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Pandey S, Jain N, Singh A, Paliwal VK, Kumar S. MRI Evaluation of Microstructural and Perfusion Changes in Patients with Hemsensory Neurological Syndromes. Neurol India 2024; 72:553-560. [PMID: 39041972 DOI: 10.4103/neuroindia.ni_1050_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/28/2021] [Indexed: 07/24/2024]
Abstract
BACKGROUND Hemisensory syndrome is characterized by a nondermatomal sensory deficit involving one half of the body. With the conventional imaging techniques, researches find low diagnostic yield in this condition; however, with the advancements in MRI imaging, there is hope to find the pathophysiological basis of hemisensory symptoms. OBJECTIVE To evaluate microstructural and perfusion changes in brain parenchyma in patients with hemisensory syndrome on MRI with diffusion tensor imaging (DTI) and arterial spin labeling (ASL). MATERIAL AND METHODS A total of 20 patients with hemisensory symptoms and 10 age-matched controls were enrolled and divided in two study groups - a) case vs. control and b) affected vs. nonaffected cerebral hemisphere in cases. Quantification of absolute cerebral blood flow (aCBF), fractional anisotropy (FA), and mean diffusivity (MD) was done in both groups. RESULTS On ASL, there was significantly increased aCBF in thalamus on the contralateral-affected side. DTI revealed significantly decreased FA in the thalamus and increased FA in corona radiata of the affected side. There was a significant difference for MD of corona radiata between affected and nonaffected hemisphere. The mean value of MD in corona radiata is decreased on the affected side. CONCLUSION Changes in advanced neuroimaging techniques like ASL and DTI along the pain processing pathway suggest an alteration in neuronal density and activity at the microstructural level. These findings may provide an insight into the etiopathogenesis of pain syndromes.
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Affiliation(s)
- Saurabh Pandey
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Neeraj Jain
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anuradha Singh
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Sunil Kumar
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
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2
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Yang CL, Qu Y, Huang JP, Wang TT, Zhang H, Chen Y, Tan YC. Efficacy and safety of transcranial direct current stimulation in the treatment of fibromyalgia: A systematic review and meta-analysis. Neurophysiol Clin 2024; 54:102944. [PMID: 38387108 DOI: 10.1016/j.neucli.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To update a systematic review of the efficacy and safety of transcranial direct current stimulation (tDCS) for analgesia, for antidepressant effects, and to reduce the impact of fibromyalgia (FM), looking for optimal areas of stimulation. METHODS We searched five databases to identify randomized controlled trials comparing active and sham tDCS for FM. The primary outcome was pain intensity, and secondary outcome measures included FM Impact Questionnaire (FIQ) and depression score. Meta-analysis was conducted using standardized mean difference (SMD). Subgroup analysis was performed to determine the effects of different regional stimulation, over the primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), opercular-insular cortex (OIC), and occipital nerve (ON) regions. We analyzed the minimal clinically important difference (MCID) by the value of the mean difference (MD) for an 11-point scale for pain, the Beck Depressive Inventory-II (BDI-II), and the Fibromyalgia Impact Questionnaire (FIQ) score. We described the certainty of the evidence (COE) using the tool GRADE profile. RESULTS Twenty studies were included in the analysis. Active tDCS had a positive effect on pain (SMD= -1.04; 95 % CI -1.38 to -0.69), depression (SMD= -0.46; 95 % CI -0.64 to -0.29), FIQ (SMD= -0.73; 95 % CI -1.09 to -0.36), COE is moderate. Only group M1 (SD=-1.57) and DLPFC (SD=-1.44) could achieve MCID for analgesia; For BDI-II, only group DLPFC (SD=-5.36) could achieve an MCID change. Adverse events were mild. CONCLUSION tDCS is a safe intervention that relieves pain intensity, reduces depression, and reduces the impact of FM on life. Achieving an MCID is related to the stimulation site and the target symptom.
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Affiliation(s)
- Chun-Lan Yang
- Minda Hospital of Hubei Minzu University, Enshi 445000, Hubei, China; Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jia-Peng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ting-Ting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Han Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yin Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ying-Chao Tan
- Enshi Prefecture Central Hospital, Enshi 445000, Hubei, China.
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3
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Wang S, Du SH, Wang XQ, Lu JY. Mechanisms of transcranial direct current stimulation (tDCS) for pain in patients with fibromyalgia syndrome. Front Mol Neurosci 2024; 17:1269636. [PMID: 38356687 PMCID: PMC10865494 DOI: 10.3389/fnmol.2024.1269636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Fibromyalgia syndrome (FMS) is a recurrent pain condition that can be challenging to treat. Transcranial direct current stimulation (tDCS) has become a promising non-invasive therapeutic option in alleviating FMS pain, but the mechanisms underlying its effectiveness are not yet fully understood. In this article, we discuss the most current research investigating the analgesic effects of tDCS on FMS and discuss the potential mechanisms. TDCS may exert its analgesic effects by influencing neuronal activity in the brain, altering cortical excitability, changing regional cerebral blood flow, modulating neurotransmission and neuroinflammation, and inducing neuroplasticity. Overall, evidence points to tDCS as a potentially safe and efficient pain relief choice for FMS by multiple underlying mechanisms. This article provides a thorough overview of our ongoing knowledge regarding the mechanisms underlying tDCS and emphasizes the possibility of further studies to improve the clinical utility of tDCS as a pain management tool.
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Affiliation(s)
- Shan Wang
- Department of Health School, Shanghai Normal University Tianhua College, Shanghai, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jun-Yan Lu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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4
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Lim M, Kim DJ, Nascimento TD, Ichesco E, Kaplan C, Harris RE, DaSilva AF. Functional Magnetic Resonance Imaging Signal Variability Is Associated With Neuromodulation in Fibromyalgia. Neuromodulation 2023; 26:999-1008. [PMID: 34309138 PMCID: PMC8789944 DOI: 10.1111/ner.13512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/11/2021] [Accepted: 06/29/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Although primary motor cortex (M1) transcranial direct current stimulation (tDCS) has an analgesic effect in fibromyalgia (FM), its neural mechanism remains elusive. We investigated whether M1-tDCS modulates a regional temporal variability of blood-oxygenation-level-dependent (BOLD) signals, an indicator of the brain's flexibility and efficiency and if this change is associated with pain improvement. MATERIALS AND METHODS In a within-subjects cross-over design, 12 female FM patients underwent sham and active tDCS on five consecutive days, respectively. Each session was performed with an anode placed on the left M1 and a cathode on the contralateral supraorbital region. The subjects also participated in resting-state functional magnetic resonance imaging (fMRI) at baseline and after sham and active tDCS. We compared the BOLD signal variability (SDBOLD), defined as the standard deviation of the BOLD time-series, between the tDCS conditions. Baseline SDBOLD was compared to 15 healthy female controls. RESULTS At baseline, FM patients showed reduced SDBOLD in the ventromedial prefrontal cortex (vmPFC), lateral PFC, and anterior insula and increased SDBOLD in the posterior insula compared to healthy controls. After active tDCS, compared to sham, we found an increased SDBOLD in the left rostral anterior cingulate cortex (rACC), lateral PFC, and thalamus. After sham tDCS, compared to baseline, we found a decreased SDBOLD in the dorsomedial PFC and posterior cingulate cortex/precuneus. Interestingly, after active tDCS compared to sham, pain reduction was correlated with an increased SDBOLD in the rACC/vmPFC but with a decreased SDBOLD in the posterior insula. CONCLUSION Our findings suggest that M1-tDCS might revert temporal variability of fMRI signals in the rACC/vmPFC and posterior insula linked to FM pain. Changes in neural variability would be part of the mechanisms underlying repetitive M1-tDCS analgesia in FM.
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Affiliation(s)
- Manyoel Lim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Dajung J Kim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Thiago D Nascimento
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Alexandre F DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
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5
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Piras C, Pibiri M, Conte S, Ferranti G, Leoni VP, Liggi S, Spada M, Muntoni S, Caboni P, Atzori L. Metabolomics analysis of plasma samples of patients with fibromyalgia and electromagnetic sensitivity using GC-MS technique. Sci Rep 2022; 12:21923. [PMID: 36535959 PMCID: PMC9763344 DOI: 10.1038/s41598-022-25588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Fibromyalgia (FM) is a chronic and systemic condition that causes widespread chronic pain, asthenia, and muscle stiffness, as well as in some cases depression, anxiety, and disorders of the autonomic system. The exact causes that lead to the development of FM are still unknown today. In a percentage of individuals, the symptoms of FM are often triggered and/or exacerbated by proximity to electrical and electromagnetic devices. Plasma metabolomic profile of 54 patients with fibromyalgia and self-reported electromagnetic sensitivity (IEI-EMF) were compared to 23 healthy subjects using gas chromatography-mass spectrometry (GC-MS) coupled with multivariate statistical analysis techniques. Before the GC-MS analysis the plasma samples were extracted with a modified Folch method and then derivatized with methoxamine hydrochloride in pyridine solution and N-trimethylsilyltrifuoroacetamide. The combined analysis allowed to identify a metabolomic profile able of distinguishing IEI-EMF patients and healthy subjects. IEI-EMF patients were therefore characterized by the alteration of 19 metabolites involved in different metabolic pathways such as energy metabolism, muscle, and pathways related to oxidative stress defense and chronic pain. The results obtained in this study complete the metabolomic "picture" previously investigated on the same cohort of IEI-EMF patients with 1H-NMR spectroscopy, placing a further piece for better understanding the pathophysiological mechanisms in patients with IEI-EMF.
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Affiliation(s)
- Cristina Piras
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Monica Pibiri
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Stella Conte
- grid.7763.50000 0004 1755 3242Department of Education, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Gabriella Ferranti
- grid.7763.50000 0004 1755 3242Department of Education, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Vera Piera Leoni
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Sonia Liggi
- grid.7445.20000 0001 2113 8111Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Martina Spada
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Sandro Muntoni
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Pierluigi Caboni
- grid.7763.50000 0004 1755 3242Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Atzori
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
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Gyorfi M, Rupp A, Abd-Elsayed A. Fibromyalgia Pathophysiology. Biomedicines 2022; 10:biomedicines10123070. [PMID: 36551826 PMCID: PMC9776089 DOI: 10.3390/biomedicines10123070] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
This article examines the biological, genetic, and environmental aspects of fibromyalgia that may have an impact on its pathogenesis. Symptoms of fibromyalgia may be related to aberrations in the endogenous inhibition of pain as well as changes in the central processing of sensory input. Genetic research has revealed familial aggregation of fibromyalgia and other related disorders like major depressive disorder. Dysfunctional pain processing may also be influenced by exposure to physical or psychological stressors, abnormal biologic reactions in the autonomic nervous system, and neuroendocrine responses. With more research the pathophysiology of fibromyalgia will be better understood, leading to more logical and focused treatment options for fibromyalgia patients.
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Affiliation(s)
- Michael Gyorfi
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
- Correspondence:
| | - Adam Rupp
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
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7
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Lia EN, Papassidero PC, Coelho EB, Dach F, Alexandre-Santos L, Trevisan AC, Santos LELE, Silvah JH, Lanchote VL, Pasqua OD, Wichert-Ana L. Neurobiological substrates of chronic low back pain (CLBP): a brain [ 99mTc]Tc-ECD SPECT study. Eur J Hybrid Imaging 2022; 6:26. [PMID: 36404393 PMCID: PMC9676153 DOI: 10.1186/s41824-022-00145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent neuroimaging studies have demonstrated pathological mechanisms related to cerebral neuroplasticity in chronic low back pain (CLBP). Few studies have compared cerebral changes between patients with and without pain in the absence of an experimentally induced stimulus. We investigated the neurobiological substrates associated with chronic low back pain using [99mTc]Tc-ECD brain SPECT and correlated rCBF findings with the numeric rating scale (NRS) of pain and douleur neuropathique en 4 questions (DN4). Ten healthy control volunteers and fourteen patients with neuropathic CLBP due to lumbar disc herniation underwent cerebral SPECT scans. A quantitative comparison of rCBF findings between patients and controls was made using the Statistical Parametric Mapping (SPM), revealing clusters of voxels with a significant increase or decrease in rCBF. The intensity of CLBP was assessed by NRS and by DN4. RESULTS The results demonstrated an rCBF increase in clusters A (occipital and posterior cingulate cortex) and B (right frontal) and a decrease in cluster C (superior parietal lobe and middle cingulate cortex). NRS scores were inversely and moderately correlated with the intensity of rCBF increase in cluster B, but not to rCBF changes in clusters A and C. DN4 scores did not correlate with rCBF changes in all three clusters. CONCLUSIONS This study will be important for future therapeutic studies that aim to validate the association of rCBF findings with the pharmacokinetic and pharmacodynamic profiles of therapeutic challenges in pain.
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Affiliation(s)
- Erica Negrini Lia
- grid.7632.00000 0001 2238 5157Department of Dentistry, School of Health Sciences, University of Brasilia (UnB), Brasilia, DF Brazil
| | - Priscila Colavite Papassidero
- grid.11899.380000 0004 1937 0722Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Eduardo Barbosa Coelho
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Fabíola Dach
- grid.11899.380000 0004 1937 0722Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Leonardo Alexandre-Santos
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Ana Carolina Trevisan
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Lucas Emmanuel Lopes e Santos
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Jose Henrique Silvah
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Vera Lúcia Lanchote
- grid.11899.380000 0004 1937 0722Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Oscar Della Pasqua
- grid.83440.3b0000000121901201Clinical Pharmacology and Therapeutics, School of Life and Medical Sciences, University College London, London, UK
| | - Lauro Wichert-Ana
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil ,grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil ,Seção de Medicina Nuclear, Hospital das Clínicas – FMRP – USP, Av. Bandeirantes, 3900, CEP: 14048-900 Ribeirão Preto, SP Brasil
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8
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Diagnostic Ability and Capacity of Optical Coherence Tomography-Angiography to Detect Retinal and Vascular Changes in Patients with Fibromyalgia. J Ophthalmol 2022; 2022:3946017. [PMID: 36065284 PMCID: PMC9440831 DOI: 10.1155/2022/3946017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background To evaluate the neuroretina and retinal vasculature of fibromyalgia (FM) patients and calculate a linear discriminant function (LDF) to improve retinal parameters' contribution to FM diagnosis. Methods Fifty FM patients and 232 healthy controls underwent retinal evaluation using swept-source optical coherence tomography (SS-OCT) angiography (Triton plus; Topcon) and spectral domain OCT (SD-OCT) (Spectralis; Heidelberg). The macular (m) and peripapillary (p) retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) were assessed, as was the macular vascular density. A logistic regression analysis was performed, and an LDF was calculated to evaluate OCT's contribution to FM diagnosis. Results With Triton OCT, the patients presented pRNFL thinning in the temporal sector (p=0.006). Spectralis OCT measurements showed decreased pRNFL in patients in the following sectors: superonasal, p=0.001; nasal, p=0.001; inferonasal, p=0.006; temporal, p=0.001; and inferotemporal, p=0.001. No significant differences were observed in the macular vascular plexus between patients and controls. However, vascular density in the superior sector showed a strong inverse correlation with disease duration (r = −0.978, p=0.022). The LDF calculated for Spectralis OCT yielded an area under the ROC curve of 0.968. Conclusions FM patients present RNFL thinning observable using SS- and SD-OCT. However, these patients show similar vascular density in the macular area to healthy controls. The LDF that combines several RNFL parameters obtained using Spectralis OCT gives this device a powerful ability to differentiate between healthy individuals and individuals with FM.
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9
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Cordón B, Orduna-Hospital E, Viladés E, Garcia-Martin E, Garcia-Campayo J, Puebla-Guedea M, Polo V, Larrosa JM, Pablo LE, Vicente MJ, Satue M. Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life. Curr Eye Res 2021; 47:143-153. [PMID: 34213409 DOI: 10.1080/02713683.2021.1951301] [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: 10/20/2022]
Abstract
PURPOSE To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life. METHODS Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive and biological). RESULTS : Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed. CONCLUSIONS Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.
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Affiliation(s)
- B Cordón
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Orduna-Hospital
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Viladés
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Garcia-Martin
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J Garcia-Campayo
- Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain).,Psychiatry Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - M Puebla-Guedea
- Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain)
| | - V Polo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J M Larrosa
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - L E Pablo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M J Vicente
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M Satue
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
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10
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Ellerbrock I, Sandström A, Tour J, Fanton S, Kadetoff D, Schalling M, Jensen KB, Sitnikov R, Kosek E. Serotonergic gene-to-gene interaction is associated with mood and GABA concentrations but not with pain-related cerebral processing in fibromyalgia subjects and healthy controls. Mol Brain 2021; 14:81. [PMID: 33980291 PMCID: PMC8117625 DOI: 10.1186/s13041-021-00789-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
The neurotransmitter serotonin, involved in the regulation of pain and emotion, is critically regulated by the 5‐HT1A autoreceptor and the serotonin transporter (5-HTT). Polymorphisms of these genes affect mood and endogenous pain modulation, both demonstrated to be altered in fibromyalgia subjects (FMS). Here, we tested the effects of genetic variants of the 5‐HT1A receptor (CC/G-carriers) and 5-HTT (high/intermediate/low expression) on mood, pain sensitivity, cerebral processing of evoked pain (functional MRI) and concentrations of GABA and glutamate (MR spectroscopy) in rostral anterior cingulate cortex (rACC) and thalamus in FMS and healthy controls (HC). Interactions between serotonin-relevant genes were found in affective characteristics, with genetically inferred high serotonergic signalling (5-HT1A CC/5-HTThigh genotypes) being more favourable across groups. Additionally, 5‐HT1A CC homozygotes displayed higher pain thresholds than G-carriers in HC but not in FMS. Cerebral processing of evoked pressure pain differed between groups in thalamus with HC showing more deactivation than FMS, but was not influenced by serotonin-relevant genotypes. In thalamus, we observed a 5‐HT1A-by-5-HTT and group-by-5-HTT interaction in GABA concentrations, with the 5-HTT high expressing genotype differing between groups and 5‐HT1A genotypes. No significant effects were seen for glutamate or in rACC. To our knowledge, this is the first report of this serotonergic gene-to-gene interaction associated with mood, both among FMS (depression) and across groups (anxiety). Additionally, our findings provide evidence of an association between the serotonergic system and thalamic GABA concentrations, with individuals possessing genetically inferred high serotonergic signalling exhibiting the highest GABA concentrations, possibly enhancing GABAergic inhibitory effects via 5-HT.
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Affiliation(s)
- Isabel Ellerbrock
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology, Blekinge Hospital, Karlskrona, Sweden
| | - Silvia Fanton
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Rouslan Sitnikov
- MRI Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Insitutet, Nobels väg 9, 17177, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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11
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Fayed N, Oliván B, Lopez del Hoyo Y, Andrés E, Perez-Yus MC, Fayed A, Angel LF, Serrano-Blanco A, Roca M, Garcia Campayo J. Changes in metabolites in the brain of patients with fibromyalgia after treatment with an NMDA receptor antagonist. Neuroradiol J 2019; 32:408-419. [PMID: 31215319 PMCID: PMC6856999 DOI: 10.1177/1971400919857544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aims of this work were to evaluate whether the treatment of patients with fibromyalgia with memantine is associated with significant changes in metabolite concentrations in the brain, and to explore any changes in clinical outcome measures. Magnetic resonance spectroscopy was performed of the right anterior and posterior insula, both hippocampi and the posterior cingulate cortex. Questionnaires on pain, anxiety, depression, global function, quality of life and cognitive impairment were used. Ten patients were studied at baseline and after three months of treatment with memantine. Significant increases were observed in the following areas: N-acetylaspartate (4.47 at baseline vs. 4.71 at three months, p = 0.02) and N-acetylaspartate+N-acetylaspartate glutamate in the left hippocampus (5.89 vs. 5.98; p = 0.007); N-acetylaspartate+N-acetylaspartate glutamate in the right hippocampus (5.31 vs 5.79; p = 0.01) and the anterior insula (7.56 vs. 7.70; p = 0.033); glutamate+glutamine/creatine ratio in the anterior insula (2.03 vs. 2.17; p = 0.022) and the posterior insula (1.77 vs. 2.00; p = 0.004); choline/creatine ratio in the posterior cingulate (0.18 vs. 0.19; p = 0.023); and creatine in the right hippocampus (3.60 vs. 3.85; p = 0.007). At the three-month follow-up, memantine improved cognitive function assessed by the Cognition Mini-Exam (31.50, SD = 2.95 vs. 34.40, SD = 0.6; p = 0.005), depression measured by the Hamilton Depression Scale (7.70, SD = 0.81 vs. 7.56, SD = 0.68; p = 0.042) and severity of illness measured by the Clinical Global Impression severity scale (5.79, SD = 0.96 vs. 5.31, SD = 1.12; p = 0.007). Depression, clinical global impression and cognitive function showed improvement with memantine. Magnetic resonance spectroscopy could be useful in monitoring response to the pharmacological treatment of fibromyalgia.
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Affiliation(s)
- Nicolas Fayed
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Barbara Oliván
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Yolanda Lopez del Hoyo
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Eva Andrés
- CIBER Epidemiology and Public Health,
Clinical Epidemiology Unit, October 12 Hospital, Spain
| | | | - Alicia Fayed
- Department of Neurorehabilitation, San
Juan de Dios Hospital, Spain
| | - Luisa F Angel
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Antoni Serrano-Blanco
- Department of Psychiatry, Parc Sanitari
St. Joan of God and the St. Joan of God Foundation, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Miquel Roca
- Health Sciences Research University
Institute, Juan March Hospital, Illes Balears University, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Javier Garcia Campayo
- Department of Psychiatry, Miguel Servet
Hospital and the University of Zaragoza. Aragon Institute for Health Research (IIS
Aragon), Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
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12
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Nishioka K, Suzuki M, Nakajima M, Hara T, Iseki M, Hattori N. Painful legs and moving toes syndrome evaluated through brain single photon emission computed tomography: a case series. J Neurol 2019; 266:717-725. [PMID: 30637456 DOI: 10.1007/s00415-019-09194-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 11/24/2022]
Abstract
Painful legs and moving toes (PLMT) syndrome is a clinical entity characterized by persistent pain in the feet or legs and involuntary movements of one or more toes. The precise patho-mechanisms of PLMT still remain unknown. Herein, we examined ten patients clinically identified with PLMT syndrome. All patients first presented persistent pain prior to the onset of motor symptoms. Each patient was examined by neurological investigation, neuro-imaging methods including brain magnetic resonance imaging (MRI) and electrophysiological methods. The brain single photon emission computed tomography (SPECT) images of eight patients indicated hypoperfusion of frontal lobes and cerebellum. The conjunction analysis of brain SPECT imaging data of all eight patients, using the 3D-SSP program, compared to 34 controls indicated significant hypoperfusion in the prefrontal cortical, occipital cortical, and cerebellar surfaces, and thalamus, and hyperperfusion in the surface of the anterior cingulate gyrus and parietal cortices including primary and secondary somatosensory cortices, bilaterally. These areas reflected on a part of the pain matrix. Other electrophysiological examinations did not indicate specific abnormalities to explain the patients' symptoms. On treatment with clonazepam, four out of nine patients could resolve their foot-related motor symptoms, but not the sensory symptoms. Overall, their pain was an intractable and persistent symptom throughout their clinical course. Our study infers that PLMT syndrome is fundamentally a chronic pain disorder, possibly relating to the central sensitization, involving the region of a part of pain matrix. Further studies need to confirm our results by adding more patients.
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Affiliation(s)
- Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, 3-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine, 3-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Takeshi Hara
- Department of Neurosurgery, Juntendo University School of Medicine, 3-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Masako Iseki
- Department of Anesthesiology, Juntendo University School of Medicine, 3-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
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13
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Kang D, McAuley JH, Kassem MS, Gatt JM, Gustin SM. What does the grey matter decrease in the medial prefrontal cortex reflect in people with chronic pain? Eur J Pain 2018; 23:203-219. [PMID: 30101509 DOI: 10.1002/ejp.1304] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 08/05/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Alterations in the grey matter volume of several brain regions have been reported in people with chronic pain. The most consistent observation is a decrease in grey matter volume in the medial prefrontal cortex. These findings are important as the medial prefrontal cortex plays a critical role in emotional and cognitive processing in chronic pain. Although a logical cause of grey matter volume decrease may be neurodegeneration, this is not supported by the current evidence. Therefore, the purpose of this review was to evaluate the existing literature to unravel what the decrease in medial prefrontal cortex grey matter volume in people with chronic pain may represent on a biochemical and cellular level. DATABASES AND DATA TREATMENT A literature search for this topical review was conducted using PubMed and SCOPUS library. Search terms included chronic pain, pain, medial prefrontal cortex, anterior cingulate cortex, grey matter, neurochemistry, spectroscopy, magnetic resonance imaging, positron emission tomography, dendrite, neurodegeneration, glia, astrocyte, microglia, neurotransmitter, glutamate, GABA and different combinations of these terms. RESULTS Adopting a stress model of chronic pain, two major pathways are proposed that contribute to grey matter volume decrease in the medial prefrontal cortex: (a) changes in dendritic morphology as a result of hypothalamic-pituitary axis dysfunction and (b) neurotransmitter dysregulation, specifically glutamate and γ-Aminobutyric acid, which affects local microvasculature. CONCLUSION Our model proposes new mechanisms in chronic pain pathophysiology responsible for mPFC grey matter loss as alternatives to neurodegeneration. SIGNIFICANCE It is unclear what the decrease in medial prefrontal cortex grey matter volume represents in chronic pain. The most attractive reason is neurodegeneration. However, there is no evidence to support this. Our review reveals nondegenerative causes of decreased medial prefrontal grey matter to guide future research into chronic pain pathophysiology.
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Affiliation(s)
- David Kang
- Neuroscience Research Australia, Sydney, NSW, Australia.,UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - James H McAuley
- Neuroscience Research Australia, Sydney, NSW, Australia.,UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Justine M Gatt
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, UNSW Sydney, Sydney, NSW, Australia
| | - Sylvia M Gustin
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, UNSW Sydney, Sydney, NSW, Australia
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14
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Acute and Chronic Pain Processing in the Thalamocortical System of Humans and Animal Models. Neuroscience 2018; 387:58-71. [DOI: 10.1016/j.neuroscience.2017.09.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
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15
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Grayston R, Czanner G, Elhadd K, Goebel A, Frank B, Üçeyler N, Malik RA, Alam U. A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Semin Arthritis Rheum 2018; 48:933-940. [PMID: 30314675 DOI: 10.1016/j.semarthrit.2018.08.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/01/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Fibromyalgia is a condition which exhibits chronic widespread pain with neuropathic pain features and has a major impact on health-related quality of life. The pathophysiology remains unclear, however, there is increasing evidence for involvement of the peripheral nervous system with a high prevalence of small fiber pathology (SFP). The aim of this systematic literature review is to establish the prevalence of SFP in fibromyalgia. METHODS An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, CINAHL and the Cochrane Library databases. Published full-text, English language articles that provide SFP prevalence data in studies of fibromyalgia of patients over 18years old were included. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using the critical appraisal tool by Munn et al. Overall and subgroup pooled prevalence were calculated by random-effects meta-analysis with 95% CI. RESULTS Database searches found 935 studies; 45 articles were screened of which 8 full text articles satisfied the inclusion criteria, providing data from 222 participants. The meta-analysis demonstrated the pooled prevalence of SFP in fibromyalgia is 49% (95% CI: 38-60%) with a moderate degree of heterogeneity, (I2 = 68%). The prevalence estimate attained by a skin biopsy was 45% (95% CI: 32-59%, I2 = 70%) and for corneal confocal microscopy it was 59% (95% CI: 40-78%, I2 = 51%). CONCLUSION There is a high prevalence of SFP in fibromyalgia. This study provides compelling evidence of a distinct phenotype involving SFP in fibromyalgia. Identifying SFP will aid in determining its relationship to pain and potentially facilitate the development of future interventions and pharmacotherapy.
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Affiliation(s)
- Rebecca Grayston
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Gabriela Czanner
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Kareim Elhadd
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andreas Goebel
- The Pain Research Institute, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernhard Frank
- The Pain Research Institute, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | | | - Uazman Alam
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Diabetes & Endocrinology Research & Pain Research Institute, Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK; Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK.
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16
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Khedr EM, Omran EA, Ismail NM, El-Hammady DH, Goma SH, Kotb H, Galal H, Osman AM, Farghaly HS, Karim AA, Ahmed GA. Effects of transcranial direct current stimulation on pain, mood and serum endorphin level in the treatment of fibromyalgia: A double blinded, randomized clinical trial. Brain Stimul 2017; 10:893-901. [DOI: 10.1016/j.brs.2017.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/27/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022] Open
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17
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Prise en charge des symptômes médicalement inexpliqués en médecine interne : un paradigme de la relation médecin-malade en situation d’incertitude. Rev Med Interne 2017; 38:458-466. [DOI: 10.1016/j.revmed.2016.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/17/2016] [Indexed: 11/18/2022]
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18
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Brain activations during pain: a neuroimaging meta-analysis of patients with pain and healthy controls. Pain 2017; 157:1279-1286. [PMID: 26871535 DOI: 10.1097/j.pain.0000000000000517] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In response to recent publications from pain neuroimaging experiments, there has been a debate about the existence of a primary pain region in the brain. Yet, there are few meta-analyses providing assessments of the minimum cerebral denominators of pain. Here, we used a statistical meta-analysis method, called activation likelihood estimation, to define (1) core brain regions activated by pain per se, irrelevant of pain modality, paradigm, or participants and (2) activation likelihood estimation commonalities and differences between patients with chronic pain and healthy individuals. A subtraction analysis of 138 independent data sets revealed that the minimum denominator for activation across pain modalities and paradigms included the right insula, secondary sensory cortex, and right anterior cingulate cortex (ACC). Common activations for healthy subjects and patients with pain alike included the thalamus, ACC, insula, and cerebellum. A comparative analysis revealed that healthy individuals were more likely to activate the cingulum, thalamus, and insula. Our results point toward the central role of the insular cortex and ACC in pain processing, irrelevant of modality, body part, or clinical experience; thus, furthering the importance of ACC and insular activation as key regions for the human experience of pain.
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19
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Gray Matter Atrophy within the Default Mode Network of Fibromyalgia: A Meta-Analysis of Voxel-Based Morphometry Studies. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7296125. [PMID: 28105430 PMCID: PMC5220433 DOI: 10.1155/2016/7296125] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/06/2016] [Indexed: 12/30/2022]
Abstract
Over the years, studies have demonstrated morphological changes in the brain of fibromyalgia (FMS). We aimed to conduct a coordinate-based meta-analytic research through systemic review on voxel-based morphometry (VBM) imaging results to identify consistent gray matter (GM) difference between FMS patients and healthy subjects. We performed a comprehensive literature search in PubMed (January 2000–December 2015) and included six VBM publication on FMS. Stereotactic data were extracted from 180 patients of FMS and 123 healthy controls. By means of activation likelihood estimation (ALE) technique, regional GM reduction in left medial prefrontal cortex and right dorsal posterior cingulate cortex was identified. Both regions are within the default mode network. In conclusion, the gray matter deficit is related to the both affective and nonaffective components of pain processing. This result also provided the neuroanatomical correlates for emotional and cognitive symptoms in FMS.
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20
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Walitt B, Ceko M, Gracely JL, Gracely RH. Neuroimaging of Central Sensitivity Syndromes: Key Insights from the Scientific Literature. Curr Rheumatol Rev 2016; 12:55-87. [PMID: 26717948 DOI: 10.2174/1573397112666151231111104] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/24/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
Abstract
Central sensitivity syndromes are characterized by distressing symptoms, such as pain and fatigue, in the absence of clinically obvious pathology. The scientific underpinnings of these disorders are not currently known. Modern neuroimaging techniques promise new insights into mechanisms mediating these postulated syndromes. We review the results of neuroimaging applied to five central sensitivity syndromes: fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular joint disorder, and vulvodynia syndrome. Neuroimaging studies of basal metabolism, anatomic constitution, molecular constituents, evoked neural activity, and treatment effect are compared across all of these syndromes. Evoked sensory paradigms reveal sensory augmentation to both painful and nonpainful stimulation. This is a transformative observation for these syndromes, which were historically considered to be completely of hysterical or feigned in origin. However, whether sensory augmentation represents the cause of these syndromes, a predisposing factor, an endophenotype, or an epiphenomenon cannot be discerned from the current literature. Further, the result from cross-sectional neuroimaging studies of basal activity, anatomy, and molecular constituency are extremely heterogeneous within and between the syndromes. A defining neuroimaging "signature" cannot be discerned for any of the particular syndromes or for an over-arching central sensitization mechanism common to all of the syndromes. Several issues confound initial attempts to meaningfully measure treatment effects in these syndromes. At this time, the existence of "central sensitivity syndromes" is based more soundly on clinical and epidemiological evidence. A coherent picture of a "central sensitization" mechanism that bridges across all of these syndromes does not emerge from the existing scientific evidence.
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Affiliation(s)
- Brian Walitt
- National Center for Complementary and Integrative Health, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA.
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21
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Van Der Gucht A, Aoun Sebaiti M, Guedj E, Aouizerate J, Yara S, Gherardi RK, Evangelista E, Chalaye J, Cottereau AS, Verger A, Bachoud-Levi AC, Abulizi M, Itti E, Authier FJ. Brain 18F-FDG PET Metabolic Abnormalities in Patients with Long-Lasting Macrophagic Myofascitis. J Nucl Med 2016; 58:492-498. [DOI: 10.2967/jnumed.114.151878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022] Open
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22
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Matsudaira T, Takahashi Y, Matsuda K, Ikeda H, Usui K, Obi T, Inoue Y. Cognitive dysfunction and regional cerebral blood flow changes in Japanese females after human papillomavirus vaccination. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ncn3.12083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takashi Matsudaira
- Department of Neurology National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Yukitoshi Takahashi
- Department of Pediatrics National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Kazumi Matsuda
- Department of Neurosurgery National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Hitoshi Ikeda
- Department of Neurology National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Keiko Usui
- Department of Neurology National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Tomokazu Obi
- Department of Neurology National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
| | - Yushi Inoue
- Department of Psychiatry National Epilepsy Center Shizuoka Institute of Epilepsy and Neurological Disorders NHO Shizuoka Japan
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23
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Choy EH. Current treatments to counter sleep dysfunction as a pathogenic stimulus of fibromyalgia. Pain Manag 2016; 6:339-46. [PMID: 27312978 DOI: 10.2217/pmt-2016-0009] [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] [Indexed: 11/21/2022] Open
Abstract
Fibromyalgia is characterized by chronic widespread pain, fatigue and nonrestorative sleep. Polysomnography showed reduced short-wave sleep and abnormal alpha rhythms during nonrapid eye movement sleep in patients with fibromyalgia. However, sleep dysfunction might be pathogenic in fibromyalgia since myalgia and fatigue could be induced in healthy individuals by disrupting sleep. Poor sleep quality was a major risk factor for the subsequent development of chronic widespread pain in healthy pain-free individuals. Sleep disruption leads to impairment of the descending pain inhibition pathways. Aside from good sleep, hygiene, exercise can promote sleep. Among currently available pharmacological treatments, evidence suggests amitriptyline and pregabalin can improve sleep in fibromyalgia.
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Affiliation(s)
- Ernest H Choy
- Section of Rheumatology, Institute of Infection & Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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24
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Basal Ganglia Perfusion in Fibromyalgia is Related to Pain Disability and Disease Impact. Clin J Pain 2016; 32:495-505. [DOI: 10.1097/ajp.0000000000000295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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25
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Lim M, Kim JS, Kim DJ, Chung CK. Increased Low- and High-Frequency Oscillatory Activity in the Prefrontal Cortex of Fibromyalgia Patients. Front Hum Neurosci 2016; 10:111. [PMID: 27014041 PMCID: PMC4789463 DOI: 10.3389/fnhum.2016.00111] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/29/2016] [Indexed: 11/30/2022] Open
Abstract
Recent human neuroimaging studies have suggested that fibromyalgia (FM), a chronic widespread pain disorder, exhibits altered thalamic structure and function. Since the thalamus has extensive reciprocal connection with the cortex, structural and functional thalamic alterations in FM might be linked to aberrant thalamocortical oscillation. This study investigated the presence of abnormal brain rhythmicity in low- and high-frequency bands during resting state in patients with FM and their relationship to clinical pain symptom. Spontaneous magnetoencephalography (MEG) activity was recorded in 18 females with FM and 18 age- and sex-matched healthy control (HC) subjects. The most remarkable finding was that FM patients had general increases in theta, beta and gamma power along with a slowing of the dominant alpha peak. Increased spectral powers in the theta-band were primarily localized to the left dorsolateral prefrontal (DLPFC) and orbitofrontal cortex (OFC). Beta and gamma over-activation were localized to insular, primary motor and primary and secondary somatosensory (S2) cortices, as well as the DLPFC and OFC. Furthermore, enhanced high-frequency oscillatory activities in the DLPFC and OFC were associated with higher affective pain scores in patients with FM. Our results demonstrate that FM patients feature enhanced low- and high-frequency oscillatory activity in the brain areas related to cognitive and emotional modulation of pain. Increased low- and high-frequency activity of the prefrontal cortex may contribute to persistent perception of pain in FM. Therapeutic intervention based on manipulating neural oscillation to restore normal thalamocortical rhythmicity may be beneficial to pain relief in FM.
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Affiliation(s)
- Manyoel Lim
- Neuroscience Research Institute, Seoul National University College of Medicine Seoul, South Korea
| | - June Sic Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences Seoul, South Korea
| | - Dajung J Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences Seoul, South Korea
| | - Chun Kee Chung
- Neuroscience Research Institute, Seoul National University College of MedicineSeoul, South Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural SciencesSeoul, South Korea; Department of Neurosurgery, Seoul National University HospitalSeoul, South Korea
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Vijayan S, Klerman EB, Adler GK, Kopell NJ. Thalamic mechanisms underlying alpha-delta sleep with implications for fibromyalgia. J Neurophysiol 2015; 114:1923-30. [PMID: 26245315 DOI: 10.1152/jn.00280.2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/04/2015] [Indexed: 01/11/2023] Open
Abstract
Alpha-delta sleep is the abnormal intrusion of alpha activity (8- to 13-Hz oscillations) into the delta activity (1- to 4-Hz oscillations) that defines slow-wave sleep. Alpha-delta sleep is especially prevalent in fibromyalgia patients, and there is evidence suggesting that the irregularities in the sleep of these patients may cause the muscle and tissue pain that characterizes the disorder. We constructed a biophysically realistic mathematical model of alpha-delta sleep. Imaging studies in fibromyalgia patients suggesting altered levels of activity in the thalamus motivated a thalamic model as the source of alpha activity. Since sodium oxybate helps to alleviate the symptoms of fibromyalgia and reduces the amount of alpha-delta sleep in fibromyalgia patients, we examined how changes in the molecular targets of sodium oxybate affected alpha-delta activity in our circuit. Our model shows how alterations in GABAB currents and two thalamic currents, Ih (a hyperpolarization-activated current) and a potassium leak current, transform a circuit that normally produces delta oscillations into one that produces alpha-delta activity. Our findings suggest that drugs that reduce Ih conductances and/or increase potassium conductances, without necessarily increasing GABAB conductances, might be sufficient to restore delta sleep. Furthermore, they suggest that delta sleep might be restored by drugs that preferentially target these currents in the thalamus; such drugs might have fewer side effects than drugs that act systemically.
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Affiliation(s)
- Sujith Vijayan
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts;
| | - Elizabeth B Klerman
- Harvard Medical School, Boston, Massachusetts; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Gail K Adler
- Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy J Kopell
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
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Abstract
BACKGROUND The search for effective treatments for fibromyalgia (FM) has continued for years. The present study premises that thalamocortical dysrhythmia is implicated in fibromyalgia and that low-frequency sound stimulation (LFSS) can play a regulatory function by driving neural rhythmic oscillatory activity. OBJECTIVE To assess the effect of LFSS on FM. METHOD The present open-label study with no control group used a repeated-measures design with no noncompleters. Nineteen female volunteers (median age 51 years; median duration of FM 5.76 years) were administered 10 treatments (twice per week for five weeks). Treatments involved 23 min of LFSS at 40 Hz, delivered using transducers in a supine position. Measures (repeated before and after treatment) included the Fibromyalgia Impact Questionnaire, Jenkins Sleep Scale, Pain Disability Index, sitting and standing without pain (in minutes), cervical muscle range of motion and muscle tone. Mean percentages were calculated on end of treatment self-reports of improvement on pain, mood, insomnia and activities of daily living. RESULTS Significant improvements were observed with median scores: Fibromyalgia Impact Questionnaire, 81% (P<0.0001); Jenkins Sleep Scale, 90% (P<0.0001); and Pain Disability Index, 49.1% (P<0.0001). Medication dose was reduced in 73.68% of patients and completely discontinued in 26.32%. Time sitting and standing without pain increased significantly (P<0.0001). Cervical muscle range of motion increased from 25% to 75% (P=0.001), while muscle tone changed from hypertonic to normal (P=0.0002). CONCLUSION In the present study, the LFSS treatment showed no adverse effects and patients receiving the LFSS treatment showed statistically and clinically relevant improvement. Further phase 2 and 3 trials are warranted.
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Kim DJ, Lim M, Kim JS, Son KM, Kim HA, Chung CK. Altered White Matter Integrity in the Corpus Callosum in Fibromyalgia Patients Identified by Tract-Based Spatial Statistical Analysis. Arthritis Rheumatol 2014; 66:3190-9. [DOI: 10.1002/art.38771] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Dajung J. Kim
- Seoul National University Hospital and Seoul National University College of Natural Sciences; Seoul Republic of Korea
| | - Manyoel Lim
- Seoul National University Hospital and Seoul National University Medical Research Center; Seoul Republic of Korea
| | - June Sic Kim
- Seoul National University Hospital and Seoul National University Medical Research Center; Seoul Republic of Korea
| | - Kyeong Min Son
- Hallym University College of Medicine; Chuncheon Republic of Korea
| | - Hyun Ah Kim
- Hallym University College of Medicine, Chuncheon, Republic of Korea, and Hallym University Sacred Heart Hospital; Anyang Republic of Korea
| | - Chun Kee Chung
- Seoul National University Hospital, Seoul National University Medical Research Center, and Seoul National University College of Natural Sciences; Seoul Republic of Korea
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Martinsen S, Flodin P, Berrebi J, Löfgren M, Bileviciute-Ljungar I, Ingvar M, Fransson P, Kosek E. Fibromyalgia patients had normal distraction related pain inhibition but cognitive impairment reflected in caudate nucleus and hippocampus during the Stroop Color Word Test. PLoS One 2014; 9:e108637. [PMID: 25275449 PMCID: PMC4183523 DOI: 10.1371/journal.pone.0108637] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/27/2014] [Indexed: 11/18/2022] Open
Abstract
The mechanisms causing cognitive problems in chronic pain patients are not well understood. We used the Stroop color word task (SCWT) to investigate distraction-induced analgesia, cognitive performance, and cerebral activation patterns in 29 fibromyalgia (FM) patients (mean age 49.8 years, range 25–64 years) and 31 healthy controls (HC) (mean age 46.3 years, range 20–63 years). In the first study, SCWT was used to investigate distraction-induced analgesia in FM patients. Two versions of the task were applied, one with only congruent color-word images and one with incongruent images. Pressure pain thresholds were assessed using a pressure algometer before, during, and following SCWT. In the second study, reaction times (RTs) were assessed and functional magnetic resonance imaging (fMRI) was used to investigate cerebral activation patterns in FM patients and HC during the SCWT. An event-related task mixing incongruent and congruent images was used. In study one, we found reduced pressure pain sensitivity during SCWT in both groups alike and no statistically significant differences were seen between the incongruent and congruent conditions. The study two revealed longer RTs during the incongruent compared to the congruent condition in both groups. FM patients had longer RTs than HC in both conditions. Furthermore, we found a significant interaction between group and congruency; that is, the group differences in RTs were more pronounced during the incongruent condition. This was reflected in a reduced activation of the caudate nucleus, lingual gyrus, temporal areas, and the hippocampus in FM patients compared to HC. In conclusion, we found normal pain inhibition during SWTC in FM patients. The cognitive difficulties seen in FM patients, reflected in longer RTs, were related to reduced activation of the caudate nucleus and hippocampus during incongruent SCWT, which most likely affected the mechanisms of cognitive learning in FM patients.
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Affiliation(s)
- Sofia Martinsen
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Pär Flodin
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Berrebi
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Löfgren
- Dept. of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
| | | | - Martin Ingvar
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Peter Fransson
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Kosek
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Fayed N, Olivan-Blázquez B, Herrera-Mercadal P, Puebla-Guedea M, Pérez-Yus MC, Andrés E, López del Hoyo Y, Magallon R, Viguera L, Garcia-Campayo J. Changes in metabolites after treatment with memantine in fibromyalgia. A double-blind randomized controlled trial with magnetic resonance spectroscopy with a 6-month follow-up. CNS Neurosci Ther 2014; 20:999-1007. [PMID: 25230216 DOI: 10.1111/cns.12314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia (FM) patients. METHODS Doubled-blind parallel randomized controlled trial. Twenty-five patients diagnosed with FM were enrolled in the study. Patients were administered questionnaires on pain, anxiety, depression, quality of life, and cognitive impairment, and single-voxel MRS of the brain was performed. All assessments were performed at baseline and after 6 months of treatment with memantine or placebo. RESULTS Patients treated with memantine exhibited a significant increase in the glutamate (P = 0.010), glutamate/creatine ratio (P = 0.013), combined glutamate + glutamine (P = 0.016) and total N-acetyl-aspartate (NAA+NAAG) (P = 0.034) in the posterior cingulate cortex compared with those on placebo. Furthermore, the memantine group exhibited increases in creatine (P = 0.013) and choline (Cho) (P = 0.025) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire (FIQ) in the posterior insula (P = 0.050) was observed. CONCLUSION Memantine treatment resulted in an increase in cerebral metabolism in FM patients, suggesting its utility for the treatment of the illness.
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Affiliation(s)
- Nicolás Fayed
- Magnetic Resonance Unit, Department of Radiology, Clinica Quiron, Zaragoza, Spain
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Micalos PS, Korgaonkar MS, Drinkwater EJ, Cannon J, Marino FE. Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study. Int J Gen Med 2014; 7:425-32. [PMID: 25210471 PMCID: PMC4154887 DOI: 10.2147/ijgm.s55169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation before and after exercise rehabilitation in patients with chronic pain. MATERIALS AND METHODS Eleven chronic pain patients and eight healthy pain-free controls completed 12 weeks of supervised aerobic exercise intervention. Perceptual rating of standardized somatic pressure stimulation (2 kg) on the right anterior mid-thigh and brain responses during functional magnetic resonance imaging (fMRI) were assessed at pre- and postexercise rehabilitation. RESULTS There was a significant difference in the perceptual rating of innocuous somatic pressure stimulation between the chronic pain and control groups (P=0.02) but no difference following exercise rehabilitation. Whole brain voxel-wise analysis with correction for multiple comparisons revealed trends for differences in fMRI responses between the chronic pain and control groups in the superior temporal gyrus (chronic pain > control, corrected P=0.30), thalamus, and caudate (control > chronic, corrected P=0.23). Repeated measures of the regions of interest (5 mm radius) for blood oxygen level-dependent signal response revealed trend differences for superior temporal gyrus (P=0.06), thalamus (P=0.04), and caudate (P=0.21). Group-by-time interactions revealed trend differences in the caudate (P=0.10) and superior temporal gyrus (P=0.29). CONCLUSION Augmented perceptual and brain responses to innocuous somatic pressure stimulation were shown in the chronic pain group compared to the control group; however, 12-weeks of exercise rehabilitation did not significantly attenuate these responses.
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Affiliation(s)
- Peter S Micalos
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Millennium Institute, University of Sydney Medical School, Sydney, NSW, Australia
| | - Eric J Drinkwater
- School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia
| | - Jack Cannon
- School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia
| | - Frank E Marino
- School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia
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Garcia-Larrea L, Peyron R. Pain matrices and neuropathic pain matrices: A review. Pain 2013; 154 Suppl 1:S29-S43. [PMID: 24021862 DOI: 10.1016/j.pain.2013.09.001] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 01/18/2023]
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Youssef AM, Gustin SM, Nash PG, Reeves JM, Petersen ET, Peck CC, Murray GM, Henderson LA. Differential brain activity in subjects with painful trigeminal neuropathy and painful temporomandibular disorder. Pain 2013; 155:467-475. [PMID: 24269492 DOI: 10.1016/j.pain.2013.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 12/30/2022]
Abstract
Human brain imaging investigations have revealed that acute pain is associated with coactivation of numerous brain regions, including the thalamus, somatosensory, insular, and cingulate cortices. Surprisingly, a similar set of brain structures is not activated in all chronic pain conditions, particularly chronic neuropathic pain, which is associated with almost exclusively decreased thalamic activity. These inconsistencies may reflect technical issues or fundamental differences in the processing of acute compared with chronic pain. The appreciation of any differences is important because better treatment development will depend on understanding the underlying mechanisms of different forms of pain. In this investigation, we used quantitative arterial spin labeling to compare and contrast regional cerebral blood flow (CBF) patterns in individuals with chronic neuropathic orofacial pain (painful trigeminal neuropathy) and chronic nonneuropathic orofacial pain (painful temporomandibular disorder). Neuropathic pain was associated with CBF decreases in a number of regions, including the thalamus and primary somatosensory and cerebellar cortices. In contrast, chronic nonneuropathic pain was associated with significant CBF increases in regions commonly associated with higher-order cognitive and emotional functions, such as the anterior cingulate and dorsolateral prefrontal cortices and the precuneus. Furthermore, in subjects with nonneuropathic pain, blood flow increased in motor-related regions as well as within the spinal trigeminal nucleus.
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Affiliation(s)
- Andrew M Youssef
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia Departments of Radiology and Radiotherapy, University Medical Center Utrecht, The Netherlands Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Westmead Hospital, Westmead, NSW 2006, Australia
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Lin ZJ, Ren M, Li L, Liu Y, Su J, Yang SH, Liu H. Interleaved imaging of cerebral hemodynamics and blood flow index to monitor ischemic stroke and treatment in rat by volumetric diffuse optical tomography. Neuroimage 2013; 85 Pt 1:566-82. [PMID: 23872158 DOI: 10.1016/j.neuroimage.2013.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 12/29/2022] Open
Abstract
Diffuse optical tomography (DOT) has been used by several groups to assess cerebral hemodynamics of cerebral ischemia in humans and animals. In this study, we combined DOT with an indocyanine green (ICG)-tracking method to achieve interleaved images of cerebral hemodynamics and blood flow index (BFI) using two middle cerebral artery occlusion (MCAO) rat models. To achieve volumetric images with high-spatial resolution, we first integrated a depth compensation algorithm (DCA) with a volumetric mesh-based rat head model to generate three-dimensional (3D) DOT on a rat brain atlas. Then, the experimental DOT data from two rat models were collected using interleaved strategy for cerebral hemodynamics and BFI during and after ischemic stroke, with and without a thrombolytic therapy for the embolic MCAO model. The acquired animal data were further analyzed using the integrated rat-atlas-guided DOT method to form time-evolving 3D images of both cerebral hemodynamics and BFI. In particular, we were able to show and identify therapeutic outcomes of a thrombolytic treatment applied to the embolism-induced ischemic model. This paper demonstrates that volumetric DOT is capable of providing high-quality, interleaved images of cerebral hemodynamics and blood perfusion in small animals during and after ischemic stroke, with excellent 3D visualization and quantifications.
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Affiliation(s)
- Zi-Jing Lin
- Department of Bioengineering, Joint Graduate Program between University of Texas at Arlington and University of Texas Southwestern Medical Center, University of Texas at Arlington, TX 76019, USA
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Abstract
Fibromyalgia is a primary brain disorder or a result of peripheral dysfunctions inducing brain alterations, with underlying mechanisms that partially overlap with other painful conditions. Although there are methodologic variations, neuroimaging studies propose neural correlations to clinical findings of abnormal pain modulation in fibromyalgia. Growing evidences of specific differences of brain activations in resting states and pain-evoked conditions confirm clinical hyperalgesia and impaired inhibitory descending systems, and also demonstrate cognitive-affective influences on painful experiences, leading to augmented pain-processing. Functional data of neural activation abnormalities parallel structural findings of gray matter atrophy, alterations of intrinsic connectivity networks, and variations in metabolites levels along multiple pathways. Data from positron-emission tomography, single-photon-emission-computed tomography, blood-oxygen-level-dependent, voxel-based morphometry, diffusion tensor imaging, default mode network analysis, and spectroscopy enable the understanding of fibromyalgia pathophysiology, and favor the future establishment of more tailored treatments.
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Affiliation(s)
- Liliana Lourenço Jorge
- Hospital Israelita Albert Einstein and Instituto de Reabilitação Lucy Montoro, Avenida Albert Einstein, 627 3rd Floor Block D, 05651901, Morumbi, Sao Paulo, Brazil.
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Do patients with fibromyalgia show abnormal neural responses to the observation of pain in others? Neurosci Res 2013; 75:305-15. [PMID: 23419861 DOI: 10.1016/j.neures.2013.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 12/19/2022]
Abstract
Chronic widespread pain is a hallmark of fibromyalgia (FM). Previous neuroimaging studies have reported that the pain neuro-matrix in patients with FM showed augmented activation in response to actual pain. However, the effect of observing pain in others among patients with FM remains poorly understood. Both healthy female control subjects (n=24) and female patients with FM (n=23) underwent functional magnetic resonance imaging while observing a series of color pictures depicting others' hands and feet being injured, and a matched set of control pictures that did not show any painful events. Compared with healthy subjects, patients with FM showed a smaller neural response to pain-related versus neutral stimuli in several neural regions, including the thalamus, anterior cingulate cortex, dorsolateral prefrontal cortex, pre- and post-central gyrus, and supplementary motor area. In contrast to augmented pain processing in response to actual experimental pain, patients with FM did not show an enhanced pain response but generally showed lesser activation in cortical regions known to play a role in processing of pain. These hemodynamic alterations observed in patients with FM suggest that patients with chronic pain may empathize less with others in pain, possibly in order to lessen arousal and aversive self-oriented emotions.
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Olivan-Blázquez B, Puebla M, Masluk B, Pérez-Yus MC, Arcega R, Andrés E, López-del-Hoyo Y, Magallon R, Roca M, Garcia-Campayo J. Evaluation of the efficacy of memantine in the treatment of fibromyalgia: study protocol for a doubled-blind randomized controlled trial with six-month follow-up. Trials 2013; 14:3. [PMID: 23286311 PMCID: PMC3598995 DOI: 10.1186/1745-6215-14-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Fibromyalgia is a prevalent chronic rheumatic disease of great clinical importance. Recent studies have found raised levels of glutamate in the insula, hippocampus and posterior cingulate cortex regions of the brains of fibromyalgia (FM) patients. This finding has led researchers to speculate about the usefulness of glutamate-blocking drugs such as memantine in the treatment of fibromyalgia. The hypothesis of this study is that the administration of memantine will reduce the glutamate levels, and futhermore, will decrease the perceived pain. The aim of this study is to evaluate the efficacy of memantine in the treatment of pain (pain perception). A secondary objective is to evaluate the efficacy of memantine in the treatment of other clinical symptoms of FM, and to evaluate the efficacy of memantine in reducing brain levels of glutamate, and its effects on the central nervous system as a whole. Method/Design A double-blind parallel randomized controlled trial. Participants, Seventy patients diagnosed with FM will be recruited from primary health care centers in Zaragoza, Spain. Intervention. The subjects will be randomized in two groups: A) A treatment group (n = 35), which will receive 20 mg of memantine daily; B) A control group (n = 35), to which will be administered a placebo. There will be a six-month follow-up period (including a titration period of one month). Outcomes. The main efficacy variable of this study is pain (pain perception). The secondary efficacy variables are clinical symptoms (pain threshold, cognitive function, health status, anxiety, depression, clinical impression and quality of life) and glutamate levels in different regions of the brain, which will be assessed by magnetic resonance spectroscopy. Randomization and blinding. Randomization has been computer-generated, and the random allocation sequence will be implemented by telephone. Subjects of the study and the research assistants will be blinded to group assignment. Discussion There is a need for the development of innovative and more effective treatments for fibromyalgia. This clinical trial will determine whether memantine can be an effective pharmacological treatment for fibromyalgia patients. Trial registration Current Controlled Trials
http://ISRCTN45127327 EUDRACT 2011-006244-73
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A Randomized, Controlled, Double-Blind Pilot Study of the Effects of Cranial Electrical Stimulation on Activity in Brain Pain Processing Regions in Individuals with Fibromyalgia. Explore (NY) 2013; 9:32-40. [DOI: 10.1016/j.explore.2012.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Indexed: 02/05/2023]
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Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. PAIN RESEARCH AND TREATMENT 2012; 2012:426130. [PMID: 23213512 PMCID: PMC3503476 DOI: 10.1155/2012/426130] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/09/2012] [Accepted: 09/12/2012] [Indexed: 02/06/2023]
Abstract
Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy.
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Lu W, Göder R. Does abnormal non-rapid eye movement sleep impair declarative memory consolidation? Sleep Med Rev 2012; 16:389-94. [DOI: 10.1016/j.smrv.2011.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 07/30/2011] [Accepted: 08/01/2011] [Indexed: 11/28/2022]
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Jensen KB, Berna C, Loggia ML, Wasan AD, Edwards RR, Gollub RL. The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain. Neurosci Lett 2012; 520:156-64. [PMID: 22445888 PMCID: PMC3810294 DOI: 10.1016/j.neulet.2012.03.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/02/2012] [Accepted: 03/05/2012] [Indexed: 01/30/2023]
Abstract
A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased pain-related activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today's experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.
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Affiliation(s)
- Karin B Jensen
- Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA.
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Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV, Kadetoff D, Ingvar M. Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain 2012; 153:1495-1503. [PMID: 22617632 DOI: 10.1016/j.pain.2012.04.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 11/18/2022]
Abstract
Interventions based on Cognitive Behavioral Therapy (CBT) are widely used to treat chronic pain, but the brain mechanisms responsible for these treatment effects are poorly understood. The aim of this study was to validate the relevance of the cortical control theory in response to an exposure-based form of CBT, Acceptance and Commitment Therapy, in patients with chronic pain. Forty-three female patients diagnosed with fibromyalgia syndrome were enrolled in a randomized, 12-week, waiting-list controlled clinical trial (CBT n=25; controls n=18). CBT was administered in groups of six patients during 12 weekly sessions. Functional magnetic resonance imaging (fMRI) during pressure-evoked pain was assessed before and after treatment or the 12-week period. Self-report questionnaires of depression and anxiety were administered pre- and posttreatment as well as 3 months following end of treatment. Patients treated with CBT reported larger improvement of fibromyalgia on the Patient Global Impression of Change measure, and improved depression and anxiety symptoms, compared to the waiting-list controls. However, there were no effects on clinical pain or pain sensitivity measures. An analysis of fMRI scans revealed that CBT led to increased activations in the ventrolateral prefrontal/lateral orbitofrontal cortex; regions associated with executive cognitive control. We suggest that CBT changes the brain's processing of pain through an altered cerebral loop between pain signals, emotions, and cognitions; leading to increased access to executive regions for reappraisal of pain. Our data thereby support our hypothesis about the activation of a cortical control mechanism in response to CBT treatment in chronic pain.
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Affiliation(s)
- Karin B Jensen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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Henry DE, Chiodo AE, Yang W. Central nervous system reorganization in a variety of chronic pain states: a review. PM R 2012; 3:1116-25. [PMID: 22192321 DOI: 10.1016/j.pmrj.2011.05.018] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/06/2011] [Accepted: 05/22/2011] [Indexed: 11/15/2022]
Abstract
Chronic pain can develop from numerous conditions and is one of the most widespread and disabling health problems today. Unfortunately, the pathophysiology of chronic pain in most of these conditions, along with consistently effective treatments, remain elusive. However, recent advances in neuroimaging and neurophysiology are rapidly expanding our understanding of these pain syndromes. It is now clear that substantial functional and structural changes, or plasticity, in the central nervous system (CNS) are associated with many chronic pain syndromes. A group of cortical and subcortical brain regions, often referred to as the "pain matrix," often show abnormalities on functional imaging studies in persons with chronic pain, even with different pain locations and etiologies. Changes in the motor and sensory homunculus also are seen. Some of these CNS changes return to a normal state with resolution of the pain. It is hoped that this knowledge will lead to more effective treatments or even new preventative measures. The purpose of this article is to review recent advances in the understanding of the CNS changes associated with chronic pain in a number of clinical entities encountered in the field of physical medicine and rehabilitation. These clinical entities include nonspecific low back pain, fibromyalgia, complex regional pain syndrome, postamputation phantom pain, and chronic pain after spinal cord injury.
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Affiliation(s)
- Douglas E Henry
- Department of Developmental and Rehabilitative Pediatrics, Children's Hospital, Cleveland Clinic, Cleveland, OH 44104, USA.
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Jensen KB, Loitoile R, Kosek E, Petzke F, Carville S, Fransson P, Marcus H, Williams SCR, Choy E, Mainguy Y, Vitton O, Gracely RH, Gollub R, Ingvar M, Kong J. Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network. Mol Pain 2012; 8:32. [PMID: 22537768 PMCID: PMC3404927 DOI: 10.1186/1744-8069-8-32] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence for augmented processing of pain and impaired endogenous pain inhibition in Fibromyalgia syndrome (FM). In order to fully understand the mechanisms involved in FM pathology, there is a need for closer investigation of endogenous pain modulation. In the present study, we compared the functional connectivity of the descending pain inhibitory network in age-matched FM patients and healthy controls (HC).We performed functional magnetic resonance imaging (fMRI) in 42 subjects; 14 healthy and 28 age-matched FM patients (2 patients per HC), during randomly presented, subjectively calibrated pressure pain stimuli. A seed-based functional connectivity analysis of brain activity was performed. The seed coordinates were based on the findings from our previous study, comparing the fMRI signal during calibrated pressure pain in FM and HC: the rostral anterior cingulate cortex (rACC) and thalamus. RESULTS FM patients required significantly less pressure (kPa) to reach calibrated pain at 50 mm on a 0-100 visual analogue scale (p < .001, two-tailed). During fMRI scanning, the rACC displayed significantly higher connectivity to the amygdala, hippocampus, and brainstem in healthy controls, compared to FM patients. There were no regions where FM patients showed higher rACC connectivity. Thalamus showed significantly higher connectivity to the orbitofrontal cortex in healthy controls but no regions showed higher thalamic connectivity in FM patients. CONCLUSION Patients with FM displayed less connectivity within the brain's pain inhibitory network during calibrated pressure pain, compared to healthy controls. The present study provides brain-imaging evidence on how brain regions involved in homeostatic control of pain are less connected in FM patients. It is possible that the dysfunction of the descending pain modulatory network plays an important role in maintenance of FM pain and our results may translate into clinical implications by using the functional connectivity of the pain modulatory network as an objective measure of pain dysregulation.
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Affiliation(s)
- Karin B Jensen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Farrell MJ. Age-Related Changes in the Structure and Function of Brain Regions Involved in Pain Processing. PAIN MEDICINE 2012; 13 Suppl 2:S37-43. [DOI: 10.1111/j.1526-4637.2011.01287.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Fibromyalgia is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in fibromyalgia patients. Interventions to treat fibromyalgia should aim at different targets simultaneously in order to reduce peripheral and central sensitization. There are both pharmacologic and non-pharmacologic approaches with evidence for effectiveness in the treatment of fibromyalgia and its associated symptoms. Evidence from randomized trials and meta-analyses shows that partial and short-term improvements in fibromyalgia symptoms can be achieved with low doses of antidepressants and with physical activity such as aerobic and strengthening exercises. A multidimensional approach which emphasizes education and integration of exercise and cognitive behavior therapy improves quality of life and reduces pain, fatigue and depressive symptoms when measured on a short term basis. More recently, trials have shown the neuromodulators gabapentin and pregabalin to be effective in reducing pain and improving quality of sleep in fibromyalgia. In addition, small trials of noninvasive brain stimulation have also shown benefits in reducing pain in fibromyalgia. It is essential to keep in mind that some important clinical conditions can mimic and overlap with fibromyalgia and should always be ruled out by a complete history, physical examination and appropriate laboratory testing.
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Affiliation(s)
- Marta Imamura
- Collaborative Professor University of Sao Paulo School of Medicine, Division of Physical Medicine and Rehabilitation, Department of Orthopaedics and Traumatology, São Paulo, Brazil
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Abstract
OBJECTIVE To investigate the impact of chronic pain on brain dynamics at rest. METHODS Functional connectivity was examined in patients with fibromyalgia (FM) (n = 9) and healthy controls (n = 11) by calculating partial correlations between low-frequency blood oxygen level-dependent fluctuations extracted from 15 brain regions. RESULTS Patients with FM had more positive and negative correlations within the pain network than healthy controls. Patients with FM displayed enhanced functional connectivity of the anterior cingulate cortex (ACC) with the insula (INS) and basal ganglia (p values between .01 and .05), the secondary somatosensory area with the caudate (CAU) (p = .012), the primary motor cortex with the supplementary motor area (p = .007), the globus pallidus with the amygdala and superior temporal sulcus (both p values < .05), and the medial prefrontal cortex with the posterior cingulate cortex (PCC) and CAU (both p values < .05). Functional connectivity of the ACC with the amygdala and periaqueductal gray (PAG) matter (p values between .001 and .05), the thalamus with the INS and PAG (both p values < .01), the INS with the putamen (p = .038), the PAG with the CAU (p = .038), the secondary somatosensory area with the motor cortex and PCC (both p values < .05), and the PCC with the superior temporal sulcus (p = .002) was also reduced in FM. In addition, significant negative correlations were observed between depression and PAG connectivity strength with the thalamus (r = -0.64, p = .003) and ACC (r = -0.60, p = .004). CONCLUSIONS These findings demonstrate that patients with FM display a substantial imbalance of the connectivity within the pain network during rest, suggesting that chronic pain may also lead to changes in brain activity during internally generated thought processes such as occur at rest.
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Caro XJ, Winter EF. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Appl Psychophysiol Biofeedback 2011; 36:193-200. [PMID: 21656150 DOI: 10.1007/s10484-011-9159-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fibromyalgia (FMS) is a chronic, painful disorder often associated with measurable deficiencies in attention. Since EEG biofeedback (EEG-BF) has been used successfully to treat attention problems, we reasoned that this modality might be helpful in the treatment of attention problems in FMS. We also speculated that improvement in central nervous system (CNS) function might be accompanied by improvement in FMS somatic symptoms. We studied fifteen FMS patients with attention problems, demonstrated by visual and auditory continuous performance testing (CPT), while completing 40 or more EEG-BF sessions. Training consisted of a "SMR protocol" that augmented 12-15 Hz brainwaves (sensory motor rhythm; SMR), while simultaneously inhibiting 4-7 Hz brainwaves (theta) and 22-30 Hz brainwaves (high beta). Serial measurements of pain, fatigue, psychological distress, morning stiffness, and tenderness were also obtained. Sixty-three FMS patients who received standard medical care, but who did not receive EEG-BF, served as controls. Visual, but not auditory, attention improved significantly (P < 0.008). EEG-BF treated subjects also showed improvement in tenderness, pain and fatigue. Somatic symptoms did not change significantly in controls. Visual attention parameters and certain somatic features of FMS appear to improve with an EEG-BF SMR protocol. EEG-BF training in FMS deserves further study.
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Affiliation(s)
- Xavier J Caro
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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