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Mochizuki H, Hernandez LE, Yosipovitch G, Sadato N, Kakigi R. The Functional Network Processing Acute Electrical Itch Stimuli in Humans. Front Physiol 2019; 10:555. [PMID: 31156452 PMCID: PMC6529842 DOI: 10.3389/fphys.2019.00555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/23/2019] [Indexed: 01/31/2023] Open
Abstract
The posterior insula (pIns) is a major brain region that receives itch-related signals from the periphery and transfers these signals to broad areas in the brain. Previous brain imaging studies have successfully identified brain regions that respond to itch stimuli. However, it is still unknown which brain regions receive and process itch-related signals from the pIns. Addressing this question is important in identifying key functional networks that process itch. Thus, the present study investigated brain regions with significantly increased functional connectivity with the pIns during itch stimuli with 25 healthy subjects by using functional MRI. Electrical itch stimuli was applied to the left wrist. Similar to previous brain imaging studies, many cortical and subcortical areas were activated by itch stimuli. However, not all of these regions showed significant increments of functional connectivity with the pIns during itch stimuli. While the subjects perceived the itch sensation, functional connectivity was significantly increased between the right pIns and the supplementary motor area (SMA), pre-SMA, anterior midcingulate cortex (aMCC), anterior insula (aIns), secondary somatosensory cortex (SII), and basal ganglia (BG), suggesting that this is a key network in processing itch. In particular, intensity of functional connectivity between the pIns and BG was negatively correlated with itch rating. The functional pIns-BG pathway may play an important role in regulation of subjective itch sensation. This study first identified a key brain network to process itch.
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Affiliation(s)
- Hideki Mochizuki
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan
| | - Loren E Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Norihiro Sadato
- Department of System Neuroscience, National Institute for Physiological Sciences, Okazaki, Japan
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan
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102
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Herpertz SC, Schmitgen MM, Fuchs C, Roth C, Wolf RC, Bertsch K, Flor H, Grinevich V, Boll S. Oxytocin Effects on Pain Perception and Pain Anticipation. THE JOURNAL OF PAIN 2019; 20:1187-1198. [PMID: 31009765 DOI: 10.1016/j.jpain.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/11/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
There is an ongoing debate whether the neuropeptide oxytocin (OT) modulates pain processing in humans. This study differentiates behavioral and neuronal OT effects on pain perception and pain anticipation by using a Pavlovian conditioning paradigm. Forty-six males received intranasally administered OT in a randomized, double-blind, placebo-controlled group design. Although OT exerted no direct effect on perceived pain, OT was found to modulate the blood oxygen level-dependent response in the ventral striatum for painful versus warm unconditioned stimuli and to decrease activity in the anterior insula (IS) with repeated thermal pain stimuli. Regarding pain anticipation, OT increased responses to CSpain versus CSminus in the nucleus accumbens. Furthermore, in the OT condition increased correct expectations, particularly for the most certain conditioned stimuli (CS)-unconditioned stimuli associations (CSminus and CSpain) were found, as well as greatest deactivations in the right posterior IS in response to the least certain condition (CSwarm) with posterior IS activity and correct expectancies being positively correlated. In conclusion, OT seems to have both a direct effect on pain processing via the ventral striatum and by inducing habituation in the anterior IS as well as on pain anticipation by boostering associative learning in general and the neuronal conditioned fear of pain response in particular. PERSPECTIVE: The neuropeptide OT has recently raised the hope to offer a novel avenue for modulating pain experience. This study found OT to modulate pain processing and to facilitate the anticipation of pain, inspiring further research on OT effects on the affective dimension of the pain experience.
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Affiliation(s)
- Sabine C Herpertz
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Mike M Schmitgen
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christine Fuchs
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Corinna Roth
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health Mannheim, University of Heidelberg, Mannheim, Germany
| | - Valery Grinevich
- Schaller Research Group on Neuropeptides, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - Sabrina Boll
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
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103
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Abstract
Primary burning mouth syndrome (BMS) is defined as an "intraoral burning or dysaesthetic sensation, recurring daily… more than 3 months, without clinically evident causative lesions" (IHS 2013). In addition to pain, taste alterations are frequent (dysgeusia, xerostomia). Although lacking clinical signs of neuropathy, more accurate diagnostic methods have shown neuropathic involvement at various levels of the neuraxis in BMS: peripheral small fiber damage (thermal quantitative sensory testing, electrogustatometry, epithelial nerve fiber density), trigeminal system lesions in the periphery or the brainstem (brainstem reflex recordings, trigeminal neurography, evoked potentials), or signs of decreased inhibition within the central nervous system (deficient brainstem reflex habituation, positive signs in quantitative sensory testing, neurotransmitter-positron emission tomography findings indicative of deficient striatal dopamine function). Abnormalities in electrogustatometry indicate the involvement of the small Aδ taste afferents, in addition to somatosensory small fibers. According to these findings, the clinical entity of BMS can be divided into 2 main subtypes compatible with either peripheral or central neuropathic pain, which may overlap in individual patients. The central type does not respond to local treatments and associates often with psychiatric comorbidity (depression or anxiety), whereas the peripheral type responds to peripheral lidocaine blocks and topical clonazepam. Burning mouth syndrome is most prevalent in postmenopausal women, having led to a hypothesis that BMS is triggered as a consequence of nervous system damage caused by neurotoxic factors affecting especially vulnerable small fibers and basal ganglia in a setting of decrease in neuroprotective gonadal hormones and increase in stress hormone levels, typical for menopause.
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104
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Szabó E, Galambos A, Kocsel N, Édes AE, Pap D, Zsombók T, Kozák LR, Bagdy G, Kökönyei G, Juhász G. Association between migraine frequency and neural response to emotional faces: An fMRI study. NEUROIMAGE-CLINICAL 2019; 22:101790. [PMID: 31146320 PMCID: PMC6462777 DOI: 10.1016/j.nicl.2019.101790] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/12/2019] [Accepted: 03/23/2019] [Indexed: 01/03/2023]
Abstract
Previous studies have demonstrated that migraine is associated with enhanced perception and altered cerebral processing of sensory stimuli. More recently, it has been suggested that this sensory hypersensitivity might reflect a more general enhanced response to aversive emotional stimuli. Using functional magnetic resonance imaging and emotional face stimuli (fearful, happy and sad faces), we compared whole-brain activation between 41 migraine patients without aura in interictal period and 49 healthy controls. Migraine patients showed increased neural activation to fearful faces compared to neutral faces in the right middle frontal gyrus and frontal pole relative to healthy controls. We also found that higher attack frequency in migraine patients was related to increased activation mainly in the right primary somatosensory cortex (corresponding to the face area) to fearful expressions and in the right dorsal striatal regions to happy faces. In both analyses, activation differences remained significant after controlling for anxiety and depressive symptoms. These findings indicate that enhanced response to emotional stimuli might explain the migraine trigger effect of psychosocial stressors that gradually leads to increased somatosensory response to emotional clues and thus contributes to the progression or chronification of migraine. First fMRI study to explore neural response to emotional faces in migraine patients Migraine patients showed increased activation to fear in the right frontal regions Migraine frequency was related to enhanced activation to fearful and happy faces Activation in the right S1 and dorsal striatum was linked to migraine frequency Sensitivity to emotional stimuli might have a role in triggering migraine
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Affiliation(s)
- Edina Szabó
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary.
| | - Attila Galambos
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary.
| | - Natália Kocsel
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Nagyvárad square 4, H-1089 Budapest, Hungary.
| | - Andrea Edit Édes
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Nagyvárad square 4, H-1089 Budapest, Hungary.
| | - Dorottya Pap
- Department of Neurology, Faculty of Medicine, Semmelweis University, Balassa street 6, H-1083 Budapest, Hungary
| | - Terézia Zsombók
- MR Research Center, Semmelweis University, Balassa street 6, H-1083 Budapest, Hungary
| | - Lajos Rudolf Kozák
- Neuroscience and Psychiatry Unit, The University of Manchester and Manchester Academic Health Sciences Centre, Stopford Building, Oxford Road, Manchester, United Kingdom.
| | - György Bagdy
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Nagyvárad square 4, H-1089 Budapest, Hungary.
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Izabella street 46, H-1064 Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Nagyvárad square 4, H-1089 Budapest, Hungary.
| | - Gabriella Juhász
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Üllői Street 26, H-1085 Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Nagyvárad square 4, H-1089 Budapest, Hungary; Neuroscience and Psychiatry Unit, The University of Manchester and Manchester Academic Health Sciences Centre, Stopford Building, Oxford Road, Manchester, United Kingdom.
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105
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Ruffle JK, Patel A, Giampietro V, Howard MA, Sanger GJ, Andrews PLR, Williams SCR, Aziz Q, Farmer AD. Functional brain networks and neuroanatomy underpinning nausea severity can predict nausea susceptibility using machine learning. J Physiol 2019; 597:1517-1529. [PMID: 30629751 PMCID: PMC6418775 DOI: 10.1113/jp277474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
KEY POINTS Nausea is an adverse experience characterised by alterations in autonomic and cerebral function. Susceptibility to nausea is difficult to predict, but machine learning has yet to be applied to this field of study. The severity of nausea that individuals experience is related to the underlying morphology (shape) of the subcortex, namely of the amygdala, caudate and putamen; a functional brain network related to nausea severity was identified, which included the thalamus, cingulate cortices (anterior, mid- and posterior), caudate nucleus and nucleus accumbens. Sympathetic nervous system function and sympathovagal balance, by heart rate variability, was closely related to both this nausea-associated anatomical variation and the functional connectivity network, and machine learning accurately predicted susceptibility or resistance to nausea. These novel anatomical and functional brain biomarkers for nausea severity may permit objective identification of individuals susceptible to nausea, using artificial intelligence/machine learning; brain data may be useful to identify individuals more susceptible to nausea. ABSTRACT Nausea is a highly individual and variable experience. The central processing of nausea remains poorly understood, although numerous influential factors have been proposed, including brain structure and function, as well as autonomic nervous system (ANS) activity. We investigated the role of these factors in nausea severity and if susceptibility to nausea could be predicted using machine learning. Twenty-eight healthy participants (15 males; mean age 24 years) underwent quantification of resting sympathetic and parasympathetic nervous system activity by heart rate variability. All were exposed to a 10-min motion-sickness video during fMRI. Neuroanatomical shape differences of the subcortex and functional brain networks associated with the severity of nausea were investigated. A machine learning neural network was trained to predict nausea susceptibility, or resistance, using resting ANS data and detected brain features. Increasing nausea scores positively correlated with shape variation of the left amygdala, right caudate and bilateral putamen (corrected P = 0.05). A functional brain network linked to increasing nausea severity was identified implicating the thalamus, anterior, middle and posterior cingulate cortices, caudate nucleus and nucleus accumbens (corrected P = 0.043). Both neuroanatomical differences and the functional nausea-brain network were closely related to sympathetic nervous system activity. Using these data, a machine learning model predicted susceptibility to nausea with an overall accuracy of 82.1%. Nausea severity relates to underlying subcortical morphology and a functional brain network; both measures are potential biomarkers in trials of anti-nausea therapies. The use of machine learning should be further investigated as an objective means to develop models predicting nausea susceptibility.
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Affiliation(s)
- James K. Ruffle
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of NeurogastroenterologyBarts and the London School of Medicine & DentistryQueen Mary University of London26 Ashfield StreetLondonE1 2AJUK
| | - Anya Patel
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of NeurogastroenterologyBarts and the London School of Medicine & DentistryQueen Mary University of London26 Ashfield StreetLondonE1 2AJUK
| | - Vincent Giampietro
- Department of NeuroimagingKing's College LondonInstitute of PsychiatryPsychology & NeuroscienceLondonSE5 8AFUK
| | - Matthew A. Howard
- Department of NeuroimagingKing's College LondonInstitute of PsychiatryPsychology & NeuroscienceLondonSE5 8AFUK
| | - Gareth J. Sanger
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of NeurogastroenterologyBarts and the London School of Medicine & DentistryQueen Mary University of London26 Ashfield StreetLondonE1 2AJUK
| | - Paul L. R. Andrews
- Division of Biomedical SciencesSt George's University of LondonLondonSW17 0REUK
| | - Steven C. R. Williams
- Department of NeuroimagingKing's College LondonInstitute of PsychiatryPsychology & NeuroscienceLondonSE5 8AFUK
| | - Qasim Aziz
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of NeurogastroenterologyBarts and the London School of Medicine & DentistryQueen Mary University of London26 Ashfield StreetLondonE1 2AJUK
| | - Adam D. Farmer
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of NeurogastroenterologyBarts and the London School of Medicine & DentistryQueen Mary University of London26 Ashfield StreetLondonE1 2AJUK
- Institute of Applied Clinical SciencesUniversity of KeeleKeeleST5 5BGUK
- Department of GastroenterologyUniversity Hospitals of North Midlands NHS TrustStoke on TrentST6 8QGUK
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106
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De Martino E, Seminowicz DA, Schabrun SM, Petrini L, Graven-Nielsen T. High frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex modulates sensorimotor cortex function in the transition to sustained muscle pain. Neuroimage 2019; 186:93-102. [DOI: 10.1016/j.neuroimage.2018.10.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022] Open
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107
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The Pain of Sleep Loss: A Brain Characterization in Humans. J Neurosci 2019; 39:2291-2300. [PMID: 30692228 DOI: 10.1523/jneurosci.2408-18.2018] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/24/2022] Open
Abstract
Sleep loss increases the experience of pain. However, the brain mechanisms underlying altered pain processing following sleep deprivation are unknown. Moreover, it remains unclear whether ecologically modest night-to-night changes in sleep, within an individual, confer consequential day-to-day changes in experienced pain. Here, we demonstrate that acute sleep deprivation amplifies pain reactivity within human (male and female) primary somatosensory cortex yet blunts pain reactivity in higher-order valuation and decision-making regions of the striatum and insula cortex. Consistent with this altered neural signature, we further show that sleep deprivation expands the temperature range for classifying a stimulus as painful, specifically through a lowering of pain thresholds. Moreover, the degree of amplified reactivity within somatosensory cortex following sleep deprivation significantly predicts this expansion of experienced pain across individuals. Finally, outside of the laboratory setting, we similarly show that even modest nightly changes in sleep quality (increases and decreases) within an individual determine consequential day-to-day changes in experienced pain (decreases and increases, respectively). Together, these data provide a novel framework underlying the impact of sleep loss on pain and, furthermore, establish that the association between sleep and pain is expressed in a night-to-day, bidirectional relationship within a sample of the general population. More broadly, our findings highlight sleep as a novel therapeutic target for pain management within and outside the clinic, including circumstances where sleep is frequently short yet pain is abundant (e.g., the hospital setting).SIGNIFICANCE STATEMENT Are you experiencing pain? Did you have a bad night of sleep? This study provides underlying brain and behavioral mechanisms explaining this common co-occurrence. We show that sleep deprivation enhances pain responsivity within the primary sensing regions of the brain's cortex yet blunts activity in other regions that modulate pain processing, the striatum and insula. We further establish that even subtle night-to-night changes in sleep in a sample of the general population predict consequential day-to-day changes in pain (bidirectionally). Considering the societal rise in chronic pain conditions in lock-step with the decline in sleep time through the industrial world, our data support the hypothesis that these two trends may not simply be co-occurring but are significantly interrelated.
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108
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Hansen MS, Becerra L, Dahl JB, Borsook D, Mårtensson J, Christensen A, Nybing JD, Havsteen I, Boesen M, Asghar MS. Brain resting-state connectivity in the development of secondary hyperalgesia in healthy men. Brain Struct Funct 2019; 224:1119-1139. [PMID: 30631932 DOI: 10.1007/s00429-018-01819-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/16/2018] [Indexed: 01/25/2023]
Abstract
Central sensitization is a condition in which there is an abnormal responsiveness to nociceptive stimuli. As such, the process may contribute to the development and maintenance of pain. Factors influencing the propensity for development of central sensitization have been a subject of intense debate and remain elusive. Injury-induced secondary hyperalgesia can be elicited by experimental pain models in humans, and is believed to be a result of central sensitization. Secondary hyperalgesia may thus reflect the individual level of central sensitization. The objective of this study was to investigate possible associations between increasing size of secondary hyperalgesia area and brain connectivity in known resting-state networks. We recruited 121 healthy participants (male, age 22, SD 3.35) who underwent resting-state functional magnetic resonance imaging. Prior to the scan session, areas of secondary hyperalgesia following brief thermal sensitization (3 min. 45 °C heat stimulation) were evaluated in all participants. 115 participants were included in the final analysis. We found a positive correlation (increasing connectivity) with increasing area of secondary hyperalgesia in the sensorimotor- and default mode networks. We also observed a negative correlation (decreasing connectivity) with increasing secondary hyperalgesia area in the sensorimotor-, fronto-parietal-, and default mode networks. Our findings indicate that increasing area of secondary hyperalgesia is associated with increasing and decreasing connectivity in multiple networks, suggesting that differences in the propensity for central sensitization, assessed as secondary hyperalgesia areas, may be expressed as differences in the resting-state central neuronal activity.
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Affiliation(s)
- Morten Sejer Hansen
- Department of Anaesthesiology, 4231, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Lino Becerra
- Invicro, A Konica Minolta Company, 27 Drydock Avenue, 7th Floor West, Boston, MA, 02210, USA
| | - Jørgen Berg Dahl
- Department of Anaesthesiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - David Borsook
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johan Mårtensson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Box 213, 221 00, Lund, Sweden
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Mikael Boesen
- Department of Radiology and the Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Mohammad Sohail Asghar
- Department of Neuroanaesthesiology, Neurocentre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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109
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Ou Y, Su Q, Liu F, Ding Y, Chen J, Zhang Z, Zhao J, Guo W. Increased Nucleus Accumbens Connectivity in Resting-State Patients With Drug-Naive, First-Episode Somatization Disorder. Front Psychiatry 2019; 10:585. [PMID: 31474890 PMCID: PMC6706814 DOI: 10.3389/fpsyt.2019.00585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
The nucleus accumbens (NAc) plays an important role in the reward circuit, and abnormal regional activities of the reward circuit have been reported in various psychiatric disorders including somatization disorder (SD). However, few researches are designed to analyze the NAc connectivity in SD. This study was designed to explore the NAc connectivity in first-episode, drug-naive patients with SD using the bilateral NAc as seeds. Twenty-five first-episode, drug-naive patients with SD and 28 healthy controls were recruited. Functional connectivity (FC) was designed to analyze the images. LIBSVM (a library for support vector machines) was used to identify whether abnormal FC could be utilized to discriminate the patients from the controls. The patients showed significantly increased FC between the left NAc and the right gyrus rectus and left medial prefrontal cortex/anterior cingulate cortex (MPFC/ACC), and between the right NAc and the left gyrus rectus and left MPFC/ACC compared with the controls. The patients could be separated from the controls through increased FC between the left NAc and the right gyrus rectus with a sensitivity of 88.00% and a specificity of 82.14%. The findings reveal that patients with SD have increased NAc connectivity with the frontal regions of the reward circuit. Increased left NAc-right gyrus rectus connectivity can be used as a potential marker to discriminate patients with SD from healthy controls. The study thus highlights the importance of the reward circuit in the neuropathology of SD.
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Affiliation(s)
- Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Qinji Su
- Mental Health Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yudan Ding
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Zhikun Zhang
- Mental Health Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
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110
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Blanchet PJ, Brefel-Courbon C. Chronic pain and pain processing in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:200-206. [PMID: 29031913 DOI: 10.1016/j.pnpbp.2017.10.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/26/2017] [Accepted: 10/07/2017] [Indexed: 12/24/2022]
Abstract
Pain is experienced by the vast majority of patients living with Parkinson's disease. It is most often of nociceptive origin, but may also be ascribed to neuropathic (radicular or central) or miscellaneous sources. The recently validated King's Parkinson's Disease Pain Scale is based on 7 domains including musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, oro-facial pain, pain with discolouration/oedema/swelling, and radicular pain. The basal ganglia integrate incoming nociceptive information and contribute to coordinated motor responses in pain avoidance and nocifensive behaviors. In Parkinson's disease, nigral and extra-nigral pathology, involving cortical areas, brainstem nuclei, and spinal cord, may contribute to abnormal central nociceptive processing in patients experiencing pain or not. The dopamine deficit lowers multimodal pain thresholds that are amenable to correction following levodopa dosing. Functional brain imaging with positron emission tomography following administration of H215O revealed abnormalities in the sensory discriminative processing of pain (insula/SII), as well as in the affective motivational processing of pain (anterior cingulate cortex, prefrontal cortex). Pain management is dependent on efforts invested in diagnostic accuracy to distinguish nociceptive from neuropathic pain. Treatment requires an integrated approach including strategies to lessen levodopa-related response fluctuations, in addition to other pharmacological and non-pharmacological options such as deep brain stimulation and rehabilitation.
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Affiliation(s)
- Pierre J Blanchet
- Department of Stomatology, Faculty of Dental Medicine, Université de Montréal; Montréal, QC, Canada; Service de neurologie, CHU Montréal, Montréal, QC, Canada.
| | - Christine Brefel-Courbon
- Service de Pharmacologie Clinique, Faculty of Medicine, University Hospital, Toulouse, France; Service de neurologie B8, Pierre Paul Riquet Hospital, University Hospital, Toulouse, France.
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111
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Reddan MC, Wager TD. Brain systems at the intersection of chronic pain and self-regulation. Neurosci Lett 2018; 702:24-33. [PMID: 30503923 DOI: 10.1016/j.neulet.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is a multidimensional experience with cognitive, affective, and somatosensory components that can be modified by expectations and learning. Individual differences in cognitive and affective processing, as well as contextual aspects of the pain experience, render chronic pain an inherently personal experience. Such individual differences are supported by the heterogeneity of brain representations within and across chronic pain pathologies. In this review, we discuss the complexity of brain representations of pain, and, with respect to this complexity, identify common elements of network-level disruptions in chronic pain. Specifically, we identify prefrontal-limbic circuitry and the default mode network as key elements of functional disruption. We then discuss how these disrupted circuits can be targeted through self-regulation and related cognitive strategies to alleviate chronic pain. We conclude with a proposal for how to develop personalized multivariate models of pain representation in the brain and target them with real-time neurofeedback, so that patients can explore and practice self-regulatory techniques with maximal efficiency.
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Affiliation(s)
| | - Tor D Wager
- University of Colorado, Boulder, United States.
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112
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Bishop JH, Shpaner M, Kubicki A, Clements S, Watts R, Naylor MR. Structural network differences in chronic muskuloskeletal pain: Beyond fractional anisotropy. Neuroimage 2018; 182:441-455. [DOI: 10.1016/j.neuroimage.2017.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/29/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022] Open
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113
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Zhang S, Li T, Kobinata H, Ikeda E, Ota T, Kurata J. Attenuation of offset analgesia is associated with suppression of descending pain modulatory and reward systems in patients with chronic pain. Mol Pain 2018; 14:1744806918767512. [PMID: 29592786 PMCID: PMC5882045 DOI: 10.1177/1744806918767512] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Offset analgesia is a disproportionate decrease of pain perception following a slight decrease of noxious thermal stimulus and attenuated in patients with neuropathic pain. We examined offset analgesia in patients with heterogeneous chronic pain disorders and used functional magnetic resonance imaging to explore modification of cerebral analgesic responses in comparison with healthy controls. Results We recruited seventeen patients with chronic pain and seventeen age-, sex-matched healthy controls. We gave a noxious thermal stimulation paradigm including offset analgesia and control stimuli on the left volar forearm, while we obtained a real-time continuous pain rating and a whole-brain functional magnetic resonance imaging. Baseline, first plateau (5 s), increment (5 s), and second plateau (20 s) temperatures of offset analgesia stimulus were set at 32°C, 46°C, 47°C, and 46°C, respectively. Control stimulus included 30-s 46°C stimulus or only the first 10 s of offset analgesia stimulus. We evaluated magnitude of offset analgesia, analyzed cerebral activation by thermal stimulation, and further compared offset analgesia-related activation between the groups. Magnitude of offset analgesia was larger in controls than in patients (median: 28.9% (interquartile range: 11.0–56.0%) vs. 19.0% (4.2–48.7%), p = 0.047). During the second plateau, controls showed a larger blood oxygenation level-dependent activation than patients at the putamen, anterior cingulate, dorsolateral prefrontal cortices, nucleus accumbens, brainstem, and medial prefrontal cortex (p < 0.05), which are known to mediate either of descending pain modulation or reward responses. Offset analgesia-related activity at the anterior cingulate cortex was negatively correlated with neuropathic component of pain in patients with chronic pain (p = 0.004). Conclusions Attenuation of offset analgesia was associated with suppressed activation of the descending pain modulatory and reward systems in patients with chronic pain, at least in the studied cohort. The present findings might implicate both behavioral and cerebral plastic alterations contributing to chronification of pain. Clinical trial registry: The Japanese clinical trials registry (UMIN-CTR, No. UMIN000011253; http://www.umin.ac.jp/ctr/)
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Affiliation(s)
- Shuo Zhang
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Tianjiao Li
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Hiroyuki Kobinata
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Eri Ikeda
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Takashi Ota
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Jiro Kurata
- 2 Department of Anesthesiology and Pain Clinic, 13100 Tokyo Medical and Dental University Hospital of Medicine, Japan
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114
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Eggink H, Szlufik S, Coenen MA, van Egmond ME, Moro E, Tijssen MA. Non-motor effects of deep brain stimulation in dystonia: A systematic review. Parkinsonism Relat Disord 2018; 55:26-44. [DOI: 10.1016/j.parkreldis.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 12/15/2022]
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115
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Ruffle JK, Coen SJ, Giampietro V, Williams SCR, Aziz Q, Farmer AD. Preliminary report: parasympathetic tone links to functional brain networks during the anticipation and experience of visceral pain. Sci Rep 2018; 8:13410. [PMID: 30194351 PMCID: PMC6128833 DOI: 10.1038/s41598-018-31522-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
The mechanisms that underpin the anti-nociceptive effect of the parasympathetic nervous system (PNS) on visceral pain remain incompletely understood. We sought to describe the effect of resting parasympathetic tone on functional brain networks during the anticipation and experience of oesophageal pain. 21 healthy participants had their resting cardiac vagal tone (CVT), a validated measure of the PNS, quantified, and underwent functional magnetic resonance imaging during the anticipation and experience of painful oesophageal distention. The relationship between resting CVT and functional brain networks was examined using 11 hypothesis-driven nodes and network-based statistics. A network comprising all nodes was apparent in individuals with high resting CVT, compared to those with low CVT, during oesophageal pain (family wise error rate (FWER)-corrected p < 0.048). Functional connections included the thalamus-amygdala, thalamus-hypothalamus, hypothalamus-nucleus accumbens, amygdala-pallidum, pallidum-nucleus accumbens and insula-pallidum. A smaller network was seen during pain anticipation, comprising the amygdala, pallidum and anterior insula (FWER-corrected p < 0.049). These findings suggest that PNS tone is associated with functional brain networks during the anticipation and experience of visceral pain. Given the role of these subcortical regions in the descending inhibitory modulation of pain, these networks may represent a potential neurobiological explanation for the anti-nociceptive effect of the PNS.
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Affiliation(s)
- James K Ruffle
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK
| | - Steven J Coen
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Vincent Giampietro
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, SE5 8AF, UK
| | - Steven C R Williams
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, SE5 8AF, UK
| | - Qasim Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK.
| | - Adam D Farmer
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK.,Institute of Applied Clinical Sciences, University of Keele, Keele, Staffordshire, ST5 5BG, UK
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116
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Lichtner G, Auksztulewicz R, Velten H, Mavrodis D, Scheel M, Blankenburg F, von Dincklage F. Nociceptive activation in spinal cord and brain persists during deep general anaesthesia. Br J Anaesth 2018; 121:291-302. [DOI: 10.1016/j.bja.2018.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
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117
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Ghaziri J, Tucholka A, Girard G, Boucher O, Houde JC, Descoteaux M, Obaid S, Gilbert G, Rouleau I, Nguyen DK. Subcortical structural connectivity of insular subregions. Sci Rep 2018; 8:8596. [PMID: 29872212 PMCID: PMC5988839 DOI: 10.1038/s41598-018-26995-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/18/2018] [Indexed: 12/19/2022] Open
Abstract
Hidden beneath the Sylvian fissure and sometimes considered as the fifth lobe of the brain, the insula plays a multi-modal role from its strategic location. Previous structural studies have reported cortico-cortical connections with the frontal, temporal, parietal and occipital lobes, but only a few have looked at its connections with subcortical structures. The insular cortex plays a role in a wide range of functions including processing of visceral and somatosensory inputs, olfaction, audition, language, motivation, craving, addiction and emotions such as pain, empathy and disgust. These functions implicate numerous subcortical structures, as suggested by various functional studies. Based on these premises, we explored the structural connectivity of insular ROIs with the thalamus, amygdala, hippocampus, putamen, globus pallidus, caudate nucleus and nucleus accumbens. More precisely, we were interested in unraveling the specific areas of the insula connected to these subcortical structures. By using state-of-the-art HARDI tractography algorithm, we explored here the subcortical connectivity of the insula.
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Affiliation(s)
- Jimmy Ghaziri
- Département de psychologie, Université du Québec à Montréal, Montréal, Qc, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada
| | - Alan Tucholka
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Gabriel Girard
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Olivier Boucher
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada.,Département de psychologie, Université de Montréal, Montréal, Qc, Canada
| | - Jean-Christophe Houde
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Sami Obaid
- Service de Neurochirurgie, Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada
| | | | - Isabelle Rouleau
- Département de psychologie, Université du Québec à Montréal, Montréal, Qc, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada. .,Service de Neurologie, Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada.
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118
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Vega E, Beaulieu Y, Gauvin R, Ferland C, Stabile S, Pitt R, Gonzalez Cardenas VH, Ingelmo PM. Chronic non-cancer pain in children: we have a problem, but also solutions. Minerva Anestesiol 2018; 84:1081-1092. [PMID: 29745621 DOI: 10.23736/s0375-9393.18.12367-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic non-cancer pain in children and adolescents has been described as "a modern public health disaster" that has generated significant medical and economic burdens within society. Seen as a disease in its own right, chronic pain has short and long-term consequences that impact not only the patient's health but also that of friends and families, due to significant parenting stress and disruptions in family life and structure. The evidence supporting pharmacological treatments and interventional procedures is limited, and no single strategy has been shown to be completely effective in children with chronic non-cancer pain. Therefore, considering the multifactorial nature of chronic pain, these patients should be treated with a multidisciplinary, balanced approach that seeks a primary outcome of improved functioning rather than of pain reduction. Using a bio-psycho-social approach, a multidisciplinary team, including a physiotherapist, nurse, social worker, psychologist, and physician, has been effective in achieving this outcome of improved functioning in children and adolescents with chronic pain. In this review, we discuss the impact, associated conditions, and evolution of chronic pain, along with the crucial role of every member of a multidisciplinary chronic pain clinic involved in the care of the children and adolescents with chronic non-cancer pain.
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Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yves Beaulieu
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rachel Gauvin
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Catherine Ferland
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Stephanie Stabile
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rebecca Pitt
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Victor H Gonzalez Cardenas
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,University Foundation for Health Sciences, Bogotá, Colombia
| | - Pablo M Ingelmo
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada - .,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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119
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Abstract
Pain is a frequent but still neglected nonmotor symptom of Parkinson disease (PD). However, neural mechanisms underlying pain in PD are poorly understood. Here, we explored whether the high prevalence of pain in PD might be related to dysfunctional descending pain control. Using functional magnetic resonance imaging we explored neural responses during the anticipation and processing of heat pain in 21 PD patients (Hoehn and Yahr I-III) and 23 healthy controls (HC). Parkinson disease patients were naive to dopaminergic medication to avoid confounding drug effects. Fifteen heat pain stimuli were applied to the participants' forearm. Intensity and unpleasantness ratings were provided for each stimulus. Subjective pain perception was comparable for PD patients and HC. Neural processing, however, differed between groups: PD patients showed lower activity in several descending pain modulation regions (dorsal anterior cingulate cortex [dACC], subgenual anterior cingulate cortex, and dorsolateral prefrontal cortex [DLPFC]) and lower functional connectivity between dACC and DLPFC during pain anticipation. Parkinson disease symptom severity was negatively correlated with dACC-DLPFC connectivity indicating impaired functional coupling of pain modulatory regions with disease progression. During pain perception PD patients showed higher midcingulate cortex activity compared with HC, which also scaled with PD severity. Interestingly, dACC-DLPFC connectivity during pain anticipation was negatively associated with midcingulate cortex activity during the receipt of pain in PD patients. This study indicates altered neural processing during the anticipation and receipt of experimental pain in drug-naive PD patients. It provides first evidence for a progressive decline in descending pain modulation in PD, which might be related to the high prevalence of pain in later stages of PD.
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120
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Chen Y, Wang R, Hou B, Feng F, Fang X, Zhu L, Sun X, Wang Z, Ke M. Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study. J Neurogastroenterol Motil 2018; 24:268-279. [PMID: 29605982 PMCID: PMC5885726 DOI: 10.5056/jnm17076] [Citation(s) in RCA: 12] [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: 06/22/2017] [Revised: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 01/26/2023] Open
Abstract
Background/Aims Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. Methods Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. Results For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). Conclusions Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.
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Affiliation(s)
- Yanwen Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastroenterology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruifeng Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastroenterology, No.4 Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohong Sun
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhifeng Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meiyun Ke
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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121
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Baarbé JK, Yielder P, Haavik H, Holmes MWR, Murphy BA. Subclinical recurrent neck pain and its treatment impacts motor training-induced plasticity of the cerebellum and motor cortex. PLoS One 2018; 13:e0193413. [PMID: 29489878 PMCID: PMC5831387 DOI: 10.1371/journal.pone.0193413] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/09/2018] [Indexed: 12/21/2022] Open
Abstract
The cerebellum processes pain inputs and is important for motor learning. Yet, how the cerebellum interacts with the motor cortex in individuals with recurrent pain is not clear. Functional connectivity between the cerebellum and motor cortex can be measured by a twin coil transcranial magnetic stimulation technique in which stimulation is applied to the cerebellum prior to stimulation over the motor cortex, which inhibits motor evoked potentials (MEPs) produced by motor cortex stimulation alone, called cerebellar inhibition (CBI). Healthy individuals without pain have been shown to demonstrate reduced CBI following motor acquisition. We hypothesized that CBI would not reduce to the same extent in those with mild-recurrent neck pain following the same motor acquisition task. We further hypothesized that a common treatment for neck pain (spinal manipulation) would restore reduced CBI following motor acquisition. Motor acquisition involved typing an eight-letter sequence of the letters Z,P,D,F with the right index finger. Twenty-seven neck pain participants received spinal manipulation (14 participants, 18–27 years) or sham control (13 participants, 19–24 years). Twelve healthy controls (20–27 years) also participated. Participants had CBI measured; they completed manipulation or sham control followed by motor acquisition; and then had CBI re-measured. Following motor acquisition, neck pain sham controls remained inhibited (58 ± 33% of test MEP) vs. healthy controls who disinhibited (98 ± 49% of test MEP, P<0.001), while the spinal manipulation group facilitated (146 ± 95% of test MEP, P<0.001). Greater inhibition in neck pain sham vs. healthy control groups suggests that neck pain may change cerebellar-motor cortex interaction. The change to facilitation suggests that spinal manipulation may reverse inhibitory effects of neck pain.
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Affiliation(s)
- Julianne K. Baarbé
- Division of Neurology, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Yielder
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Mount Wellington, Auckland, New Zealand
| | - Michael W. R. Holmes
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Bernadette Ann Murphy
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- * E-mail:
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Solstrand Dahlberg L, Linnman CN, Lee D, Burstein R, Becerra L, Borsook D. Responsivity of Periaqueductal Gray Connectivity Is Related to Headache Frequency in Episodic Migraine. Front Neurol 2018; 9:61. [PMID: 29487563 PMCID: PMC5816750 DOI: 10.3389/fneur.2018.00061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 01/17/2023] Open
Abstract
Migraineurs show hypersensitivity to sensory stimuli at various stages throughout the migraine cycle. A number of putative processes have been implicated including a dysfunction in the descending pain modulatory system in which the periaqueductal gray (PAG) is considered to play a crucial role. Recurring migraine attacks could progressively perturb this system, lowering the threshold for future attacks, and contribute to disease chronification. Here, we investigated PAG connectivity with other brain regions during a noxious thermal stimulus to determine changes in migraineurs, and associations with migraine frequency. 21 episodic migraine patients and 22 matched controls were included in the study. During functional MRI, a thermode was placed on the subjects' temple delivering noxious and non-noxious heat stimuli. A psychophysiological interaction (PPI) analysis was carried out to examine pain-induced connectivity of the PAG with other brain regions. The PPI analysis showed increased PAG connectivity with the S1 face representation area and the supplementary motor area, an area involved with pain expectancy, in patients with higher frequency of migraine attacks. PAG connectivity with regions involved with the descending pain modulatory system (i.e., prefrontal cortex) was decreased in the migraineurs versus healthy individuals. Our results suggest that high frequency migraineurs may have diminished resistance to cephalic pain and a less efficient inhibitory pain modulatory response to external stressor (i.e., noxious heat). The findings support the notion that in migraine there is less effective pain modulation (viz., decreased pain inhibition or increased pain facilitation), potentially contributing to increased occurrence of attacks/chronification of migraine.
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Affiliation(s)
- Linda Solstrand Dahlberg
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Clas N Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Danielle Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
| | - Rami Burstein
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Johnson MO, Frank S, Mendlik M, Casarett D. Utilization of Hospice Services in a Population of Patients With Huntington's Disease. J Pain Symptom Manage 2018; 55:440-443. [PMID: 28916295 DOI: 10.1016/j.jpainsymman.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT Although the early and middle stages of Huntington's disease (HD) and its complications have been well described, less is known about the course of late-stage illness. In particular, little is known about the population of patients who enroll in hospice. OBJECTIVES Our goal is to describe the characteristics of patients with HD who enrolled in hospice. METHODS This is a retrospective cohort study of electronic medical record data from 12 not-for-profit hospices in the United States from 2008 to 2012. RESULTS Of the 164,032 patients admitted to these hospices, 101 (0.06%) had a primary diagnosis of HD. Their median age was 57 (IQR 48-65) and 53 (52.5%) were women. Most patients were cared for by a spouse (n = 36, 36.6%) or adult child (n = 20, 19.8%). At the time of admission, most patients were living either at home (n = 39, 38.6%) or in a nursing home (n = 41, 40.6%). All were either bedbound or could ambulate only with assistance. The most common symptom reported during enrollment in hospice was pain (n = 34, 33.7%) followed by anxiety (n = 30, 29.7%), nausea (n = 18, 17.8%), and dyspnea (n = 10, 9.9%). Patients had a median length of stay in hospice of 42 days, which was significantly longer than that of other hospice patients in the sample (17 days), P < 0.001. Of the 101 patients who were admitted to hospice, 73 died, 11 were still enrolled at the time of data analysis, and 17 left hospice either because they no longer met eligibility criteria (n = 14, 13.7%) or because they decided to seek treatment for other medical conditions (n = 3, 3.0%). Of the 73 patients who died while on hospice, most died either in a nursing home (n = 29; 40%) or a hospital (n = 27; 37%). Seventeen patients (23%) died at home. No patient that started in a facility died at home. CONCLUSION Patients with HD are admitted to hospice at a younger age compared with other patients (57 vs. 76 years old) but have a significant symptom burden and limited functional status. Although hospice care emphasizes the importance of helping patients to remain in their homes, only a minority of these patients were able to die at home.
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Affiliation(s)
- Margaret O Johnson
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Samuel Frank
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Mendlik
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Casarett
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gupta A, Woodworth DC, Ellingson BM, Rapkin AJ, Naliboff B, Kilpatrick LA, Stains J, Masghati S, Tillisch K, Mayer EA, Labus JS. Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia. THE JOURNAL OF PAIN 2018; 19:528.e1-528.e15. [PMID: 29391213 DOI: 10.1016/j.jpain.2017.12.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/06/2017] [Accepted: 12/17/2017] [Indexed: 12/13/2022]
Abstract
Provoked vestibulodynia (PVD) is a chronic pelvic pain disorder affecting 16% of the female population. Neuroimaging studies have highlighted central abnormalities in PVD, similar to other chronic pelvic pain disorders, including brain regions involved in sensory processing and modulation of pain. The aim of the study was to determine alterations in the subvoxel, microstructural organization within tissues in PVD compared with healthy control participants (HCs) and a disease control group (irritable bowel syndrome [IBS]). Diffusion tensor imaging magnetic resonance imaging was conducted in 87 age-matched premenopausal women (29 PVD, 29 HCs, 29 IBS). Statistical parameter mapping of fractional anisotropy (FA) and mean diffusivity (MD) maps were used to identify microstructural difference in the brain specific to PVD or shared with IBS. PVD alterations in microstructural organization of the brain were predominantly observed in fibers associated with sensorimotor integration and pain processing that relay information between the thalamus, basal ganglia, sensorimotor, and insular cortex. PVD, compared with HCs, showed extensive increases in the FA of somatosensory and basal ganglia regions. In contrast, PVD and IBS subjects did not show any FA-related group differences. PVD subjects showed greater MD in the basal ganglia compared with HCs (higher MD in the internal capsule and pallidum) and IBS (higher MD in the putamen and pallidum). Increases in MD were associated with increased vaginal muscle tenderness and vulvar pain. The current findings highlight possible shared mechanisms between 2 different pelvic pain disorders, but also highlight the widespread alterations observed specifically in PVD compared with HCs. PERSPECTIVE Alterations in microstructure in PVD were observed in fibers associated with sensorimotor integration and pain processing, which were also associated with increased vaginal muscle tenderness and vulvar pain. These alterations may be contributing to increased pain sensitivity and tenderness, highlighting the need for new therapies targeting the central nervous system.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Davis C Woodworth
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Benjamin M Ellingson
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Department of Radiology at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrea J Rapkin
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lisa A Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jean Stains
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California
| | - Salome Masghati
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Kirsten Tillisch
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California.
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125
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Thobois S, Brefel-Courbon C, Le Bars D, Sgambato-Faure V. Molecular Imaging of Opioid System in Idiopathic Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 141:275-303. [DOI: 10.1016/bs.irn.2018.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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126
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Zhang B, Xu Y, He W, Wang J, Chai H, Shen C, Zhu Q, Wang W. Intensity Dependence of Auditory Evoked Potentials in Primary Dysmenorrhea. THE JOURNAL OF PAIN 2017; 18:1324-1332. [PMID: 28694148 DOI: 10.1016/j.jpain.2017.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/06/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Some studies suggest that women with primary dysmenorrhea have distinct emotional or personality features. For example, they might exaggerate their responses to external stimuli, such as to intensity-increasing auditory stimuli. Fifteen women with primary dysmenorrhea and 15 healthy women were invited to undergo tests of the intensity dependence of auditory evoked potentials (IDAEP), the Functional and Emotional Measure of Dysmenorrhea, and the Plutchik-van Praag Depression Inventory. Study participants with dysmenorrhea showed higher Functional and Emotional scale scores and stronger IDAEP. Regarding the IDAEP generation, the source inversion of N1 and P2 disclosed the activated bilateral superior temporal gyri, medial and superior prefrontal gyri in all participants, and additionally, the middle frontal gyri in dysmenorrhea patients. We report a pronounced IDAEP in primary dysmenorrhea, which indicates the decreased cerebral serotonergic innervations and points to increased activations in the prefrontal and frontal areas in the disorder. PERSPECTIVE Using an IDAEP technique, the authors found decreased serotonergic innervation and altered cerebral activation in women with primary dysmenorrhea, which might offer some pharmacotherapeutic clues for the disorder.
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Affiliation(s)
- Bingren Zhang
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - You Xu
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China; Department of Psychosomatic Medicine, Mental Health Center, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei He
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China; Department of Cogntive Science, Macquarie Univeristy, and Australian Research Council Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, Australia
| | - Jiawei Wang
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Hao Chai
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Qisha Zhu
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry, School of Public Health, Zhejiang University College of Medicine, Hangzhou, China; Department of Psychosomatic Medicine, Mental Health Center, Zhejiang University College of Medicine, Hangzhou, China.
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127
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Domínguez D JF, van Nunspeet F, Gupta A, Eres R, Louis WR, Decety J, Molenberghs P. Lateral orbitofrontal cortex activity is modulated by group membership in situations of justified and unjustified violence. Soc Neurosci 2017; 13:739-755. [DOI: 10.1080/17470919.2017.1392342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Juan F. Domínguez D
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Félice van Nunspeet
- Social, Health, and Organizational Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
| | - Ayushi Gupta
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Robert Eres
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | | | - Jean Decety
- Department of Psychology, The University of Chicago, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, USA
| | - Pascal Molenberghs
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
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128
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Allen LA, Harper RM, Kumar R, Guye M, Ogren JA, Lhatoo SD, Lemieux L, Scott CA, Vos SB, Rani S, Diehl B. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:544. [PMID: 29085330 PMCID: PMC5650686 DOI: 10.3389/fneur.2017.00544] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. METHODS 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). RESULTS High-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. CONCLUSION TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy and mechanisms involved in SUDEP. Furthermore, these findings represent possible objective biomarkers which could help to identify high-risk patients and enhance SUDEP risk stratification via the use of non-invasive neuroimaging, which would require validation in larger cohorts, with extension to patients with other epilepsies and subjects who succumb to SUDEP.
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Affiliation(s)
- Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States.,Department of Anaesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Louis Lemieux
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom
| | - Catherine A Scott
- Institute of Neurology, University College London, London, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Translational Imaging Group, University College London, London, United Kingdom
| | - Sandhya Rani
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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Abstract
Fibromyalgia (FMS) is a complex clinical syndrome that includes many symptoms beyond chronic pain. The studies that have addressed brain morphometry in FMS have had very heterogeneous results. Thus, the question of which specific FMS symptoms and clinical features-pain, but also psychological distress, sleep-related problems, health status, and medication intake-impact on brain morphometry remains open. Here, we wanted to determine if brain changes in FMS are "symptom-related" more than "diagnostic-related". We performed an observational study of 46 premenopausal women (23 FMS patients and 23 age-matched healthy participants). Magnetic resonance images were analyzed using voxel-based morphometry and subcortical segmentation. We used multiple regression models to assess the associations between total and local brain volumes and FMS clinical characteristics. Furthermore, we calculated associations between subcortical structures' shapes and volumes and FMS clinical characteristics. Larger psychological distress, anxiety, and sleepiness, and higher analgesic consumption accounted for 38 % of FMS patients' smaller total gray matter volume (GMV). For both groups, local decrements of GMV in the medial orbitofrontal cortex were associated to larger psychological distress. Local increases of GMV were positively related to pain scores (superior frontal gyrus), psychological distress (cerebellum), anxiety (medial orbitofrontal cortex), and sleepiness (frontal superior medial cortex). FMS clinical characteristics were also associated to deformations in subcortical structures and volumes changes. This study reveals that total and local GMV changes in FMS go beyond the traditional "pain matrix" alterations. We demonstrated that brain morphology is altered by pain, but also by clinical characteristics that define the FMS experience.
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130
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Tseng MT, Lin CH. Pain in early-stage Parkinson's disease: Implications from clinical features to pathophysiology mechanisms. J Formos Med Assoc 2017; 116:571-581. [DOI: 10.1016/j.jfma.2017.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 12/13/2022] Open
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131
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Pain processing in atypical Parkinsonisms and Parkinson disease: A comparative neurophysiological study. Clin Neurophysiol 2017; 128:1978-1984. [PMID: 28829981 DOI: 10.1016/j.clinph.2017.06.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/17/2017] [Accepted: 06/27/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Pain is a frequent non-motor feature in Parkinsonism but mechanistic data on the alteration of pain processing are insufficient to understand the possible causes and to define specifically-targeted treatments. METHODS we investigated spinal nociception through the neurophysiological measure of the threshold (TR) of nociceptive withdrawal reflex (NWR) and its temporal summation threshold (TST) comparatively in 12 Progressive Supranuclear Palsy (PSP) subjects, 11 Multiple System Atrophy (MSA) patients, 15 Parkinson's disease (PD) subjects and 24 healthy controls (HC). We also investigated the modulatory effect of L-Dopa in these three parkinsonian groups. RESULTS We found a significant reduction in the TR of NWR and in the TST of NWR in PSP, MSA and PD patients compared with HC. L-Dopa induced an increase in the TR of NWR in the PSP group while TST of NWR increased in both PSP and PD. CONCLUSIONS Our neurophysiological findings identify a facilitation of nociceptive processing in PSP that is broadly similar to that observed in MSA and PD. Specific peculiarities have emerged for PSP. SIGNIFICANCE Our data advance the knowledge of the neurophysiology of nociception in the advanced phases of parkinsonian syndromes and on the role of dopaminergic pathways in the control on pain processing.
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132
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Opioidergic tone and pain susceptibility: interactions between reward systems and opioid receptors. Pain 2017; 158:185-186. [PMID: 28092322 DOI: 10.1097/j.pain.0000000000000726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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133
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Dysfunction of Nucleus Accumbens Is Associated With Psychiatric Problems in Patients With Chronic Low Back Pain: A Functional Magnetic Resonance Imaging Study. Spine (Phila Pa 1976) 2017; 42:844-853. [PMID: 27755492 DOI: 10.1097/brs.0000000000001930] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE The aim of this study was to evaluate activity of the nucleus accumbens (NAc) in response to lumbar mechanical stimulation in patients with chronic low back pain (cLBP) using functional magnetic resonance imaging (fMRI). SUMMARY OF BACKGROUND DATA Although a modified activity of the NAc was characterized in cLBP patients, its pathological significance has yet to be determined. We hypothesized that NAc activation in response to pain might differ depending on the extent of psychiatric problems, which might be associated with the affective/motivational background of chronic pain. METHODS Twenty-one patients with cLBP (four men, 17 women) were recruited. Subjects were divided into two groups on the basis of scores on the patient version of the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP) scores: ≥17 (High Score, HiS group) and <17 (non-High Score, non-HiS group). Each subject was placed in the prone position on a 3-Tesla magnetic resonance imaging (MRI) scanner and stimulated by mechanical stimulation on the left lower back. Three blocks of 30-second pain stimulus calibrated at either 3 or 5 on an 11-grade numerical rating scale (NRS) were applied with intervening 30-second rest conditions during whole-brain echo-planar imaging. Functional images were analyzed using a multisubject general linear model with Bonferroni multiple comparisons. RESULTS Subjects in the HiS group had more intense daily pain and lower quality of life than those in the non-HiS group (P < 0.05). Catastrophic thinking in relation to pain experience did not differ between the groups. Activation at the NAc was smaller in the HiS group than in the non-HiS group (P < 0.001). CONCLUSION The presence of psychiatric problems was associated with attenuated activity of the NAc in cLBP patients. Dysfunction of the NAc might potentially be involved in the affective/motivational factors in the chronification of LBP. LEVEL OF EVIDENCE N/A.
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134
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Király A, Szabó N, Párdutz Á, Tóth E, Tajti J, Csete G, Faragó P, Bodnár P, Szok D, Tuka B, Pálinkás É, Ertsey C, Vécsei L, Kincses ZT. Macro- and microstructural alterations of the subcortical structures in episodic cluster headache. Cephalalgia 2017; 38:662-673. [PMID: 28425325 DOI: 10.1177/0333102417703762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Previous functional and structural imaging studies have revealed that subcortical structures play a key a role in pain processing. The recurring painful episodes might trigger maladaptive plasticity or alternatively degenerative processes that might be detected by MRI as changes in size or microstructure. In the current investigation, we aimed to identify the macro- and microstructural alterations of the subcortical structures in episodic cluster headache. Methods High-resolution T1-weighted and diffusion-weighted MRI images with 60 gradient directions were acquired from 22 patients with cluster headache and 94 healthy controls. Surface-based segmentation analysis was used to measure the volume of the subcortical nuclei, and mean diffusion parameters (fractional anisotropy, mean, radial and axial diffusivity) were determined for these structures. In order to understand whether the size and diffusion parameters could be investigated in a headache lateralised manner, first the asymmetry of the size and diffusion parameters of the subcortical structures was analysed. Volumes and diffusion parameters were compared between groups and correlated with the cumulative number of headache days. To account for the different size of the patient and control group, a bootstrap approach was used to investigate the stability of the findings. Results A significant lateralisation of the size (caudate, putamen and thalamus) and the diffusion parameters of the subcortical structures were found in normal controls. In cluster headache patients, the mean fractional anisotropy of the right amygdalae, the mean axial and mean diffusivity of the right caudate nucleus and the radial diffusivity of the right pallidum were higher. The mean anisotropy of the right pallidum was lower in patients. Conclusion The analysis of the pathology in the subcortical structures in episodic cluster headache reveals important features of the disease, which might allow a deeper insight into the pathomechanism of the pain processing in this headache condition.
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Affiliation(s)
- András Király
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,2 International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Árpád Párdutz
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - János Tajti
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gergő Csete
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Bodnár
- 3 Department of Image Processing and Computer Graphics, Faculty of Science and Informatics, Szeged, Hungary
| | - Délia Szok
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bernadett Tuka
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,4 MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Éva Pálinkás
- 5 Bacs-Kiskun County Hospital, Kecskemét, Hungary
| | - Csaba Ertsey
- 6 Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Vécsei
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,4 MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,2 International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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135
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Quantifying cerebral contributions to pain beyond nociception. Nat Commun 2017; 8:14211. [PMID: 28195170 PMCID: PMC5316889 DOI: 10.1038/ncomms14211] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/05/2016] [Indexed: 12/21/2022] Open
Abstract
Cerebral processes contribute to pain beyond the level of nociceptive input and mediate psychological and behavioural influences. However, cerebral contributions beyond nociception are not yet well characterized, leading to a predominant focus on nociception when studying pain and developing interventions. Here we use functional magnetic resonance imaging combined with machine learning to develop a multivariate pattern signature-termed the stimulus intensity independent pain signature-1 (SIIPS1)-that predicts pain above and beyond nociceptive input in four training data sets (Studies 1-4, N=137). The SIIPS1 includes patterns of activity in nucleus accumbens, lateral prefrontal and parahippocampal cortices, and other regions. In cross-validated analyses of Studies 1-4 and in two independent test data sets (Studies 5-6, N=46), SIIPS1 responses explain variation in trial-by-trial pain ratings not captured by a previous fMRI-based marker for nociceptive pain. In addition, SIIPS1 responses mediate the pain-modulating effects of three psychological manipulations of expectations and perceived control. The SIIPS1 provides an extensible characterization of cerebral contributions to pain and specific brain targets for interventions.
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136
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Becerra L, Bishop J, Barmettler G, Kainz V, Burstein R, Borsook D. Brain network alterations in the inflammatory soup animal model of migraine. Brain Res 2017; 1660:36-46. [PMID: 28167076 DOI: 10.1016/j.brainres.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/11/2017] [Accepted: 02/01/2017] [Indexed: 12/21/2022]
Abstract
Advances in our understanding of the human pain experience have shifted much of the focus of pain research from the periphery to the brain. Current hypotheses suggest that the progression of migraine depends on abnormal functioning of neurons in multiple brain regions. Accordingly, we sought to capture functional brain changes induced by the application of an inflammatory cocktail known as inflammatory soup (IS), to the dura mater across multiple brain networks. Specifically, we aimed to determine whether IS alters additional neural networks indirectly related to the primary nociceptive pathways via the spinal cord to the thalamus and cortex. IS comprises an acidic combination of bradykinin, serotonin, histamine and prostaglandin PGE2 and was introduced to basic pain research as a tool to activate and sensitize peripheral nociceptors when studying pathological pain conditions associated with allodynia and hyperalgesia. Using this model of intracranial pain, we found that dural application of IS in awake, fully conscious, rats enhanced thalamic, hypothalamic, hippocampal and somatosensory cortex responses to mechanical stimulation of the face (compared to sham synthetic interstitial fluid administration). Furthermore, resting state MRI data revealed altered functional connectivity in a number of networks previously identified in clinical chronic pain populations. These included the default mode, sensorimotor, interoceptive (Salience) and autonomic networks. The findings suggest that activation and sensitization of meningeal nociceptors by IS can enhance the extent to which the brain processes nociceptive signaling, define new level of modulation of affective and cognitive responses to pain; set new tone for hypothalamic regulation of autonomic outflow to the cranium; and change cerebellar functions.
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Affiliation(s)
- Lino Becerra
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
| | - James Bishop
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Gabi Barmettler
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Vanessa Kainz
- Department of Anaesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anaesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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Jeon SY, Seo S, Lee JS, Choi SH, Lee DH, Jung YH, Song MK, Lee KJ, Kim YC, Kwon HW, Im HJ, Lee DS, Cheon GJ, Kang DH. [11C]-(R)-PK11195 positron emission tomography in patients with complex regional pain syndrome: A pilot study. Medicine (Baltimore) 2017; 96:e5735. [PMID: 28072713 PMCID: PMC5228673 DOI: 10.1097/md.0000000000005735] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Complex regional pain syndrome (CRPS) is characterized by severe and chronic pain, but the pathophysiology of this disease are not clearly understood. The primary aim of our case-control study was to explore neuroinflammation in patients with CRPS using positron emission tomography (PET), with an 18-kDa translocator protein specific radioligand [C]-(R)-PK11195. [C]-(R)-PK11195 PET scans were acquired for 11 patients with CRPS (30-55 years) and 12 control subjects (30-52 years). Parametric image of distribution volume ratio (DVR) for each participant was generated by applying a relative equilibrium-based graphical analysis. The DVR of [C]-(R)-PK11195 in the caudate nucleus (t(21) = -3.209, P = 0.004), putamen (t(21) = -2.492, P = 0.022), nucleus accumbens (t(21) = -2.218, P = 0.040), and thalamus (t(21) = -2.395, P = 0.026) were significantly higher in CRPS patients than in healthy controls. Those of globus pallidus (t(21) = -2.045, P = 0.054) tended to be higher in CRPS patients than in healthy controls. In patients with CRPS, there was a positive correlation between the DVR of [C]-(R)-PK11195 in the caudate nucleus and the pain score, the visual analog scale (r = 0.661, P = 0.026, R = 0.408) and affective subscales of McGill Pain Questionnaire (r = 0.604, P = 0.049, R = 0.364). We demonstrated that neuroinflammation of CRPS patients in basal ganglia. Our results suggest that microglial pathology can be an important pathophysiology of CRPS. Association between the level of caudate nucleus and pain severity indicated that neuroinflammation in this region might play a key role. These results may be essential for developing effective medical treatments.
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Affiliation(s)
- So Yeon Jeon
- Department of Neuropsychiatry, Seoul National University Hospital
| | - Seongho Seo
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences
- Institute of Radiation Medicine, Medical Research Center
| | - Soo-Hee Choi
- Department of Neuropsychiatry, Seoul National University Hospital
- Department of Psychiatry, Seoul National University College of Medicine
| | - Do-Hyeong Lee
- Department of Neuropsychiatry, Seoul National University Hospital
| | - Ye-Ha Jung
- Department of Neuropsychiatry, Seoul National University Hospital
| | - Man-Kyu Song
- Department of Neuropsychiatry, Seoul National University Hospital
| | - Kyung-Jun Lee
- Department of Neuropsychiatry, Seoul National University Hospital
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul
| | - Hyun Woo Kwon
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea
| | - Hyung-Jun Im
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine
- Institute of Radiation Medicine, Medical Research Center
| | - Do-Hyung Kang
- Department of Neuropsychiatry, Seoul National University Hospital
- Department of Psychiatry, Seoul National University College of Medicine
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138
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Abstract
We do not know precisely why pain develops and becomes chronic after peripheral nerve injury (PNI), but it is likely due to biological and psychological factors. Here, we tested the hypotheses that (1) high Pain Catastrophizing Scale (PCS) scores at the time of injury and repair are associated with pain and cold sensitivity after 1-year recovery and (2) insula gray matter changes reflect the course of injury and improvements over time. Ten patients with complete median and/or ulnar nerve transections and surgical repair were tested ∼3 weeks after surgical nerve repair (time 1) and ∼1 year later for 6 of the 10 patients (time 2). Patients and 10 age-/sex-matched healthy controls completed questionnaires that assessed pain (patients) and personality and underwent quantitative sensory testing and 3T MRI to assess cortical thickness. In patients, pain intensity and neuropathic pain correlated with pain catastrophizing. Time 1 pain catastrophizing trended toward predicting cold pain thresholds at time 2, and at time 1 cortical thickness of the right insula was reduced. At time 2, chronic pain was related to the time 1 pain-PCS relationship and cold sensitivity, pain catastrophizing correlated with cold pain threshold, and insula thickness reversed to control levels. This study highlights the interplay between personality, sensory function, and pain in patients following PNI and repair. The PCS-pain association suggests that a focus on affective or negative components of pain could render patients vulnerable to chronic pain. Cold sensitivity and structural insula changes may reflect altered thermosensory or sensorimotor awareness representations.
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139
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Azqueta-Gavaldon M, Schulte-Göcking H, Storz C, Azad S, Reiners A, Borsook D, Becerra L, Kraft E. Basal ganglia dysfunction in complex regional pain syndrome - A valid hypothesis? Eur J Pain 2016; 21:415-424. [DOI: 10.1002/ejp.975] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 01/27/2023]
Affiliation(s)
- M. Azqueta-Gavaldon
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - H. Schulte-Göcking
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - C. Storz
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - S. Azad
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Anaesthesia; Medical Centre of University of Munich; Germany
| | - A. Reiners
- Department of Rehabilitation; City Hospital Bogenhausen; Munich Germany
| | - D. Borsook
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - L. Becerra
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - E. Kraft
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
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140
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Hansen MS, Asghar MS, Wetterslev J, Pipper CB, Johan Mårtensson J, Becerra L, Christensen A, Nybing JD, Havsteen I, Boesen M, Dahl JB. Is the Volume of the Caudate Nuclei Associated With Area of Secondary Hyperalgesia? - Protocol for a 3-Tesla MRI Study of Healthy Volunteers. JMIR Res Protoc 2016; 5:e117. [PMID: 27317630 PMCID: PMC4930528 DOI: 10.2196/resprot.5680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background Experience and development of pain may be influenced by a number of physiological, psychological, and psychosocial factors. In a previous study we found differences in neuronal activation to noxious stimulation, and microstructural neuroanatomical differences, when comparing healthy volunteers with differences in size of the area of secondary hyperalgesia following a standardized burn injury. Objective We aim to investigate the degree of association between the volume of pain-relevant structures in the brain and the size of the area of secondary hyperalgesia following brief thermal sensitization. Methods The study consists of one experimental day, in which whole-brain magnetic resonance imaging (MRI) scans will be conducted including T1-weighed three-dimensional anatomy scan, diffusion tensor imaging, and resting state functional MRI. Before the experimental day, all included participants will undergo experimental pain testing in a parallel study (Clinicaltrials.gov Identifier: NCT02527395). Results from this experimental pain testing, as well as the size of the area of secondary hyperalgesia from the included participants, will be extracted from this parallel study. Results The association between the volume of pain-relevant structures in the brain and the area of secondary hyperalgesia will be investigated by linear regression of the estimated best linear unbiased predictors on the individual volumes of the pain relevant brain structures. Conclusions We plan to investigate the association between experimental pain testing parameters and the volume, connectivity, and resting state activity of pain-relevant structures in the brain. These results may improve our knowledge of the mechanisms responsible for the development of acute and chronic pain. ClinicalTrial Danish Research Ethics Committee (identifier: H-15010473). Danish Data Protection Agency (identifier: RH-2015-149). Clinicaltrials.gov NCT02567318; http://clinicaltrials.gov/ct2/show/NCT02567318 (Archived by WebCite at http://www.webcitation.org/6i4OtP0Oi)
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Affiliation(s)
- Morten Sejer Hansen
- Department of Anaesthesiology, 4231, Centre of head and orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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141
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Belasen A, Youn Y, Gee L, Prusik J, Lai B, Ramirez-Zamora A, Rizvi K, Yeung P, Shin DS, Argoff C, Pilitsis JG. The Effects of Mechanical and Thermal Stimuli on Local Field Potentials and Single Unit Activity in Parkinson's Disease Patients. Neuromodulation 2016; 19:698-707. [DOI: 10.1111/ner.12453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/24/2016] [Accepted: 04/24/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Abigail Belasen
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Youngwon Youn
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Lucy Gee
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Julia Prusik
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Brant Lai
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | | | - Khizer Rizvi
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Philip Yeung
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Damian S. Shin
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Charles Argoff
- Department of Neurology; Albany Medical Center; Albany NY USA
| | - Julie G. Pilitsis
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
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142
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Koefman AJ, Licari M, Bynevelt M, Lind CRP. Functional magnetic resonance imaging evaluation of lumbosacral radiculopathic pain. J Neurosurg Spine 2016; 25:517-522. [PMID: 27203812 DOI: 10.3171/2016.3.spine151230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE An objective biomarker for pain is yet to be established. Functional MRI (fMRI) is a promising neuroimaging technique that may reveal an objective radiological biomarker. The purpose of this study was to evaluate fMRI technology in the setting of lumbosacral radiculopathy and discuss its application in revealing a biomarker for pain in the future. METHODS A prospective, within-participant control study was conducted. Twenty participants with painful lumbosacral radiculopathy from intervertebral disc pathology were recruited. Functional imaging of the brain was performed during a randomly generated series of nonprovocative and provocative straight leg raise maneuvers. RESULTS With a statistical threshold set at p < 0.000001, 3 areas showed significant blood oxygen level-dependent (BOLD) signal change: right superior frontal gyrus (x = 2, y = 13, z = 48, k = 29, Brodmann area 6 [BA6]), left supramarginal cortex (x = -37, y = -44, z = 33, k = 1084, BA40), and left parietal cortex (x = -19, y = -41, z = 63, k = 354, BA5). With a statistical threshold set at p < 0.0002, 2 structures showed significant BOLD signal change: right putamen (x = 29, y = -11, z = 6, k = 72) and bilateral thalami (right: x = 23, y = -11, z = 21, k = 29; x = 8, y = -11, z = 9, k = 274; and left: x = -28, y = -32, z = 6, k = 21). CONCLUSIONS The results in this study compare with those in previous studies and suggest that fMRI technology can provide an objective assessment of the pain experience.
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Affiliation(s)
| | | | | | - Christopher R P Lind
- Departments of 1 Neurosurgery and.,Surgery, University of Western Australia, Perth, Western Australia, Australia
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143
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George E, Elman I, Becerra L, Berg S, Borsook D. Pain in an era of armed conflicts: Prevention and treatment for warfighters and civilian casualties. Prog Neurobiol 2016; 141:25-44. [PMID: 27084355 DOI: 10.1016/j.pneurobio.2016.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/23/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Chronic pain is a common squealae of military- and terror-related injuries. While its pathophysiology has not yet been fully elucidated, it may be potentially related to premorbid neuropsychobiological status, as well as to the type of injury and to the neural alterations that it may evoke. Accordingly, optimized approaches for wounded individuals should integrate primary, secondary and tertiary prevention in the form of thorough evaluation of risk factors along with specific interventions to contravene and mitigate the ensuing chronicity. Thus, Premorbid Events phase may encompass assessments of psychological and neurobiological vulnerability factors in conjunction with fostering preparedness and resilience in both military and civilian populations at risk. Injuries per se phase calls for immediate treatment of acute pain in the field by pharmacological agents that spare and even enhance coping and adaptive capabilities. The key objective of the Post Injury Events is to prevent and/or reverse maladaptive peripheral- and central neural system's processes that mediate transformation of acute to chronic pain and to incorporate timely interventions for concomitant mental health problems including post-traumatic stress disorder and addiction We suggest that the proposed continuum of care may avert more disability and suffering than the currently employed less integrated strategies. While the requirements of the armed forces present a pressing need for this integrated continuum and a framework in which it can be most readily implemented, this approach may be also instrumental for the care of civilian casualties.
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Affiliation(s)
- E George
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, MGH, HMS, Boston, MA, United States; Commander, MC, USN (Ret), United States
| | - I Elman
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Psychiatry, Boonshoft School of Medicine and Dayton VA Medical Center, United States; Veterans Administration Medical Center, Dayton, OH, United States
| | - L Becerra
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, BCH, HMS, Boston, MA, United States; Departments of Psychiatry and Radiology, MGH, Boston, MA, United States
| | - Sheri Berg
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, MGH, HMS, Boston, MA, United States
| | - D Borsook
- Center for Pain and the Brain, Harvard Medical School (HMS), United States; Department of Anesthesia, Critical Care and Pain Medicine, BCH, HMS, Boston, MA, United States; Departments of Psychiatry and Radiology, MGH, Boston, MA, United States.
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144
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Sterling M, Head J, Cabot PJ, Farrell M. Serum C-reactive protein levels predict regional brain responses to noxious cold stimulation of the hand in chronic whiplash associated disorders. Scand J Pain 2016; 11:19-26. [PMID: 28850464 DOI: 10.1016/j.sjpain.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Whiplash Associated Disorders (WAD) are a costly health burden. The condition is characterised by sensory disturbances such as widespread hyperalgesia likely indicative of central hyperexcitability. Recently elevated levels of pro-inflammatory biomarkers have also found in acute and chronic WAD. The aim of this cross-sectional study was to investigate the relationship between inflammatory biomarkers and pain processing in people with persistent whiplash associated disorders (WAD). METHODS Twenty one participants with chronic whiplash (>3 months) were recruited. Venous blood samples were collected and assays performed for C-reactive protein (CRP) and TNF-α. Blood oxygen level-dependent (BOLD) contrast images of the brain were acquired with a Siemens 1.5T MRI scanner during repeated 24s stimulus blocks of innocuous or painful stimuli (thumbnail pressure and cold stimulation of dorsum of hand) separated by 36s inter-stimulus intervals. Stimulus intensities used during scanning were at the level of participants' thresholds for moderate pain. Parameter estimates representing BOLD signal increases during painful events from each participant were tested for associations with inflammatory biomarkers. RESULTS Clinically relevant levels of CRP and TNF-α were found in 33% and 38% of participants. Levels of CRP showed a positive correlation with levels of cold pain activation in brain regions including the anterior insula, posterior parietal cortex, caudate and thalamus (pcorrected<0.05). Levels of TNF-α were not related to activation levels during either noxious pressure or cold. Pressure pain activations also did not show a relationship with CRP levels. CONCLUSIONS Shared variance between inflammation and increased levels of regional pain-related activation in people with persistent whiplash symptoms is apparent for cold, but not pressure stimuli. IMPLICATIONS The results highlight cold pain processing as an important aspect of whiplash chronicity, although the implications of this modality-specific effect are not readily apparent.
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Affiliation(s)
- Michele Sterling
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), CRE in Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Parklands, Australia.
| | - Jessica Head
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Peter J Cabot
- The School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, St Lucia, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia
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145
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Reimann HM, Hentschel J, Marek J, Huelnhagen T, Todiras M, Kox S, Waiczies S, Hodge R, Bader M, Pohlmann A, Niendorf T. Normothermic Mouse Functional MRI of Acute Focal Thermostimulation for Probing Nociception. Sci Rep 2016; 6:17230. [PMID: 26821826 PMCID: PMC4731789 DOI: 10.1038/srep17230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022] Open
Abstract
Combining mouse genomics and functional magnetic resonance imaging (fMRI) provides a promising tool to unravel the molecular mechanisms of chronic pain. Probing murine nociception via the blood oxygenation level-dependent (BOLD) effect is still challenging due to methodological constraints. Here we report on the reproducible application of acute noxious heat stimuli to examine the feasibility and limitations of functional brain mapping for central pain processing in mice. Recent technical and procedural advances were applied for enhanced BOLD signal detection and a tight control of physiological parameters. The latter includes the development of a novel mouse cradle designed to maintain whole-body normothermia in anesthetized mice during fMRI in a way that reflects the thermal status of awake, resting mice. Applying mild noxious heat stimuli to wildtype mice resulted in highly significant BOLD patterns in anatomical brain structures forming the pain matrix, which comprise temporal signal intensity changes of up to 6% magnitude. We also observed sub-threshold correlation patterns in large areas of the brain, as well as alterations in mean arterial blood pressure (MABP) in response to the applied stimulus.
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Affiliation(s)
- Henning Matthias Reimann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Jan Hentschel
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Jaroslav Marek
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Till Huelnhagen
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Mihail Todiras
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Stefanie Kox
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Sonia Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Russ Hodge
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Michael Bader
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine, Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Berlin, Germany
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146
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Simons LE, Erpelding N, Hernandez JM, Serrano P, Zhang K, Lebel AA, Sethna NF, Berde CB, Prabhu SP, Becerra L, Borsook D. Fear and Reward Circuit Alterations in Pediatric CRPS. Front Hum Neurosci 2016; 9:703. [PMID: 26834606 PMCID: PMC4717323 DOI: 10.3389/fnhum.2015.00703] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022] Open
Abstract
In chronic pain, a number of brain regions involved in emotion (e.g., amygdala, hippocampus, nucleus accumbens, insula, anterior cingulate, and prefrontal cortex) show significant functional and morphometric changes. One phenotypic manifestation of these changes is pain-related fear (PRF). PRF is associated with profoundly altered behavioral adaptations to chronic pain. For example, patients with a neuropathic pain condition known as complex regional pain syndrome (CRPS) often avoid use of and may even neglect the affected body area(s), thus maintaining and likely enhancing PRF. These changes form part of an overall maladaptation to chronic pain. To examine fear-related brain circuit alterations in humans, 20 pediatric patients with CRPS and 20 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) in response to a well-established fearful faces paradigm. Despite no significant differences on self-reported emotional valence and arousal between the two groups, CRPS patients displayed a diminished response to fearful faces in regions associated with emotional processing compared to healthy controls. Additionally, increased PRF levels were associated with decreased activity in a number of brain regions including the right amygdala, insula, putamen, and caudate. Blunted activation in patients suggests that (a) individuals with chronic pain may have deficits in cognitive-affective brain circuits that may represent an underlying vulnerability or consequence to the chronic pain state; and (b) fear of pain may contribute and/or maintain these brain alterations. Our results shed new light on altered affective circuits in patients with chronic pain and identify PRF as a potentially important treatment target.
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Affiliation(s)
- Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; Department of Psychiatry, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA; Harvard Medical School, BostonMA, USA
| | - Nathalie Erpelding
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA
| | - Jessica M Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston MA, USA
| | - Paul Serrano
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA
| | - Kunyu Zhang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston MA, USA
| | - Alyssa A Lebel
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA; Harvard Medical School, BostonMA, USA
| | - Navil F Sethna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; Harvard Medical School, BostonMA, USA
| | - Charles B Berde
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; Harvard Medical School, BostonMA, USA
| | - Sanjay P Prabhu
- Harvard Medical School, BostonMA, USA; Department of Radiology, Boston Children's Hospital, BostonMA, USA
| | - Lino Becerra
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA; Department of Radiology, Boston Children's Hospital, BostonMA, USA
| | - David Borsook
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, BostonMA, USA; PAIN Research Group, Boston Children's Hospital, WalthamMA, USA; Harvard Medical School, BostonMA, USA; Department of Radiology, Boston Children's Hospital, BostonMA, USA
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147
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Mao CP, Bai ZL, Zhang XN, Zhang QJ, Zhang L. Abnormal Subcortical Brain Morphology in Patients with Knee Osteoarthritis: A Cross-sectional Study. Front Aging Neurosci 2016; 8:3. [PMID: 26834629 PMCID: PMC4717185 DOI: 10.3389/fnagi.2016.00003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
Despite the involvement of subcortical brain structures in the pathogenesis of chronic pain and persistent pain as the defining symptom of knee osteoarthritis (KOA), little attention has been paid to the morphometric measurements of these subcortical nuclei in patients with KOA. The purpose of this study is to explore the potential morphological abnormalities of subcortical brain structures in patients with KOA as compared to the healthy control subjects by using high-resolution MRI. Structural MR data were acquired from 26 patients with KOA and 31 demographically similar healthy individuals. The MR data were analyzed by using FMRIB’s integrated registration and segmentation tool. Both volumetric analysis and surface-based shape analysis were performed to characterize the subcortical morphology. The normalized volumes of bilateral caudate nucleus were significantly smaller in the KOA group than in the control group (P = 0.004). There was also a trend toward smaller volume of the hippocampus in KOA as compared to the control group (P = 0.027). Detailed surface analyses further localized these differences with a greater involvement of the left hemisphere (P < 0.05, corrected) for the caudate nucleus. Hemispheric asymmetry (right larger than left) of the caudate nucleus was found in both KOA and control groups. Besides, no significant correlation was found between the structural data and pain intensities. Our results indicated that patients with KOA had statistically significant smaller normalized volumes of bilateral caudate nucleus and a trend toward smaller volume of the hippocampus as compared to the control subjects. Further investigations are necessary to characterize the role of caudate nucleus in the course of chronicity of pain associated with KOA.
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Affiliation(s)
- Cui Ping Mao
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Zhi Lan Bai
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Xiao Na Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Qiu Juan Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Lei Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
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148
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Gao Q, Xu F, Jiang C, Chen Z, Chen H, Liao H, Zhao L. Decreased functional connectivity density in pain-related brain regions of female migraine patients without aura. Brain Res 2015; 1632:73-81. [PMID: 26688226 DOI: 10.1016/j.brainres.2015.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 01/01/2023]
Abstract
Migraine is one of the most prevalent neurological disorders which is suggested to be associated with dysfunctions of the central nervous system. The purpose of the present study was to detect the altered functional connectivity architecture in the large-scale network of the whole brain in migraine without aura (MWoA). Meanwhile, the brain functional hubs which are targeted by MWoA could be identified. A new voxel-based method named functional connectivity density (FCD) mapping was applied to resting-state functional magnetic resonance imaging data of 55 female MWoA patients and 44 age-matched female healthy controls (HC). Comparing to HC, MWoA patients showed abnormal short-range FCD values in bilateral hippocampus, bilateral insula, right amygdale, right anterior cingulate cortex, bilateral putamen, bilateral caudate nucleus and the prefrontal cortex. The results suggested decreased intraregional connectivity of these pain-related brain regions in female MWoA. In addition, short-range FCD values in left prefrontal cortex, putamen and caudate nucleus were significantly negatively correlated with duration of disease in MWoA group, implying the repeated migraine attacks over time may consistently affect the resting-state functional connectivity architecture of these brain hubs. Our findings revealed the dysfunction of brain hubs in female MWoA, and suggested the left prefrontal cortex, putamen and caudate nucleus served as sensitive neuroimaging markers for reflecting the disease duration of female MWoA. This may provide us new insights into the changes in the organization of the large-scale brain network in MWoA.
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Affiliation(s)
- Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Fei Xu
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Cui Jiang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Zhifeng Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Huaqiang Liao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
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149
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Priebe JA, Kunz M, Morcinek C, Rieckmann P, Lautenbacher S. Does Parkinson's disease lead to alterations in the facial expression of pain? J Neurol Sci 2015; 359:226-35. [DOI: 10.1016/j.jns.2015.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
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150
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