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Kim DJ, Nascimento TD, Lim M, Danciu T, Zubieta JK, Scott PJH, Koeppe R, Kaciroti N, DaSilva AF. Exploring HD-tDCS Effect on μ-opioid Receptor and Pain Sensitivity in Temporomandibular Disorder: A Pilot Randomized Clinical Trial Study. THE JOURNAL OF PAIN 2024; 25:1070-1081. [PMID: 37956741 DOI: 10.1016/j.jpain.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/05/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
This study explored the association between experimentally-induced pain sensitivity and µ-opioid receptor (μOR) availability in patients with temporomandibular disorder (TMD) and further investigated any changes in the pain and μOR availability following high-definition transcranial direct current stimulation (HD-tDCS) over the primary motor cortex (M1) with pilot randomized clinical trials. Seven patients with TMD completed either active (n = 3) or sham treatment (n = 4) for 10 daily sessions and underwent positron emission tomography (PET) scans with [11C]carfentanil, a selective μOR agonist, a week before and after treatment. PET imaging consisted of an early resting and late phase with the sustained masseteric pain challenge by computer-controlled injection of 5% hypertonic saline. We also included 12 patients with TMD, obtained from our previous study, for baseline PET analysis. We observed that patients with more sensitivity to pain, indicated by lower infusion rate, had less μOR availability in the right amygdala during the late phase. Moreover, active M1 HD-tDCS, compared to sham, increased μOR availability post-treatment in the thalamus during the early resting phase and the amygdala, hippocampus, and parahippocampal gyrus during the late pain challenge phase. Importantly, increased μOR availability post-treatment in limbic structures including the amygdala and hippocampus was associated with decreased pain sensitivity. The findings underscore the role of the μOR system in pain regulation and the therapeutic potential of HD-tDCS for TMD. Nonetheless, large-scale studies are necessary to establish the clinical significance of these results. TRIAL REGISTRATION: ClinicalTrial.gov (NCT03724032) PERSPECTIVE: This study links pain sensitivity and µ-opioid receptors in patients with TMD. HD-tDCS over M1 improved µOR availability, which was associated with reduced pain sensitivity. Implications for TMD pain management are promising, but larger clinical trials are essential for validation.
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Affiliation(s)
- Dajung J Kim
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Thiago D Nascimento
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Manyoel Lim
- Food Processing Research Group, Food Convergence Research Division, Korea Food Research Institute, Jeollabuk-do, Republic of Korea
| | - Theodora Danciu
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Jon-Kar Zubieta
- Department of Psychiatry, Mass General Brigham, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Alexandre F DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
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Kuisell C, Ploutz-Snyder R, Williams DA, Voepel-Lewis T, Hutchinson R, Dudding KM, Bridges C, Smith EML. Adolescents and Young Adults With Sickle Cell Disease: Nociplastic Pain and Pain Catastrophizing as Predictors of Pain Interference and Opioid Consumption. Clin J Pain 2023; 39:326-333. [PMID: 37083638 PMCID: PMC10330104 DOI: 10.1097/ajp.0000000000001119] [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: 05/21/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Some patients with sickle cell disease (SCD) have features of nociplastic pain. While research suggests that many patients with nociplastic pain consume more opioids due to opioid nonresponsiveness, little is known about the impact of nociplastic pain and pain catastrophizing on opioid consumption and pain interference among adolescents and young adults (AYA) with SCD. The purpose of this study was to (1) characterize nociplastic pain and pain catastrophizing among AYA with SCD, and (2) determine whether these characterizations are associated with subsequent opioid consumption and pain interference 1 month after characterization. METHODS Participants completed surveys characterizing nociplastic pain and catastrophizing at a routine clinic visit (baseline). Thereafter, participants received weekly text messages that included pain interference and opioid consumption surveys. Multipredictor 2-part models were used to evaluate the predictive relationships between baseline characterizations and subsequent pain interference, and opioid consumption. RESULTS Forty-eight AYA aged 14 to 35 completed baseline measures. Twenty-five percent of participants had scores suggestive of nociplastic pain. Greater nociplastic pain features significantly increased the odds of consuming opioids (odds ratio=1.2) and having greater interference from pain (odds ratio=1.46). Regression analyses found that greater baseline nociplastic pain characteristics were significantly associated with opioid consumption (β=0.13) and pain interference (β=0.061); whereas higher pain catastrophizing scores predicted less opioid consumption (β=-0.03) and less pain interference (β=-0.0007). DISCUSSION In this sample of AYA with SCD, features of nociplastic pain predicted higher subsequent opioid consumption and pain interference. Being aware of nociplastic pain features in patients with SCD may better guide individualized pain management.
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Affiliation(s)
| | | | | | | | | | | | - Celia Bridges
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
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Marino S, Jassar H, Kim DJ, Lim M, Nascimento TD, Dinov ID, Koeppe RA, DaSilva AF. Classifying migraine using PET compressive big data analytics of brain's μ-opioid and D2/D3 dopamine neurotransmission. Front Pharmacol 2023; 14:1173596. [PMID: 37383727 PMCID: PMC10294712 DOI: 10.3389/fphar.2023.1173596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction: Migraine is a common and debilitating pain disorder associated with dysfunction of the central nervous system. Advanced magnetic resonance imaging (MRI) studies have reported relevant pathophysiologic states in migraine. However, its molecular mechanistic processes are still poorly understood in vivo. This study examined migraine patients with a novel machine learning (ML) method based on their central μ-opioid and dopamine D2/D3 profiles, the most critical neurotransmitters in the brain for pain perception and its cognitive-motivational interface. Methods: We employed compressive Big Data Analytics (CBDA) to identify migraineurs and healthy controls (HC) in a large positron emission tomography (PET) dataset. 198 PET volumes were obtained from 38 migraineurs and 23 HC during rest and thermal pain challenge. 61 subjects were scanned with the selective μ-opioid receptor (μOR) radiotracer [11C]Carfentanil, and 22 with the selective dopamine D2/D3 receptor (DOR) radiotracer [11C]Raclopride. PET scans were recast into a 1D array of 510,340 voxels with spatial and intensity filtering of non-displaceable binding potential (BPND), representing the receptor availability level. We then performed data reduction and CBDA to power rank the predictive brain voxels. Results: CBDA classified migraineurs from HC with accuracy, sensitivity, and specificity above 90% for whole-brain and region-of-interest (ROI) analyses. The most predictive ROIs for μOR were the insula (anterior), thalamus (pulvinar, medial-dorsal, and ventral lateral/posterior nuclei), and the putamen. The latter, putamen (anterior), was also the most predictive for migraine regarding DOR D2/D3 BPND levels. Discussion: CBDA of endogenous μ-opioid and D2/D3 dopamine dysfunctions in the brain can accurately identify a migraine patient based on their receptor availability across key sensory, motor, and motivational processing regions. Our ML-based findings in the migraineur's brain neurotransmission partly explain the severe impact of migraine suffering and associated neuropsychiatric comorbidities.
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Affiliation(s)
- Simeone Marino
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Hassan Jassar
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Dajung J. Kim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Manyoel Lim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Thiago D. Nascimento
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Ivo D. Dinov
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States
| | - Robert A. Koeppe
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alexandre F. DaSilva
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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Chen Y, Liu Y, Song Y, Zhao S, Li B, Sun J, Liu L. Therapeutic applications and potential mechanisms of acupuncture in migraine: A literature review and perspectives. Front Neurosci 2022; 16:1022455. [PMID: 36340786 PMCID: PMC9630645 DOI: 10.3389/fnins.2022.1022455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Acupuncture is commonly used as a treatment for migraines. Animal studies have suggested that acupuncture can decrease neuropeptides, immune cells, and proinflammatory and excitatory neurotransmitters, which are associated with the pathogenesis of neuroinflammation. In addition, acupuncture participates in the development of peripheral and central sensitization through modulation of the release of neuronal-sensitization-related mediators (brain-derived neurotrophic factor, glutamate), endocannabinoid system, and serotonin system activation. Clinical studies have demonstrated that acupuncture may be a beneficial migraine treatment, particularly in decreasing pain intensity, duration, emotional comorbidity, and days of acute medication intake. However, specific clinical effectiveness has not been substantiated, and the mechanisms underlying its efficacy remain obscure. With the development of biomedical and neuroimaging techniques, the neural mechanism of acupuncture in migraine has gained increasing attention. Neuroimaging studies have indicated that acupuncture may alter the abnormal functional activity and connectivity of the descending pain modulatory system, default mode network, thalamus, frontal-parietal network, occipital-temporal network, and cerebellum. Acupuncture may reduce neuroinflammation, regulate peripheral and central sensitization, and normalize abnormal brain activity, thereby preventing pain signal transmission. To summarize the effects and neural mechanisms of acupuncture in migraine, we performed a systematic review of literature about migraine and acupuncture. We summarized the characteristics of current clinical studies, including the types of participants, study designs, and clinical outcomes. The published findings from basic neuroimaging studies support the hypothesis that acupuncture alters abnormal neuroplasticity and brain activity. The benefits of acupuncture require further investigation through basic and clinical studies.
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Higginbotham JA, Markovic T, Massaly N, Morón JA. Endogenous opioid systems alterations in pain and opioid use disorder. Front Syst Neurosci 2022; 16:1014768. [PMID: 36341476 PMCID: PMC9628214 DOI: 10.3389/fnsys.2022.1014768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Decades of research advances have established a central role for endogenous opioid systems in regulating reward processing, mood, motivation, learning and memory, gastrointestinal function, and pain relief. Endogenous opioid systems are present ubiquitously throughout the central and peripheral nervous system. They are composed of four families, namely the μ (MOPR), κ (KOPR), δ (DOPR), and nociceptin/orphanin FQ (NOPR) opioid receptors systems. These receptors signal through the action of their endogenous opioid peptides β-endorphins, dynorphins, enkephalins, and nociceptins, respectfully, to maintain homeostasis under normal physiological states. Due to their prominent role in pain regulation, exogenous opioids-primarily targeting the MOPR, have been historically used in medicine as analgesics, but their ability to produce euphoric effects also present high risks for abuse. The ability of pain and opioid use to perturb endogenous opioid system function, particularly within the central nervous system, may increase the likelihood of developing opioid use disorder (OUD). Today, the opioid crisis represents a major social, economic, and public health concern. In this review, we summarize the current state of the literature on the function, expression, pharmacology, and regulation of endogenous opioid systems in pain. Additionally, we discuss the adaptations in the endogenous opioid systems upon use of exogenous opioids which contribute to the development of OUD. Finally, we describe the intricate relationship between pain, endogenous opioid systems, and the proclivity for opioid misuse, as well as potential advances in generating safer and more efficient pain therapies.
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Affiliation(s)
- Jessica A. Higginbotham
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States,Pain Center, Washington University in St. Louis, St. Louis, MO, United States,School of Medicine, Washington University in St. Louis, St. Louis, MO, United States,*Correspondence: Jessica A. Higginbotham,
| | - Tamara Markovic
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicolas Massaly
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States,Pain Center, Washington University in St. Louis, St. Louis, MO, United States,School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Jose A. Morón
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States,Pain Center, Washington University in St. Louis, St. Louis, MO, United States,School of Medicine, Washington University in St. Louis, St. Louis, MO, United States,Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, United States,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
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Chen WT, Hsieh CY, Liu YH, Cheong PL, Wang YM, Sun CW. Migraine classification by machine learning with functional near-infrared spectroscopy during the mental arithmetic task. Sci Rep 2022; 12:14590. [PMID: 36028633 PMCID: PMC9418153 DOI: 10.1038/s41598-022-17619-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Migraine is a common and complex neurovascular disorder. Clinically, the diagnosis of migraine mainly relies on scales, but the degree of pain is too subjective to be a reliable indicator. It is even more difficult to diagnose the medication-overuse headache, which can only be evaluated by whether the symptom is improved after the medication adjustment. Therefore, an objective migraine classification system to assist doctors in making a more accurate diagnosis is needed. In this research, 13 healthy subjects (HC), 9 chronic migraine subjects (CM), and 12 medication-overuse headache subjects (MOH) were measured by functional near-infrared spectroscopy (fNIRS) to observe the change of the hemoglobin in the prefrontal cortex (PFC) during the mental arithmetic task (MAT). Our model shows the sensitivity and specificity of CM are 100% and 75%, and that of MOH is 75% and 100%.The results of the classification of the three groups prove that fNIRS combines with machine learning is feasible for the migraine classification.
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Affiliation(s)
- Wei-Ta Chen
- Department of Neurology, Keelung Hospital,Ministry of Health and Welfare, No. 268, Xin 2nd Rd., Xinyi Dist, Keelung, 20148, Taiwan, ROC
- Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec.2, Shipai Rd., Beitou Dist, Taipei, 112201, Taiwan, ROC
| | - Cing-Yan Hsieh
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC
| | - Yao-Hong Liu
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC
| | - Pou-Leng Cheong
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC
- Department of Pediatrics, National Taiwan University Hospital, Hisnchu Branch, No. 25, Ln. 442, Sec.1, Jingguo Rd., North Dist, Hsinchu, 30059, Taiwan, ROC
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Min Wang
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC
| | - Chia-Wei Sun
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC.
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, No. 1001, University Road, East District, Hsinchu, 300093, Taiwan, ROC.
- Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei, 112304, Taiwan, ROC.
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Kong L, Walz AJ. Metabolism of the active carfentanil metabolite, 4-Piperidinecarboxylic acid, 1-(2-hydroxy-2-phenylethyl)-4-[(1-oxopropyl)phenylamino]-, methyl ester in vitro. Toxicol Lett 2022; 367:32-39. [PMID: 35835351 DOI: 10.1016/j.toxlet.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Carfentanil, a µ-opioid receptor (MOR) agonist with an analgesic potency 10,000 times that of morphine, is extensively metabolized to norcarfentanil (M1), 4-Piperidinecarboxylic acid, 1-(2-hydroxy-2-phenylethyl)-4-[(1-oxopropyl)phenylamino]-, methyl ester (M0 in this article), and other low abundant metabolites in human hepatocytes and liver/lung microsomes. M0 possessed comparable MOR activity to carfentanil, and accounted for approximately 12 % of the total carfentanil metabolite formation in human liver microsomes (HLMs). Little is known about the subsequent elimination of M0. This study investigated its metabolic pathway in HLMs, separation and preliminary identification of metabolites by liquid chromatography-tandem mass spectrometry, and possible involvement of cytochrome P450 enzymes in M0 metabolism with kinetic analysis. M0 produced 9 metabolites via N-dealkylation (M1), oxidation (M3, M6-9), N-dealkylation followed by oxidation (M2 and M4), and glucuronidation (M5). Formation of the major metabolite M1 fitted typical Michaelis-Menten kinetics. Recombinant human CYP3A5 showed the highest activity toward M1 formation followed by CYP3A4 and CYP2C8, while M8 was primarily formed by CYP3A4 followed by CYP2C19 and CYP2C8. These findings reveal the main involvement of CYP3A5 and 3A4 in human hepatic elimination of M0 with a kinetic profile similar to carfentanil which may inform development of treatment protocols for carfentanil exposure.
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Affiliation(s)
- Li Kong
- Research and Technology Directorate, Combat Capabilities Development Command Chemical Biological Center, U. S. Army, Aberdeen Proving Ground, MD 21010-5424, United States.
| | - Andrew J Walz
- Research and Technology Directorate, Combat Capabilities Development Command Chemical Biological Center, U. S. Army, Aberdeen Proving Ground, MD 21010-5424, United States
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Role of Omics in Migraine Research and Management: A Narrative Review. Mol Neurobiol 2022; 59:5809-5834. [PMID: 35796901 DOI: 10.1007/s12035-022-02930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Migraine is a neurological disorder defined by episodic attacks of chronic pain associated with nausea, photophobia, and phonophobia. It is known to be a complex disease with several environmental and genetic factors contributing to its susceptibility. Risk factors for migraine include head or neck injury (Arnold, Cephalalgia 38(1):1-211, 2018). Stress and high temperature are known to trigger migraine, while sleep disorders and anxiety are considered to be the comorbid conditions with migraine. Studies have reported various biomarkers, including genetic variants, proteins, and metabolites implicated in migraine's pathophysiology. Using the "omics" approach, which deals with genetics, transcriptomics, proteomics, and metabolomics, more specific biomarkers for various migraine can be identified. On account of its multifactorial nature, migraine is an ideal study model focusing on integrated omics approaches, including genomics, transcriptomics, proteomics, and metabolomics. The current review has been compiled with an aim to focus on the genomic alterations especially involved in the regulation of glutamatergic neurotransmission, cortical excitability, ion channels, solute carrier proteins, or receptors; their expression in migraine patients and also specific proteins and metabolites, including some inflammatory biomarkers that might represent the migraine phenotype at the molecular level. The systems biology approach holds the promise to understand the pathophysiology of the disease at length and also to identify the specific therapeutic targets for novel interventions.
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Zhang Y, Huang Y, Li H, Yan Z, Zhang Y, Liu X, Hou X, Chen W, Tu Y, Hodges S, Chen H, Liu B, Kong J. Transcutaneous auricular vagus nerve stimulation (taVNS) for migraine: an fMRI study. Reg Anesth Pain Med 2020; 46:145-150. [PMID: 33262253 DOI: 10.1136/rapm-2020-102088] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysfunction of the thalamocortical connectivity network is thought to underlie the pathophysiology of the migraine. This current study aimed to explore the thalamocortical connectivity changes during 4 weeks of continuous transcutaneous vagus nerve stimulation (taVNS) treatment on migraine patients. METHODS 70 migraine patients were recruited and randomized in an equal ratio to receive real taVNS or sham taVNS treatments for 4 weeks. Resting-state functional MRI was collected before and after treatment. The thalamus was parceled into functional regions of interest (ROIs) on the basis of six priori-defined cortical ROIs covering the entire cortex. Seed-based functional connectivity analysis between each thalamic subregion and the whole brain was further compared across groups after treatment. RESULTS Of the 59 patients that finished the study, those in the taVNS group had significantly reduced number of migraine days, pain intensity and migraine attack times after 4 weeks of treatment compared with the sham taVNS. Functional connectivity analysis revealed that taVNS can increase the connectivity between the motor-related thalamus subregion and anterior cingulate cortex/medial prefrontal cortex, and decrease the connectivity between occipital cortex-related thalamus subregion and postcentral gyrus/precuneus. CONCLUSION Our findings suggest that taVNS can relieve the symptoms of headache as well as modulate the thalamocortical circuits in migraine patients. The results provide insights into the neural mechanism of taVNS and reveal potential therapeutic targets for migraine patients.
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Affiliation(s)
- Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhaoxian Yan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ying Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoyan Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sierra Hodges
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Chen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kaciroti N, DosSantos MF, Moura B, Bellile EL, Nascimento TD, Maslowski E, Danciu TE, Donnell A, DaSilva AF. Sensory-Discriminative Three-Dimensional Body Pain Mobile App Measures Versus Traditional Pain Measurement With a Visual Analog Scale: Validation Study. JMIR Mhealth Uhealth 2020; 8:e17754. [PMID: 32124732 PMCID: PMC7468641 DOI: 10.2196/17754] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 01/13/2023] Open
Abstract
Background To quantify pain severity in patients and the efficacy treatments, researchers and clinicians apply tools such as the traditional visual analog scale (VAS) that leads to inaccurate interpretation of the main sensory pain. Objective This study aimed to validate the pain measurements of a neuroscience-based 3D body pain mobile app called GeoPain. Methods Patients with temporomandibular disorder (TMD) were assessed using GeoPain measures in comparison to VAS and positive and negative affect schedule (PANAS), pain and mood scales, respectively. Principal component analysis (PCA), scatter score analysis, Pearson methods, and effect size were used to determine the correlation between GeoPain and VAS measures. Results The PCA resulted in two main orthogonal components: first principal component (PC1) and second principal component (PC2). PC1 comprises a combination score of all GeoPain measures, which had a high internal consistency and clustered together in TMD pain. PC2 included VAS and PANAS. All loading coefficients for GeoPain measures in PC1 were above 0.70, with low loadings for VAS and PANAS. Meanwhile, PC2 was dominated by a VAS and PANAS coefficient >0.4. Repeated measure analysis revealed a strong correlation between the VAS and mood scores from PANAS over time, which might be related to the subjectivity of the VAS measure, whereas sensory-discriminative GeoPain measures, not VAS, demonstrated an association between chronicity and TMD pain in locations spread away from the most commonly reported area or pain epicenter (P=.01). Analysis using VAS did not detect an association at baseline between TMD and chronic pain. The long-term reliability (lag >1 day) was consistently high for the pain area and intensity number summation (PAINS) with lag autocorrelations averaging between 0.7 and 0.8, and greater than the autocorrelations for VAS averaging between 0.3 and 0.6. The combination of higher reliability for PAINS and its objectivity, displayed by the lack of association with PANAS as compared with VAS, indicated that PAINS has better sensitivity and reliability for measuring treatment effect over time for sensory-discriminative pain. The effect sizes for PAINS were larger than those for VAS, consequently requiring smaller sample sizes to assess the analgesic efficacy of treatment if PAINS was used versus VAS. The PAINS effect size was 0.51 SD for both facial sides and 0.60 SD for the right side versus 0.35 SD for VAS. Therefore, the sample size required to detect such effect sizes with 80% power would be n=125 per group for VAS, but as low as n=44 per group for PAINS, which is almost a third of the sample size needed by VAS. Conclusions GeoPain demonstrates precision and reliability as a 3D mobile interface for measuring and analyzing sensory-discriminative aspects of subregional pain in terms of its severity and response to treatment, without being influenced by mood variations from patients.
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Affiliation(s)
- Niko Kaciroti
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Marcos Fabio DosSantos
- Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Medicina (Radiologia), Universidade Federal do Rio de Janeiro (UFRJ)., Rio de Janeiro, Brazil
| | - Brenda Moura
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Programa de Pós-Graduação em Medicina (Radiologia), Universidade Federal do Rio de Janeiro (UFRJ)., Rio de Janeiro, Brazil
| | - Emily Light Bellile
- Department of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Thiago Dias Nascimento
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | | | - Theodora E Danciu
- Department of Periodontics and Medicine School of Dentistry, University of Michigan, Ann Arbor, Michigan, MI, United States
| | - Adam Donnell
- Orthodontics, Department of Developmental Biology, Harvard University, Boston, MA, United States
| | - Alexandre F DaSilva
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
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11
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A Survey of Molecular Imaging of Opioid Receptors. Molecules 2019; 24:molecules24224190. [PMID: 31752279 PMCID: PMC6891617 DOI: 10.3390/molecules24224190] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
The discovery of endogenous peptide ligands for morphine binding sites occurred in parallel with the identification of three subclasses of opioid receptor (OR), traditionally designated as μ, δ, and κ, along with the more recently defined opioid-receptor-like (ORL1) receptor. Early efforts in opioid receptor radiochemistry focused on the structure of the prototype agonist ligand, morphine, although N-[methyl-11C]morphine, -codeine and -heroin did not show significant binding in vivo. [11C]Diprenorphine ([11C]DPN), an orvinol type, non-selective OR antagonist ligand, was among the first successful PET tracers for molecular brain imaging, but has been largely supplanted in research studies by the μ-preferring agonist [11C]carfentanil ([11C]Caf). These two tracers have the property of being displaceable by endogenous opioid peptides in living brain, thus potentially serving in a competition-binding model. Indeed, many clinical PET studies with [11C]DPN or [11C]Caf affirm the release of endogenous opioids in response to painful stimuli. Numerous other PET studies implicate μ-OR signaling in aspects of human personality and vulnerability to drug dependence, but there have been very few clinical PET studies of μORs in neurological disorders. Tracers based on naltrindole, a non-peptide antagonist of the δ-preferring endogenous opioid enkephalin, have been used in PET studies of δORs, and [11C]GR103545 is validated for studies of κORs. Structures such as [11C]NOP-1A show selective binding at ORL-1 receptors in living brain. However, there is scant documentation of δ-, κ-, or ORL1 receptors in healthy human brain or in neurological and psychiatric disorders; here, clinical PET research must catch up with recent progress in radiopharmaceutical chemistry.
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12
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Nascimento T, Yang N, Salman D, Jassar H, Kaciroti N, Bellile E, Danciu T, Koeppe R, Stohler C, Zubieta J, Ellingrod V, DaSilva A. µ-Opioid Activity in Chronic TMD Pain Is Associated with COMT Polymorphism. J Dent Res 2019; 98:1324-1331. [PMID: 31490699 PMCID: PMC6806132 DOI: 10.1177/0022034519871938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinicians have the dilemma of prescribing opioid or nonopioid analgesics to chronic pain patients; however, the impact of pain on our endogenous µ-opioid system and how our genetic profile (specifically catechol-O-methyltransferase [COMT] polymorphisms) impacts its activation are currently unknown. Twelve chronic temporomandibular disorder (TMD) patients and 12 healthy controls (HCs) were scanned using positron emission tomography (PET) with [11C]carfentanil, a selective radioligand for µ-opioid receptors (µORs). The first 45 min of each PET measured the µOR nondisplaceable binding potential (BPND) at resting state, and the last 45 min consisted of a 20-min masseteric pain challenge with an injection of 5% hypertonic saline. Participants were also genotyped for different COMT alleles. There were no group differences in µOR BPND at resting state (early phase). However, during the masseteric pain challenge (late phase), TMD patients exhibited significant reductions in µOR BPND (decreased [11C]carfentanil binding) in the contralateral parahippocampus (P = 0.002) compared to HCs. The µOR BPND was also significantly lower in TMD patients with longer pain chronicity (P < 0.001). When considering COMT genotype and chronic pain suffering, TMD patients with the COMT158Met substitution had higher pain sensitivity and longer pain chronicity with a 5-y threshold for µOR BPND changes to occur in the parahippocampus. Together, the TMD diagnosis, COMT158Met substitution, and pain chronicity explained 52% of µOR BPND variance in the parahippocampus (cumulative R2 = 52%, P < 0.003, and HC vs. TMD Cohen's effect size d = 1.33 SD). There is strong evidence of dysregulation of our main analgesic and limbic systems in chronic TMD pain. The data also support precision medicine by helping identify TMD patients who may be more susceptible to chronic pain sensitivity and opioid dysfunction based on their genetic profile.
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Affiliation(s)
- T.D. Nascimento
- Headache and Orofacial Pain Effort (H.O.P.E.),
Biologic and Materials Sciences Department, University of Michigan School of Dentistry, Ann
Arbor, MI, USA
| | - N. Yang
- Headache and Orofacial Pain Effort (H.O.P.E.),
Biologic and Materials Sciences Department, University of Michigan School of Dentistry, Ann
Arbor, MI, USA
| | - D. Salman
- Headache and Orofacial Pain Effort (H.O.P.E.),
Biologic and Materials Sciences Department, University of Michigan School of Dentistry, Ann
Arbor, MI, USA
| | - H. Jassar
- Headache and Orofacial Pain Effort (H.O.P.E.),
Biologic and Materials Sciences Department, University of Michigan School of Dentistry, Ann
Arbor, MI, USA
| | - N. Kaciroti
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development,
University of Michigan, Ann Arbor, MI, USA
- Center for Computational Medicine and
Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - E. Bellile
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - T. Danciu
- Department of Periodontics and Oral Medicine,
University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - R. Koeppe
- PET Physics Section, Division of Nuclear
Medicine, Radiology Department, University of Michigan, Ann Arbor, MI, USA
| | - C. Stohler
- College of Dental Medicine, Columbia
University, New York, NY, USA
| | - J.K. Zubieta
- Department of Psychiatry and Behavioral
Health, Stony Brook University, Stony Brook, NY, USA
| | - V. Ellingrod
- College of Pharmacy, University of Michigan,
Ann Arbor, MI, USA
| | - A.F. DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.),
Biologic and Materials Sciences Department, University of Michigan School of Dentistry, Ann
Arbor, MI, USA
- Center for Human Growth and Development,
University of Michigan, Ann Arbor, MI, USA
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13
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Tamaddonfard E, Erfanparast A, Salighedar R, Tamaddonfard S. Medial prefrontal cortex diclofenac-induced antinociception is mediated through GPR55, cannabinoid CB1, and mu-opioid receptors of this area and periaqueductal gray. Naunyn Schmiedebergs Arch Pharmacol 2019; 393:371-379. [PMID: 31641818 DOI: 10.1007/s00210-019-01735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Supraspinal mechanisms of non-steroidal anti-inflammatory drug (NSAID)-induced antinociception are not well understood. In the present study, the possible antinociceptive mechanisms induced by intra-medial prefrontal cortex (intra-mPFC) microinjection of diclofenac were investigated after blockade of GPR55, cannabinoid CB1, and mu-opioid receptors in this area and ventrolateral periaqueductal gray (vlPAG). For drug delivery, unilateral (left side) of mPFC and bilateral (right and left sides) of vlPAG were surgically cannulated. Formalin test was induced by subcutaneous injection of a diluted formalin solution into the right vibrissa pad. A typical biphasic (neurogenic and inflammatory phases) pain behavior was produced following formalin injection. Microinjection of diclofenac (2.5, 5, and 10 μg/0.25 μL) into the mPFC suppressed both phases of pain. Intra-mPFC microinjection of naloxonazine (a mu-opioid receptor antagonist, 1 μg/0.25 μL) and AM251 (a cannabinoid CB1 receptor antagonist, 1 μg/0.25 μL) increased both phases of pain intensity. In addition, intra-mPFC-microinjected diclofenac-induced antinociception was inhibited by prior intra-mPFC and intra-vlPAG administration of naloxonazine and AM251. On the other hand, intra-mPFC and intra-vlPAG microinjection of AM251 (0.25 μg/0.25 μL) decreased pain severity which was inhibited by prior administration of ML193. The above-mentioned drugs did not alter locomotor activity. In conclusion, diclofenac suppressed both the neurogenic and inflammatory phases of formalin-induced orofacial pain at the level of mPFC. GPR55, cannabinoid CB1, and mu-opioid receptors of the mPFC and vlPAG might be involved in the mPFC analgesic effects of diclofenac.
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Affiliation(s)
- Esmaeal Tamaddonfard
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Amir Erfanparast
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Reza Salighedar
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Sina Tamaddonfard
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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14
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Colom M, Vidal B, Zimmer L. Is There a Role for GPCR Agonist Radiotracers in PET Neuroimaging? Front Mol Neurosci 2019; 12:255. [PMID: 31680859 PMCID: PMC6813225 DOI: 10.3389/fnmol.2019.00255] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
Positron emission tomography (PET) is a molecular imaging modality that enables in vivo exploration of metabolic processes and especially the pharmacology of neuroreceptors. G protein-coupled receptors (GPCRs) play an important role in numerous pathophysiologic disorders of the central nervous system. Thus, they are targets of choice in PET imaging to bring proof concept of change in density in pathological conditions or in pharmacological challenge. At present, most radiotracers are antagonist ligands. In vitro data suggest that properties differ between GPCR agonists and antagonists: antagonists bind to receptors with a single affinity, whereas agonists are characterized by two different affinities: high affinity for receptors that undergo functional coupling to G-proteins, and low affinity for those that are not coupled. In this context, agonist radiotracers may be useful tools to give functional images of GPCRs in the brain, with high sensitivity to neurotransmitter release. Here, we review all existing PET radiotracers used from animals to humans and their role for understanding the ligand-receptor paradigm of GPCR in comparison with corresponding antagonist radiotracers.
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Affiliation(s)
- Matthieu Colom
- Lyon Neuroscience Research Center, INSERM, CNRS, Université de Lyon, Lyon, France.,CERMEP, Hospices Civils de Lyon, Bron, France
| | - Benjamin Vidal
- Lyon Neuroscience Research Center, INSERM, CNRS, Université de Lyon, Lyon, France
| | - Luc Zimmer
- Lyon Neuroscience Research Center, INSERM, CNRS, Université de Lyon, Lyon, France.,CERMEP, Hospices Civils de Lyon, Bron, France.,Institut National des Sciences et Techniques Nucléaires, CEA Saclay, Gif-sur-Yvette, France
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15
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Positron emission tomography imaging of endogenous mu-opioid mechanisms during pain and migraine. Pain Rep 2019; 4:e769. [PMID: 31579860 PMCID: PMC6727995 DOI: 10.1097/pr9.0000000000000769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/04/2019] [Accepted: 05/25/2019] [Indexed: 11/26/2022] Open
Abstract
The enormous advancements in the medical imaging methods witnessed in the past decades have allowed clinical researchers to study the function of the human brain in vivo, both in health and disease. In addition, a better understanding of brain responses to different modalities of stimuli such as pain, reward, or the administration of active or placebo interventions has been achieved through neuroimaging methods. Although magnetic resonance imaging has provided important information regarding structural, hemodynamic, and metabolic changes in the central nervous system related to pain, magnetic resonance imaging does not address modulatory pain systems at the molecular level (eg, endogenous opioid). Such important information has been obtained through positron emission tomography, bringing insights into the neuroplastic changes that occur in the context of the pain experience. Positron emission tomography studies have not only confirmed the brain structures involved in pain processing and modulation but also have helped elucidate the neural mechanisms that underlie healthy and pathological pain regulation. These data have shown some of the biological basis of the interindividual variability in pain perception and regulation. In addition, they provide crucial information to the mechanisms that drive placebo and nocebo effects, as well as represent an important source of variability in clinical trials. Positron emission tomography studies have also permitted exploration of the dynamic interaction between behavior and genetic factors and between different pain modulatory systems. This narrative review will present a summary of the main findings of the positron emission tomography studies that evaluated the functioning of the opioidergic system in the context of pain.
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16
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Jassar H, Nascimento TD, Kaciroti N, DosSantos MF, Danciu T, Koeppe RA, Smith YR, Bigal ME, Porreca F, Casey KL, Zubieta JK, DaSilva AF. Impact of chronic migraine attacks and their severity on the endogenous μ-opioid neurotransmission in the limbic system. NEUROIMAGE-CLINICAL 2019; 23:101905. [PMID: 31279240 PMCID: PMC6612052 DOI: 10.1016/j.nicl.2019.101905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
Objective To evaluate, in vivo, the impact of ongoing chronic migraine (CM) attacks on the endogenous μ-opioid neurotransmission. Background CM is associated with cognitive-emotional dysfunction. CM is commonly associated with frequent acute medication use, including opioids. Methods We scanned 15 migraine patients during the spontaneous headache attack (ictal phase): 7 individuals with CM and 8 with episodic migraine (EM), as well as 7 healthy controls (HC), using positron emission tomography (PET) with the selective μ-opioid receptor (μOR) radiotracer [11C]carfentanil. Migraineurs were scanned in two paradigms, one with thermal pain threshold challenge applied to the site of the headache, and one without thermal challenge. Multivariable analysis was performed between the μ-opioid receptor availability and the clinical data. Results μOR availability, measured with [11C]carfentanil nondisplaceable binding potential (BPND), in the left thalamus (P-value = 0.005) and left caudate (P-value = 0.003) were decreased in CM patients with thermal pain threshold during the ictal phase relative to HC. Lower μOR BPND in the right parahippocampal region (P-value = 0.001) and right amygdala (P-value = 0.002) were seen in CM relative to EM patients. Lower μOR BPND values indicate either a decrease in μOR concentration or an increase in endogenous μ-opioid release in CM patients. In the right amygdala, 71% of the overall variance in μOR BPND levels was explained by the type of migraine (CM vs. EM: partial-R2 = 0.47, P-value<0.001, Cohen's effect size d = 2.6SD), the severity of the attack (pain area and intensity number summation [P.A.I.N.S.]: partial-R2 = 0.16, P-value = 0.031), and the thermal pain threshold (allodynia: partial-R2 = 0.08). Conclusions Increased endogenous μ-opioid receptor-mediated neurotransmission is seen in the limbic system of CM patients, especially in right amygdala, which is highly modulated by the attack frequency, pain severity, and sensitivity. This study demonstrates for the first time the negative impact of chronification and exacerbation of headache attacks on the endogenous μ-opioid mechanisms of migraine patients. ClinicalTrials.gov identifier: NCT03004313 Increased endogenous μ-opioid neurotransmission in limbic system of chronic migraineurs Right amygdala opioid dysfunction is 71% explained by attack frequency, severity and sensitivity. Amygdala dysfunction links cognitive-emotional brain mechanisms to migraine suffering.
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Affiliation(s)
- Hassan Jassar
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.
| | - Thiago D Nascimento
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Niko Kaciroti
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI 48104, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Marcos F DosSantos
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Theodora Danciu
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48104, USA
| | - Robert A Koeppe
- PET Physics Section, Division of Nuclear Medicine, Radiology Department, University of Michigan, Ann Arbor, MI 48109-5030, USA
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, MI 48109-0276, USA
| | | | - Frank Porreca
- Department of Pharmacology, University of Arizona, Tucson, AZ 85724-5050, USA
| | - Kenneth L Casey
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry and Behavioral Heal, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alexandre F DaSilva
- Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI 48104, USA.
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17
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The Contribution of Endogenous Modulatory Systems to TMS- and tDCS-Induced Analgesia: Evidence from PET Studies. Pain Res Manag 2018; 2018:2368386. [PMID: 30538794 PMCID: PMC6257907 DOI: 10.1155/2018/2368386] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/23/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Chronic pain is an important public health issue. Moreover, its adequate management is still considered a major clinical problem, mainly due to its incredible complexity and still poorly understood pathophysiology. Recent scientific evidence coming from neuroimaging research, particularly functional magnetic resonance (fMRI) and positron emission tomography (PET) studies, indicates that chronic pain is associated with structural and functional changes in several brain structures that integrate antinociceptive pathways and endogenous modulatory systems. Furthermore, the last two decades have witnessed a huge increase in the number of studies evaluating the clinical effects of noninvasive neuromodulatory methods, especially transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), which have been proved to effectively modulate the cortical excitability, resulting in satisfactory analgesic effects with minimal adverse events. Nevertheless, the precise neuromechanisms whereby such methods provide pain control are still largely unexplored. Recent studies have brought valuable information regarding the recruitment of different modulatory systems and related neurotransmitters, including glutamate, dopamine, and endogenous opioids. However, the specific neurocircuits involved in the analgesia produced by those therapies have not been fully elucidated. This review focuses on the current literature correlating the clinical effects of noninvasive methods of brain stimulation to the changes in the activity of endogenous modulatory systems.
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18
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DosSantos MF, Moura BDS, DaSilva AF. Reward Circuitry Plasticity in Pain Perception and Modulation. Front Pharmacol 2017; 8:790. [PMID: 29209204 PMCID: PMC5702349 DOI: 10.3389/fphar.2017.00790] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 10/19/2017] [Indexed: 12/30/2022] Open
Abstract
Although pain is a widely known phenomenon and an important clinical symptom that occurs in numerous diseases, its mechanisms are still barely understood. Owing to the scarce information concerning its pathophysiology, particularly what is involved in the transition from an acute state to a chronic condition, pain treatment is frequently unsatisfactory, therefore contributing to the amplification of the chronic pain burden. In fact, pain is an extremely complex experience that demands the recruitment of an intricate set of central nervous system components. This includes cortical and subcortical areas involved in interpretation of the general characteristics of noxious stimuli. It also comprises neural circuits that process the motivational-affective dimension of pain. Hence, the reward circuitry represents a vital element for pain experience and modulation. This review article focuses on the interpretation of the extensive data available connecting the major components of the reward circuitry to pain suffering, including the nucleus accumbens, ventral tegmental area, and the medial prefrontal cortex; with especial attention dedicated to the evaluation of neuroplastic changes affecting these structures found in chronic pain syndromes, such as migraine, trigeminal neuropathic pain, chronic back pain, and fibromyalgia.
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Affiliation(s)
- Marcos F. DosSantos
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Brenda de Souza Moura
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre F. DaSilva
- Headache and Orofacial Pain Effort, Department of Biologic and Materials Sciences, School of Dentistry, Center for Human Growth and Development, Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
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19
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Nyholt DR, Borsook D, Griffiths LR. Migrainomics — identifying brain and genetic markers of migraine. Nat Rev Neurol 2017; 13:725-741. [DOI: 10.1038/nrneurol.2017.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Linnman C, Catana C, Petkov MP, Chonde DB, Becerra L, Hooker J, Borsook D. Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings. NEUROIMAGE-CLINICAL 2017; 17:680-690. [PMID: 29255671 PMCID: PMC5725156 DOI: 10.1016/j.nicl.2017.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/03/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9) and matched healthy controls (n = 9) using 11C-diprenoprhine Positron Emission Tomography (PET) and simultaneous functional Magnetic Resonance Imaging (fMRI). Intravenous saline injections (the placebo) led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.
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Affiliation(s)
- Clas Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Ciprian Catana
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Mike P Petkov
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Daniel Burje Chonde
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA; Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Jacob Hooker
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA; Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW This review aims to provide an overview of the most recent and significant functional neuroimaging studies which have clarified the complex mechanisms underlying migraine pathophysiology. RECENT FINDINGS The recent data allow us to overcome the concept of a migraine generator suggesting that functional networks abnormalities may lead to changes in different brain area activities and consequent reduced migraine thresholds susceptibility, likely associated with higher migraine severity and burden. Although functional magnetic resonance imaging studies have allowed recognition of several migraine mechanisms, its pathophysiology is not completely understood and is still a matter of research. Nevertheless, in recent years, functional magnetic resonance imaging studies have allowed us to implement our knowledge of migraine pathophysiology. The pivotal role of both the brainstem and the hippocampus in the first phase of a migraine attack, the involvement of limbic pathway in the constitution of a migrainous pain network, the disrupted functional connectivity in cognitive brain networks, as well as the abnormal function of the visual network in patients with migraine with aura are the main milestones in migraine imaging achieved through functional imaging advances. We believe that further studies based on combined functional and structural techniques and the investigation of the different phases of migraine cycle may represent an efficient methodological approach for comprehensively looking into the migrainous brain secrets.
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DaSilva AF, Nascimento TD, Jassar H, Heffernan J, Toback RL, Lucas S, DosSantos MF, Bellile EL, Boonstra PS, Taylor JMG, Casey KL, Koeppe RA, Smith YR, Zubieta JK. Dopamine D2/D3 imbalance during migraine attack and allodynia in vivo. Neurology 2017; 88:1634-1641. [PMID: 28356463 DOI: 10.1212/wnl.0000000000003861] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/20/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate in vivo the dynamics of endogenous dopamine (DA) neurotransmission during migraine ictus with allodynia. METHODS We examined 8 episodic migraineurs and 8 healthy controls (HC) using PET with [11C]raclopride. The uptake measure of [11C]raclopride, nondisplaceable binding potential (BPND), would increase when there was a reduction in endogenous DA release. The opposite is true for a decrease in [11C]raclopride BPND. Patients were scanned twice: one PET session was during a spontaneous migraine ictus at rest, followed by a sustained thermal pain threshold (STPT) challenge on the trigeminal region, eliciting an allodynia experience; another was during interictal phase. RESULTS Striatal BPND of [11C]raclopride in migraineurs did not differ from HC. We found a significant increase in [11C]raclopride BPND in the striatum region of migraineurs during both headache attack and allodynia relative to interictal phase. However, when compared to the migraine attack at rest, migraineurs during the STPT challenge had a significant sudden reduction in [11C]raclopride BPND in the insula. Such directional change was also observed in the caudate of HC relative to the interictal phase during challenge. Furthermore, ictal changes in [11C]raclopride BPND in migraineurs at rest were positively correlated with the chronicity of migraine attacks, and negatively correlated with the frequency during challenge. CONCLUSIONS Our findings demonstrate that there is an imbalanced uptake of [11C]raclopride during the headache attack and ictal allodynia, which indicates reduction and fluctuation in ictal endogenous DA release in migraineurs. Moreover, the longer the history and recurrence of migraine attacks, the lower the ictal endogenous DA release.
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Affiliation(s)
- Alexandre F DaSilva
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor.
| | - Thiago D Nascimento
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Hassan Jassar
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Joseph Heffernan
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Rebecca L Toback
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Sarah Lucas
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Marcos F DosSantos
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Emily L Bellile
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Philip S Boonstra
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Jeremy M G Taylor
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Kenneth L Casey
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Robert A Koeppe
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Yolanda R Smith
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
| | - Jon-Kar Zubieta
- From the Headache & Orofacial Pain Effort (H.O.P.E.), Biologic & Materials Sciences Department, School of Dentistry (A.F.D., T.D.N., H.J., R.L.T., S.L., M.F.D.), Translational Neuroimaging Laboratory, Molecular & Behavioral Neuroscience Institute (A.F.D., J.H.. J.-K.Z.), Department of Biostatistics (E.L.B., P.S.B., J.M.G.T.), Department of Neurology (K.L.C.), PET Physics Section, Division of Nuclear Medicine, Radiology Department (R.A.K.), and Department of Obstetrics and Gynecology (Y.R.S.), University of Michigan, Ann Arbor
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Abstract
PURPOSE OF REVIEW Over the last several years, a growing number of brain functional imaging studies have provided insights into mechanisms underlying migraine. This article reviews the recent migraine functional neuroimaging literature and provides recommendations for future studies that will help fill knowledge gaps. RECENT FINDINGS PET and functional MRI studies have identified brain regions that might be responsible for mediating the onset of a migraine attack and those associated with migraine symptoms. Enhanced activation of brain regions that facilitate processing of sensory stimuli suggests a mechanism by which migraineurs are hypersensitive to visual, olfactory, and cutaneous stimuli. Resting state functional connectivity MRI studies have identified numerous brain regions and functional networks with atypical functional connectivity in migraineurs, suggesting that migraine is associated with aberrant brain functional organization. SUMMARY Functional MRI and PET studies that have identified brain regions and brain networks that are atypical in migraine have helped to describe the neurofunctional basis for migraine symptoms. Future studies should compare functional imaging findings in migraine to other headache and pain disorders and should explore the utility of functional imaging data as biomarkers for diagnostic and treatment purposes.
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Imaging sensory effects of occipital nerve stimulation: a new computer-based method in neuromodulation. Brain Stimul 2014; 8:295-8. [PMID: 25465289 DOI: 10.1016/j.brs.2014.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/21/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Within the last years, occipital nerve stimulation (ONS) has proven to be an important method in the treatment of severe therapy-resistant neurological pain disorders. The correspondence between lead placement as well as possible stimulation parameters and the resulting stimulation effects remains unclear. OBJECTIVE The method aims to directly relate the neuromodulatory mechanisms with the clinical treatment results, to achieve insight in the mode of action of neuromodulation, to identify the most effective stimulation sets and to optimize individual treatment effects. METHODS We describe a new computer-based imaging method for mapping the spatial, cognitive and affective sensory effects of ONS. The procedure allows a quantitative and qualitative analysis of the relationship between lead positioning, the stimulation settings as well as the sensory and clinical stimulation effects. CONCLUSION A regular mapping of stimulation and sensory parameters allows a coordinated monitoring. The stimulation results can be reviewed and compared with regards to clinical effectiveness.
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25
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Nascimento TD, DosSantos MF, Lucas S, van Holsbeeck H, DeBoer M, Maslowski E, Love T, Martikainen IK, Koeppe RA, Smith YR, Zubieta JK, DaSilva AF. μ-Opioid activation in the midbrain during migraine allodynia - brief report II. Ann Clin Transl Neurol 2014; 1:445-50. [PMID: 25328905 PMCID: PMC4184673 DOI: 10.1002/acn3.66] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/21/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022] Open
Abstract
We investigated in vivo the allodynic response of the central μ-opioid system during spontaneous migraine headaches, following a sustained pain threshold challenge on the trigeminal ophthalmic region. Six migraineurs were scanned during the ictal and interictal phases using positron emission tomography (PET) with the selective μ-opioid receptor (μOR) radiotracer [11C]carfentanil. Females were scanned during the mid-late follicular phase of two separate cycles. Patients showed ictal trigeminal allodynia during the thermal challenge that was concurrent and positively correlated with μOR activation in the midbrain, extending from red nucleus to ventrolateral periaqueductal gray matter. These findings demonstrate for the first time in vivo the high μOR activation in the migraineurs' brains in response to their allodynic experience.
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Affiliation(s)
- Thiago D Nascimento
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan
| | - Marcos F DosSantos
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan
| | - Sarah Lucas
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan
| | - Hendrik van Holsbeeck
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan
| | - Misty DeBoer
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan
| | | | - Tiffany Love
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan Ann Arbor, Michigan
| | - Ilkka K Martikainen
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan ; Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan Ann Arbor, Michigan
| | - Robert A Koeppe
- PET Physics Section, Division of Nuclear Medicine, Radiology Department, University of Michigan Ann Arbor, Michigan
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan Ann Arbor, Michigan
| | - Jon-Kar Zubieta
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan Ann Arbor, Michigan
| | - Alexandre F DaSilva
- Headache and Orofacial Pain Effort (HOPE), Biologic and Materials Sciences Department, School of Dentistry, University of Michigan Ann Arbor, Michigan ; Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan Ann Arbor, Michigan ; Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan Ann Arbor, Michigan
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