control. Therefore, this study examined CNV amplitude with electroencephalography in 22 healthy humans during a rapid arm movement task prior to and following three experimental conditions: (a) a no exertion/control condition, (b) a physical exertion, and (c) a cognitive exertion. CNV amplitude was affected neither by a single bout of physical/cognitive exertion nor by the control condition. Furthermore, no time-on-task effects of the rapid arm movement task on the CNV were found. Exertion did not affect cortical movement preparation, which is in contrast to previous findings regarding time-on-task effects of exertion on CNV. Based on the current findings, the rapid arm movement task is deemed suitable to measure cortical movement preparation, without being affected by learning effects and physical/cognitive exertion.
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132
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Wang C, Laiwalla A, Salamon N, Ellingson BM, Holly LT. Compensatory brainstem functional and structural connectivity in patients with degenerative cervical myelopathy by probabilistic tractography and functional MRI. Brain Res 2020; 1749:147129. [PMID: 32950486 DOI: 10.1016/j.brainres.2020.147129] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults. Previous supraspinal investigations have primarily focused on cortical changes in this patient population. As the nexus between the brain and the spinal cord, the brainstem has been understudied in patients with DCM. The current study examined the structural and functional connectivity between the brainstem and cortex in DCM patients using probabilistic tractography and resting-state functional MRI. A total of 26 study patients and 32 neurologically intact, healthy volunteers (HCs) participated in this prospective analysis. The study cohort included DCM patients (n = 18), as well as neurologically asymptomatic patients with evidence of cervical spine degenerative changes and spinal cord compression (n = 8). Results of the study demonstrated significant differences in fiber density (FD), fiber cross-section (FDC), and the functional connectivity (FC) between the study cohort and HCs. Through seeding the brainstem, the study cohort showed reductions in FD and FDC along the corticospinal tract, including regions extending through the corona radiata and internal capsule. By correlating FD and FDC with the Neck Disability Index (NDI), and the modified Japanese Orthopaedic Association (mJOA), we identified increasing total volume of projections to the thalamus, basal ganglia, and internal capsule, and increased functional connectivity to visual network and the posterior parietal cortices. These results support our hypothesis that DCM patients tend to have long-term FC reorganization not only localized to sensorimotor regions, but also to regulatory and visual processing regions, designed to ultimately preserve neurological function.
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Affiliation(s)
- Chencai Wang
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Azim Laiwalla
- Dept. of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Benjamin M Ellingson
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States; Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Langston T Holly
- Dept. of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
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133
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Yu K, Niu X, He B. Neuromodulation Management of Chronic Neuropathic Pain in The Central Nervous system. ADVANCED FUNCTIONAL MATERIALS 2020; 30:1908999. [PMID: 34335132 PMCID: PMC8323399 DOI: 10.1002/adfm.201908999] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 05/05/2023]
Abstract
Neuromodulation is becoming one of the clinical tools for treating chronic neuropathic pain by transmitting controlled physical energy to the pre-identified neural targets in the central nervous system. Its nature of drug-free, non-addictive and improved targeting have attracted increasing attention among neuroscience research and clinical practices. This article provides a brief overview of the neuropathic pain and pharmacological routines for treatment, summarizes both the invasive and non-invasive neuromodulation modalities for pain management, and highlights an emerging brain stimulation technology, transcranial focused ultrasound (tFUS) with a focus on ultrasound transducer devices and the achieved neuromodulation effects and applications on pain management. Practical considerations of spatial guidance for tFUS are discussed for clinical applications. The safety of transcranial ultrasound neuromodulation and its future prospectives on pain management are also discussed.
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Affiliation(s)
| | | | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University
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134
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Mota-Rojas D, Olmos-Hernández A, Verduzco-Mendoza A, Lecona-Butrón H, Martínez-Burnes J, Mora-Medina P, Gómez-Prado J, Orihuela A. Infrared thermal imaging associated with pain in laboratory animals. Exp Anim 2020; 70:1-12. [PMID: 32848100 PMCID: PMC7887630 DOI: 10.1538/expanim.20-0052] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The science of animal welfare has evolved over the years, and recent scientific advances
have enhanced our comprehension of the neurological, physiological, and ethological
mechanisms of diverse animal species. Currently, the study of the affective states
(emotions) of nonhuman animals is attracting great scientific interest focused primarily
on negative experiences such as pain, fear, and suffering, which animals experience in
different stages of their lives or during scientific research. Studies underway today seek
to establish methods of evaluation that can accurately measure pain and then develop
effective treatments for it, because the techniques available up to now are not
sufficiently precise. One innovative technology that has recently been incorporated into
veterinary medicine for the specific purpose of studying pain in animals is called
infrared thermography (IRT), a technique that works by detecting and measuring levels of
thermal radiation at different points on the body’s surface with high sensitivity. Changes
in IRT images are associated mainly with blood perfusion, which is modulated by the
mechanisms of vasodilatation and vasoconstriction. IRT is an efficient, noninvasive method
for evaluating and controlling pain, two critical aspects of animal welfare in biomedical
research. The aim of the present review is to compile and analyze studies of infrared
thermographic changes associated with pain in laboratory research involving animals.
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Affiliation(s)
- Daniel Mota-Rojas
- Neurophysiology, Behaviour and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Xochimilco, Mexico City, C.P. 04960 Mexico
| | - Adriana Olmos-Hernández
- Division of Biotechnology, Department Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, C.P. 14389, Mexico
| | - Antonio Verduzco-Mendoza
- Division of Biotechnology, Department Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, C.P. 14389, Mexico
| | - Hugo Lecona-Butrón
- Division of Biotechnology, Department Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, C.P. 14389, Mexico
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, C.P. Victoria City, Tamaulipas, C.P. 87000, Mexico
| | - Patricia Mora-Medina
- Livestock Science Department, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México (UNAM), State of Mexico, C.P. 54740, Mexico
| | - Jocelyn Gómez-Prado
- Neurophysiology, Behaviour and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Xochimilco, Mexico City, C.P. 04960 Mexico
| | - Agustín Orihuela
- Facultad de Ciencias Agropecuarias, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, C.P. 62209, México
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Abstract
Human and animal imaging studies demonstrated that chronic pain profoundly alters the structure and the functionality of several brain regions. In this article, we conducted a longitudinal and multimodal study to assess how chronic pain affects the brain. Using the spared nerve injury model which promotes both long-lasting mechanical and thermal allodynia/hyperalgesia but also pain-associated comorbidities, we showed that neuropathic pain deeply modified the intrinsic organization of the brain functional network 1 and 2 months after injury. We found that both functional metrics and connectivity of the part A of the retrosplenial granular cortex (RSgA) were significantly correlated with the development of neuropathic pain behaviours. In addition, we found that the functional RSgA connectivity to the subiculum and the prelimbic system are significantly increased in spared nerve injury animals and correlated with peripheral pain thresholds. These brain regions were previously linked to the development of comorbidities associated with neuropathic pain. Using a voxel-based morphometry approach, we showed that neuropathic pain induced a significant increase of the gray matter concentration within the RSgA, associated with a significant activation of both astrocytes and microglial cells. Together, functional and morphological imaging metrics of the RSgA could be used as a predictive biomarker of neuropathic pain.
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136
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Prefrontal White Matter Abnormalities Associated With Pain Catastrophizing in Patients With Complex Regional Pain Syndrome. Arch Phys Med Rehabil 2020; 102:216-224. [PMID: 32791071 DOI: 10.1016/j.apmr.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate altered prefrontal white matter integrity in complex regional pain syndrome (CRPS) and its relation with the degree of pain catastrophizing. DESIGN Cross-sectional study. SETTING University hospital. PARTICIPANTS Twenty-one CRPS patients and 49 patients without CRPS (N=70). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The fractional anisotropy values within the prefrontal regions reflecting the structural integrity of white matter were measured in CRPS patients and patients without CRPS using diffusion tensor imaging. The degree of pain catastrophizing was also evaluated in CRPS patients. RESULTS The structural integrity of the prefrontal white matter was lower in CRPS patients than in patients without CRPS (P=.03). In addition, lower structural integrity in the prefrontal cortex was correlated with a higher degree of pain catastrophizing among CRPS patients (r= -0.54, P=.01). CONCLUSIONS Our findings suggest that pain catastrophizing, which is frequently reported in patients with CRPS, may be associated with the dysfunction of the prefrontal white matter.
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137
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The Pelvic Girdle Pain deadlock: 2. Topics that, so far, have remained out of focus. Musculoskelet Sci Pract 2020; 48:102166. [PMID: 32560869 DOI: 10.1016/j.msksp.2020.102166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In our preceding paper, we concluded that Pelvic Girdle Pain (PGP) should be taken seriously. Still, we do not know its causes. Literature reviews on treatment fail to reveal a consistent pattern, and there are patients who do not respond well to treatment. We designated the lack of progress in research and in the clinic as 'deadlock', and proposed a 'deconstruction' of PGP, that is to say, taking PGP apart into its relevant dimensions. PURPOSE We examine the proposition that PGP may emerge as local inflammation. Inflammation would be a new dimension to be taken into account, between biomechanics and psychology. To explore the consequences of this idea, we present four different topics that, so far, have remained out of focus. One: The importance of microtrauma. Two: Ways to counteract chronification. Three: The importance of sickness behaviour when systemic inflammation turns into neuroinflammation of the brain. And Four: The mainly emotional and cognitive nature of chronic pain, and how aberrant neuroinflammation may render chronic pain intractable. For intractable pain, sleep and stress management are promising treatment options. IMPLICATIONS The authors hope that the present paper helps to stimulate the flexible creativity that is required to deal with the biological and psychological impact of PGP. Measuring inflammatory mediators in PGP should be a research priority. It should be understood that the boundaries between biology and psychology are becoming blurred. Clinicians must frequently monitor pain, disability, and mood, and be ready to switch treatment whenever the patient does not improve.
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Longitudinal translocator protein-18 kDa-positron emission tomography imaging of peripheral and central myeloid cells in a mouse model of complex regional pain syndrome. Pain 2020; 160:2136-2148. [PMID: 31095093 PMCID: PMC6527343 DOI: 10.1097/j.pain.0000000000001607] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is Available in the Text. Longitudinal positron emission tomography of translocator protein-18 kDa revealed early central, and persistent peripheral, myeloid activation in a mouse tibial fracture model of complex regional pain syndrome. Complex regional pain syndrome (CRPS) is a severely disabling disease characterized by pain, temperature changes, motor dysfunction, and edema that most often occurs as an atypical response to a minor surgery or fracture. Inflammation involving activation and recruitment of innate immune cells, including both peripheral and central myeloid cells (ie, macrophages and microglia, respectively), is a key feature of CRPS. However, the exact role and time course of these cellular processes relative to the known acute and chronic phases of the disease are not fully understood. Positron emission tomography (PET) of translocator protein-18 kDa (TSPO) is a method for noninvasively tracking these activated innate immune cells. Here, we reveal the temporal dynamics of peripheral and central inflammatory responses over 20 weeks in a tibial fracture/casting mouse model of CRPS through longitudinal TSPO-PET using [18F]GE-180. Positron emission tomography tracer uptake quantification in the tibia revealed increased peripheral inflammation as early as 2 days after fracture and lasting 7 weeks. Centralized inflammation was detected in the spinal cord and brain of fractured mice at 7 and 21 days after injury. Spinal cord tissue immunofluorescent staining revealed TSPO expression in microglia (CD11b+) at 7 days but was restricted mainly to endothelial cells (PECAM1+) at baseline and 7 weeks. Our data suggest early and persistent peripheral myeloid cell activation and transient central microglial activation are limited to the acute phase of CRPS. Moreover, we show that TSPO-PET can be used to noninvasively monitor the spatiotemporal dynamics of myeloid cell activation in CRPS progression with potential to inform disease phase–specific therapeutics.
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139
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Roy R, de la Vega R, Jensen MP, Miró J. Neurofeedback for Pain Management: A Systematic Review. Front Neurosci 2020; 14:671. [PMID: 32765208 PMCID: PMC7378966 DOI: 10.3389/fnins.2020.00671] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic pain is a significant global health issue. For most individuals with chronic pain, biomedical treatments do not provide adequate relief. Given the evidence that neurophysiological abnormalities are associated with pain, it is reasonable to consider treatments that target these factors, such as neurofeedback (NF). The primary objectives of this review were to summarize the current state of knowledge regarding: (1) the different types of NF and NF protocols that have been evaluated for pain management; (2) the evidence supporting each NF type and protocol; (3) if targeted brain activity changes occur with NF training; and (4) if such brain activity change is associated with improvements on treatment outcomes. Methods: Inclusion criteria were intentionally broad to encompass every empirical study using NF in relation to pain. We considered all kinds of NF, including both electroencephalogram- (EEG-) and functional magnetic resonance imagining- (fMRI-) based. We searched the following databases from inception through September 2019: Pubmed, Ovid, Embase, Web of Science, PsycINFO. The search strategy consisted of a combination of key terms referring to all NF types and pain conditions (e.g., neurofeedback, rt-fMRI-NF, BOLD, pain, migraine). Results: A total of 6,552 citations were retrieved; 24 of these that were included in the review. Most of the studies were of moderate quality, included a control condition and but did not include a follow-up. They focused on studying pain intensity (83%), pain frequency, and other variables (fatigue, sleep, depression) in samples of adults (n = 7-71) with headaches, fibromyalgia and other pain conditions. Most studies (79%) used EEG-based NF. A wide variety of NF types and protocols have been used for pain management aiming to either increase, decrease or regulate brain activity in certain areas theoretically associated with pain. Conclusions: Given the generally positive results in the studies reviewed, the findings indicate that NF procedures have the potential for reducing pain and improving other related outcomes in individuals with chronic pain. However, the current evidence does not provide definitive conclusions or allow for reliable recommendations on which protocols or methods of administration may be the most effective. These findings support the need for continued - but higher quality - research in this area.
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Affiliation(s)
- Rubén Roy
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Tarragona, Spain
| | - Rocío de la Vega
- Center for Child Health, Behavior and Development, Children's Research Institute, Seattle, WA, United States
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Tarragona, Spain
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140
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de Zoete RMJ, Chen K, Sterling M. Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review. BMJ Open 2020; 10:e036151. [PMID: 32636282 PMCID: PMC7342432 DOI: 10.1136/bmjopen-2019-036151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Primary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes. DESIGN Systematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration's Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers. INTERVENTIONS Studies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: any brain outcome assessed with any MR technique. SECONDARY OUTCOMES any self-reported clinical outcomes, and type and dosage of the exercise intervention. RESULTS All four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims. CONCLUSIONS Only a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included. PROSPERO REGISTRATION NUMBER CRD42018108179.
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Affiliation(s)
- Rutger M J de Zoete
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kenneth Chen
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- Geriatric Education and Research Institute, Singapore
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
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Münger M, Pinto CB, Pacheco-Barrios K, Duarte D, Gunduz ME, Simis M, Battistella LR, Fregni F. Protective and Risk Factors for Phantom Limb Pain and Residual Limb Pain Severity. Pain Pract 2020; 20:578-587. [PMID: 32176435 PMCID: PMC7363546 DOI: 10.1111/papr.12881] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The exact mechanisms underlying the development and maintenance of phantom limb pain (PLP) are still unclear. This study aimed to identify the factors affecting pain intensity in patients with chronic, lower limb, traumatic PLP. METHODS This is a cross-sectional analysis of patients with PLP. We assessed amputation-related and pain-related clinical and demographic variables. We used univariate and multivariate models to evaluate the associated factors modulating PLP and residual limb pain (RLP) intensity. RESULTS We included 71 unilateral traumatic lower limb amputees. Results showed that (1) amputation-related perceptions were experienced by a large majority of the patients with chronic PLP (sensations: 90.1%, n = 64; residual pain: 81.7%, n = 58); (2) PLP intensity has 2 significant protective factors (phantom limb movement and having effective treatment for PLP previously) and 2 significant risk factors (phantom limb sensation intensity and age); and (3) on the other hand, for RLP, risk factors are different: presence of pain before amputation and level of amputation (in addition to the same protective factors). CONCLUSION These results suggest different neurobiological mechanisms to explain PLP and RLP intensity. While PLP risk factors seem to be related to maladaptive plasticity, since phantom sensation and older age are associated with more pain, RLP risk factors seem to have components leading to neuropathic pain, such as the amount of neural lesion and previous history of chronic pain. Interestingly, the phantom movement appears to be protective for both phenomena.
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Affiliation(s)
- Marionna Münger
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuropsychology, Institute of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Camila B. Pinto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Dante Duarte
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhamed Enes Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcel Simis
- Department of Physical Medicine and Rehabilitation, Instituto de Reabilitação Lucy Montoro
| | | | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
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Drlicek G, Riegler G, Pivec C, Mayer JA, Paraszti I, Traxler H, Wagner F, Moser V, Bodner G. High-Resolution Ultrasonography of the Transverse Cervical Nerve. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1599-1607. [PMID: 32279894 DOI: 10.1016/j.ultrasmedbio.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/08/2019] [Accepted: 02/04/2020] [Indexed: 06/11/2023]
Abstract
The transverse cervical nerve (TCN) is a superficial cutaneous branch of the cervical plexus that innervates the skin of the anterolateral neck. Therefore, it is exposed to injury in anterolateral cervical surgery, which can cause neuropathic pain. To provide a method with which to relieve patients' pain, this study aimed to evaluate the possibility of visualization, diagnostic assessment and blockade of the TCN with high-resolution ultrasound (HRUS). HRUS with high-frequency probes (15-22 MHz), guided ink-marking and consecutive dissection on both sides in nine fresh cadaver necks (n = 18) was conducted. On both sides of 20 healthy volunteers (n = 40), the distances between the greater auricular nerve (GAN) and the TCN at the posterior border of the sternocleidomastoid muscle were measured. Finally, cases referred to HRUS examinations because suspected TCN lesions were assessed. The TCN was visible in all anatomic specimens and in healthy volunteers. Dissection confirmed HRUS findings in all anatomic specimens (100%). In healthy volunteers, the mean distance between the GAN and the TCN was 10.42 ± 3.20 mm. The median visibility, rated on a five-point Likert scale, was four, reflecting good diagnostic quality. There were six patients with visible abnormalities on HRUS. This study confirmed the reliable visualization of the TCN with HRUS in anatomic specimens, healthy volunteers and patients.
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Affiliation(s)
- Gregor Drlicek
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria.
| | - Georg Riegler
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria
| | | | - Johannes A Mayer
- Medical University of Vienna, Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Vienna, Austria; Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tübingen, Tübingen, Germany
| | - Istvan Paraszti
- Medical University of Vienna, Department of Anatomy, Center for Anatomy and Cell Biology,Vienna, Austria
| | - Hannes Traxler
- Medical University of Vienna, Department of Anatomy, Center for Anatomy and Cell Biology,Vienna, Austria
| | - Florian Wagner
- Medical University of Vienna, Department of Oral and Maxillofacial Surgery,Vienna, Austria
| | - Veith Moser
- Lorenz Boehler Hospital, Department of Trauma Surgery,Vienna, Austria
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Osinski T, Acapo S, Bensmail D, Bouhassira D, Martinez V. Central Nervous System Reorganization and Pain After Spinal Cord Injury: Possible Targets for Physical Therapy-A Systematic Review of Neuroimaging Studies. Phys Ther 2020; 100:946-962. [PMID: 32201890 DOI: 10.1093/ptj/pzaa043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/31/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS). PURPOSE This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs. DATA SOURCES A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018. STUDY SELECTION Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery. DATA EXTRACTION Data were extracted by 2 blinded reviewers. DATA SYNTHESIS There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity. LIMITATIONS AND CONCLUSION Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.
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Affiliation(s)
- Thomas Osinski
- INSERM UMR 987-CETD-Hôpital Ambroise Paré, 9 Avenue Charles De Gaulle, Boulogne-Billancourt, 92100 France; and Université Versailles Saint-Quentin, Versailles, France
| | - Sessi Acapo
- Laboratoire de Thérapeutique, Faculté de Médecine, Université de Nantes, Nantes, France
| | - Djamel Bensmail
- Université Versailles Saint-Quentin; and Service de Médecine Physique et Réadaptation, Hôpital Raymond-Poincaré, Garches, France
| | - Didier Bouhassira
- INSERM UMR 987-CETD-Hôpital Ambroise Paré; and Université Versailles Saint-Quentin
| | - Valéria Martinez
- INSERM UMR 987-CETD-Hôpital Ambroise Paré; Université Versailles Saint-Quentin; Service d'Anesthésie, Hôpital Raymond-Poincaré; and Assistance Publique Hôpitaux de Paris, Garches, France
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The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies. J Clin Med 2020; 9:jcm9061945. [PMID: 32580436 PMCID: PMC7355617 DOI: 10.3390/jcm9061945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain.
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Reconnecting the Brain With the Rest of the Body in Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2020; 22:1-8. [PMID: 32553621 DOI: 10.1016/j.jpain.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/27/2019] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
A challenge in understanding chronic musculoskeletal pain is that research is often siloed between neuroscience, physical therapy/rehabilitation, orthopedics, and rheumatology which focus respectively on 1) neurally mediated effects on pain processes, 2) behavior and muscle activity, 3) tissue structure, and 4) inflammatory processes. Although these disciplines individually study important aspects of pain, there is a need for more cross-disciplinary research that can bridge between them. Identifying the gaps in knowledge is important to understand the whole body, especially at the interfaces between the silos-between brain function and behavior, between behavior and tissue structure, between musculoskeletal and immune systems, and between peripheral tissues and the nervous system. Research on "mind and body" practices can bridge across these silos and encourage a "whole person" approach to better understand musculoskeletal pain by bringing together the brain and the rest of the body. PERSPECTIVE: Research on chronic musculoskeletal pain is limited by significant knowledge gaps. To be fully integrated, musculoskeletal pain research will need to bridge across tissues, anatomical areas, and body systems. Research on mind and body approaches encourages a "whole person" approach to better understand musculoskeletal pain.
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Li C, Lei Y, Tian Y, Xu S, Shen X, Wu H, Bao S, Wang F. The etiological contribution of GABAergic plasticity to the pathogenesis of neuropathic pain. Mol Pain 2020; 15:1744806919847366. [PMID: 30977423 PMCID: PMC6509976 DOI: 10.1177/1744806919847366] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neuropathic pain developing after peripheral or central nerve injury is the result of pathological changes generated through complex mechanisms. Disruption in the homeostasis of excitatory and inhibitory neurons within the central nervous system is a crucial factor in the formation of hyperalgesia or allodynia occurring with neuropathic pain. The central GABAergic pathway has received attention for its extensive distribution and function in neural circuits, including the generation and development of neuropathic pain. GABAergic inhibitory changes that occur in the interneurons along descending modulatory and nociceptive pathways in the central nervous system are believed to generate neuronal plasticity, such as synaptic plasticity or functional plasticity of the related genes or proteins, that is the foundation of persistent neuropathic pain. The primary GABAergic plasticity observed in neuropathic pain includes GABAergic synapse homo- and heterosynaptic plasticity, decreased synthesis of GABA, down-expression of glutamic acid decarboxylase and GABA transporter, abnormal expression of NKCC1 or KCC2, and disturbed function of GABA receptors. In this review, we describe possible mechanisms associated with GABAergic plasticity, such as central sensitization and GABAergic interneuron apoptosis, and the epigenetic etiologies of GABAergic plasticity in neuropathic pain. Moreover, we summarize potential therapeutic targets of GABAergic plasticity that may allow for successful relief of hyperalgesia from nerve injury. Finally, we compare the effects of the GABAergic system in neuropathic pain to other types of chronic pain to understand the contribution of GABAergic plasticity to neuropathic pain.
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Affiliation(s)
- Caijuan Li
- 1 Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yanying Lei
- 2 Department of Stomatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Yi Tian
- 3 Department of Anesthesiology, Haikou Affiliated Hospital of Xiangya Medical School, Central South University, Haikou People's Hospital, Haikou, China
| | - Shiqin Xu
- 1 Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiaofeng Shen
- 1 Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Haibo Wu
- 1 Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Senzhu Bao
- 2 Department of Stomatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Fuzhou Wang
- 1 Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,4 Group of Neuropharmacology and Neurophysiology, Division of Neuroscience, The Bonoi Academy of Science and Education, Chapel Hill, NC, USA
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147
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D’Ippolito M, Purgato A, Buzzi MG. Pain and Evil: From Local Nociception to Misery Following Social Harm. J Pain Res 2020; 13:1139-1154. [PMID: 32547177 PMCID: PMC7250527 DOI: 10.2147/jpr.s236507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/07/2020] [Indexed: 01/03/2023] Open
Abstract
Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.
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Affiliation(s)
| | - Adriano Purgato
- National Health System, Azienda USL Roma 2, Rome00157, Italy
| | - Maria Gabriella Buzzi
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome00179, Italy
- Headache Centre, IRCCS Fondazione Santa Lucia, Rome00179, Italy
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148
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Losin EAR, Woo CW, Medina NA, Andrews-Hanna JR, Eisenbarth H, Wager TD. Neural and sociocultural mediators of ethnic differences in pain. Nat Hum Behav 2020; 4:517-530. [PMID: 32015488 PMCID: PMC7494052 DOI: 10.1038/s41562-020-0819-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 01/05/2020] [Indexed: 02/07/2023]
Abstract
Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity- and gender-balanced sample of African Americans, Hispanics and non-Hispanic Whites using functional magnetic resonance imaging during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased frontostriatal circuit activations associated with pain rating, discrimination, experimenter trust and extranociceptive aspects of pain elsewhere. In contrast, the neurologic pain signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extranociceptive central pain mechanisms and suggest that nociceptive pain processing may be similar across ethnicities.
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Affiliation(s)
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Natalia A Medina
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | - Tor D Wager
- Dartmouth College, Department of Psychology and Brain Sciences, Hanover, NH, USA.
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149
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Salberg S, Noel M, Burke NN, Vinall J, Mychasiuk R. Utilization of a rodent model to examine the neurological effects of early life adversity on adolescent pain sensitivity. Dev Psychobiol 2020; 62:386-399. [DOI: 10.1002/dev.21922] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sabrina Salberg
- Department of Psychology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
| | - Melanie Noel
- Department of Psychology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
| | - Nikita N. Burke
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Comparative Biology & Experimental Medicine, and Physiology & Pharmacology University of Calgary Calgary AB Canada
| | - Jillian Vinall
- Department of Anesthesia University of Calgary Calgary AB Canada
| | - Richelle Mychasiuk
- Department of Psychology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
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150
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De Vroey H, Claeys K, Shariatmadar K, Weygers I, Vereecke E, Van Damme G, Hallez H, Staes F. High Levels of Kinesiophobia at Discharge from the Hospital May Negatively Affect the Short-Term Functional Outcome of Patients Who Have Undergone Knee Replacement Surgery. J Clin Med 2020; 9:jcm9030738. [PMID: 32182895 PMCID: PMC7141217 DOI: 10.3390/jcm9030738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Kinesiophobia is a psycho-cognitive factor that hampers recovery after orthopedic surgery. No evidence exists on the influence of kinesiophobia on the short-term recovery of function in patients with knee replacement (KR). Therefore, the aim of the present study is to investigate the impact of kinesiophobia on short-term patient-reported outcomes (PROMs) and performance-based measures (PBMs). Methods: Forty-three KR patients filled in the Tampa scale for kinesiophobia (TSK) at time of discharge. Patients with TSK ≥ 37 were allocated to the kinesiophobia group (n = 24), others to the no-kinesiophobia group (n = 19). Patients were asked to complete PROMs and to execute PBMs at discharge and at 6-weeks follow-up. An independent samples t-test was used to compare group differences for PROMs and PBMs at both measurement sessions. Multiple linear regression analysis models were used to model PBM outcomes from age, pain and TSK scores. Results: Significant differences were observed between groups for PROMs and PBMs. Kinesiophobia significantly contributed to the reduced functional outcomes. Conclusion: At discharge from the hospital, 55.8% of KR patients demonstrated high levels of kinesiophobia (TSK ≥ 37). This may negatively influence short-term recovery of these patients, by putting them at higher risk for falling and reduced functionality.
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Affiliation(s)
- Henri De Vroey
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
- Correspondence: ; Tel.: +32-473-41-58-71
| | - Kurt Claeys
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
| | - Keivan Shariatmadar
- KU Leuven, Campus Bruges, Department of Mechanical Engineering, Spoorwegstraat 12, 8200 Bruges, Belgium;
| | - Ive Weygers
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
| | - Evie Vereecke
- KU Leuven, Campus Kulak Kortrijk, Department of Development and Regeneration, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium;
| | - Geert Van Damme
- AZ Sint Lucas Hospital, Department of Orthopedic Surgery, Sint-Lucaslaan 29, 8310 Bruges, Belgium;
| | - Hans Hallez
- KU Leuven, Campus Bruges, Department of Computer Science, Spoorwegstraat 12, 8200 Bruges, Belgium;
| | - Filip Staes
- KU Leuven, Campus Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium;
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