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Mosch B, Hagena V, Herpertz S, Diers M. Brain morphometric changes in fibromyalgia and the impact of psychometric and clinical factors: a volumetric and diffusion-tensor imaging study. Arthritis Res Ther 2023; 25:81. [PMID: 37208755 DOI: 10.1186/s13075-023-03064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Previous studies have repeatedly found distinct brain morphometric changes in patients with fibromyalgia (FM), mainly affecting gray and white matter abnormalities in areas related to sensory and affective pain processing. However, few studies have thus far linked different types of structural changes and not much is known about behavioral and clinical determinants that might influence the emergence and progression of such changes. METHODS We used voxel-based morphometry (VBM) and diffusion-tensor imaging (DTI) to detect regional patterns of (micro)structural gray (GM) and white matter (WM) alterations in 23 patients with FM compared to 21 healthy controls (HC), while considering the influence of demographic, psychometric, and clinical variables (age, symptom severity, pain duration, heat pain threshold, depression scores). RESULTS VBM and DTI revealed striking patterns of brain morphometric changes in FM patients. Bilateral middle temporal gyrus (MTG), parahippocampal gyrus, left dorsal anterior cingulate cortex (dACC), right putamen, right caudate nucleus, and left dorsolateral prefrontal cortex (DLPFC) showed significantly decreased GM volumes. In contrast, increased GM volume was observed in bilateral cerebellum and left thalamus. Beyond that, patients displayed microstructural changes of WM connectivity within the medial lemniscus, corpus callosum, and tracts surrounding and connecting the thalamus. Sensory-discriminative aspects of pain (pain severity, pain thresholds) primarily showed negative correlations with GM within bilateral putamen, pallidum, right midcingulate cortex (MCC), and multiple thalamic substructures, whereas the chronicity of pain was negatively correlated with GM volumes within right insular cortex and left rolandic operculum. Affective-motivational aspects of pain (depressive mood, general activity) were related to GM and FA values within bilateral putamen and thalamus. CONCLUSIONS Our results suggest a variety of distinct structural brain changes in FM, particularly affecting areas involved in pain and emotion processing such as the thalamus, putamen, and insula.
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Affiliation(s)
- Benjamin Mosch
- Clinical and Experimental Behavioral Medicine, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Verena Hagena
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Martin Diers
- Clinical and Experimental Behavioral Medicine, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
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2
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Li X, Liu M, Fan W, Xu H, Chen Z. Altered cerebral neurovascular coupling in medication-overuse headache: A study combining multi-modal resting-state fMRI with 3D PCASL. Front Neurosci 2023; 17:1139086. [PMID: 37008219 PMCID: PMC10050465 DOI: 10.3389/fnins.2023.1139086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
AimStructural and functional changes in the brain have been identified in individuals with medication-overuse headache (MOH) using MRI. However, it has not been clearly established whether neurovascular dysfunction occurs in MOH, which could be elucidated by examining neurovascular coupling (NVC) from the viewpoints of neuronal activity and cerebral blood flow. The aim of this study was to investigate potential alterations in NVC function of the brain in individuals with MOH using resting-state functional MRI (rs-fMRI) and 3D pseudo-continuous arterial spin labeling (3D PCASL) imaging techniques.MethodsA total of 40 patients with MOH and 32 normal controls (NCs) were recruited, and rs-fMRI and 3D PCASL data were obtained using a 3.0 T MR scanner. Standard preprocessing of the rs-fMRI data was performed to generate images representing regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuation (fALFF), and degree centrality (DC); cerebral blood flow (CBF) images were generated using 3D PCASL sequence data. These functional maps were all normalized into Montreal Neurological Institute (MNI) space, and NVC was subsequently determined on the basis of Pearson correlation coefficients between the rs-fMRI maps (ReHo, fALFF, and DC) and CBF maps. The statistical significance of differences between the MOH and NC groups in terms of NVC in different brain regions was established via Z-test. Further analysis was performed to examine correlations between NVC in the brain regions with NVC dysfunction and clinical variables among patients with MOH.ResultsNVC mainly presented a negative correlation in patients with MOH and NCs. No significant difference between the two groups was detected in terms of average NVC over the entire gray matter area. However, several brain regions with significantly decreased NVC in patients with MOH compared to NCs were identified: the left orbital region of the superior frontal gyrus, the bilateral gyrus rectus, and the olfactory cortex (P < 0.05). A correlation analysis revealed that the DC of the brain regions with NVC dysfunction was significantly positively correlated with disease duration (r = 0.323, P = 0.042), and DC–CBF connectivity was negatively correlated with VAS score (r = −0.424, P = 0.035).ConclusionThe current study demonstrated that cerebral NVC dysfunction occurs in patients with MOH, and the NVC technique could function as a new imaging biomarker in headache research.
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Affiliation(s)
- Xin Li
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Mengqi Liu
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Wenping Fan
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Huan Xu
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Zhiye Chen
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Zhiye Chen
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Gray matter volume and pain tolerance in a general population: the Tromsø study. Pain 2023:00006396-990000000-00257. [PMID: 36877481 DOI: 10.1097/j.pain.0000000000002871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/03/2023] [Indexed: 03/07/2023]
Abstract
ABSTRACT As pain is processed by an extensive network of brain regions, the structural status of the brain may affect pain perception. We aimed to study the association between gray matter volume (GMV) and pain sensitivity in a general population. We used data from 1522 participants in the seventh wave of the Tromsø study, who had completed the cold pressor test (3°C, maximum time 120 seconds), undergone magnetic resonance imaging (MRI) of the brain, and had complete information on covariates. Cox proportional hazards regression models were fitted with time to hand withdrawal from cold exposure as outcome. Gray matter volume was the independent variable, and analyses were adjusted for intracranial volume, age, sex, education level, and cardiovascular risk factors. Additional adjustment was made for chronic pain and depression in subsamples with available information on the respective item. FreeSurfer was used to estimate vertexwise cortical and subcortical gray matter volumes from the T1-weighted MR image. Post hoc analyses were performed on cortical and subcortical volume estimates. Standardized total GMV was associated with risk of hand withdrawal (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.71-0.93). The effect remained significant after additional adjustment for chronic pain (HR 0.84, 95% CI 0.72-0.97) or depression (HR 0.82, 95% CI 0.71-0.94). In post hoc analyses, positive associations between standardized GMV and pain tolerance were seen in most brain regions, with larger effect sizes in regions previously shown to be associated with pain. In conclusion, our findings indicate that larger GMV is associated with longer pain tolerance in the general population.
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4
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Henn AT, Larsen B, Frahm L, Xu A, Adebimpe A, Scott JC, Linguiti S, Sharma V, Basbaum AI, Corder G, Dworkin RH, Edwards RR, Woolf CJ, Habel U, Eickhoff SB, Eickhoff CR, Wagels L, Satterthwaite TD. Structural imaging studies of patients with chronic pain: an anatomical likelihood estimate meta-analysis. Pain 2023; 164:e10-e24. [PMID: 35560117 PMCID: PMC9653511 DOI: 10.1097/j.pain.0000000000002681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/09/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Neuroimaging is a powerful tool to investigate potential associations between chronic pain and brain structure. However, the proliferation of studies across diverse chronic pain syndromes and heterogeneous results challenges data integration and interpretation. We conducted a preregistered anatomical likelihood estimate meta-analysis on structural magnetic imaging studies comparing patients with chronic pain and healthy controls. Specifically, we investigated a broad range of measures of brain structure as well as specific alterations in gray matter and cortical thickness. A total of 7849 abstracts of experiments published between January 1, 1990, and April 26, 2021, were identified from 8 databases and evaluated by 2 independent reviewers. Overall, 103 experiments with a total of 5075 participants met the preregistered inclusion criteria. After correction for multiple comparisons using the gold-standard family-wise error correction ( P < 0.05), no significant differences associated with chronic pain were found. However, exploratory analyses using threshold-free cluster enhancement revealed several spatially distributed clusters showing structural alterations in chronic pain. Most of the clusters coincided with regions implicated in nociceptive processing including the amygdala, thalamus, hippocampus, insula, anterior cingulate cortex, and inferior frontal gyrus. Taken together, these results suggest that chronic pain is associated with subtle, spatially distributed alterations of brain structure.
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Affiliation(s)
- Alina T. Henn
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Bart Larsen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Lennart Frahm
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
| | - Anna Xu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
- Department of Psychology, Stanford University, Stanford, Carlifornia, US
| | - Azeez Adebimpe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA (Veterans Affairs) Medical Center, Philadelphia, Pennsylvania, US
| | - Sophia Linguiti
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Vaishnavi Sharma
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Allan I. Basbaum
- Department of Anatomy, University of California, San Francisco, US
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, US
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, Massachusetts, US
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, US
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Claudia R. Eickhoff
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Institute of Neuroscience and Medicine (INM1), Forschungszentrum Jülich, Jülich, Germany
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
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Niddam DM, Wu YT, Pan LLH, Chen YL, Wang SJ. Prediction of individual trigeminal pain sensitivity from gray matter structure within the sensorimotor network. Headache 2023; 63:146-155. [PMID: 36588467 DOI: 10.1111/head.14429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine whether multivariate pattern regression analysis based on gray matter (GM) images constrained to the sensorimotor network could accurately predict trigeminal heat pain sensitivity in healthy individuals. BACKGROUND Prediction of individual pain sensitivity is of clinical relevance as high pain sensitivity is associated with increased risks of postoperative pain, pain chronification, and a poor treatment response. However, as pain is a subjective experience accurate identification of such individuals can be difficult. GM structure of sensorimotor regions have been shown to vary with pain sensitivity. It is unclear whether GM structure within these regions can be used to predict pain sensitivity. METHODS In this cross-sectional study, structural magnetic resonance images and pain thresholds in response to contact heat stimulation of the left supraorbital area were obtained from 79 healthy participants. Voxel-based morphometry was used to extract segmented and normalized GM images. These were then constrained to a mask encompassing the functionally defined resting-state sensorimotor network. The masked images and pain thresholds entered a multivariate relevance vector regression analysis for quantitative prediction of the individual pain thresholds. The correspondence between predicted and actual pain thresholds was indexed by the Pearson correlation coefficient (r) and the mean squared error (MSE). The generalizability of the model was assessed by 10-fold and 5-fold cross-validation. Non-parametric permutation tests were used to estimate significance levels. RESULTS Trigeminal heat pain sensitivity could be predicted from GM structure within the sensorimotor network with significant accuracy (10-fold: r = 0.53, p < 0.001, MSE = 10.32, p = 0.001; 5-fold: r = 0.46, p = 0.001, MSE = 10.54, p < 0.001). The resulting multivariate weight maps revealed that accurate prediction relied on multiple widespread regions within the sensorimotor network. CONCLUSION A multivariate pattern of GM structure within the sensorimotor network could be used to make accurate predictions about trigeminal heat pain sensitivity at the individual level in healthy participants. Widespread regions within the sensorimotor network contributed to the predictive model.
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Affiliation(s)
- David M Niddam
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Te Wu
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Lin Chen
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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6
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Lu ZN, Yao SJ, Cao Y, Cheng Y, Li XT, Guo HS, Zhang XD. Aberrant gray matter structure in neurosyphilis without conventional MRI abnormality: a pilot study with voxel and surface-based morphology. Acta Radiol 2022; 64:1985-1993. [PMID: 36471581 DOI: 10.1177/02841851221142019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The underlying mechanism of neurosyphilis was not fully understood. Purpose To assess gray matter (GM) microstructure in patients with early-stage neurosyphilis without overt conventional magnetic resonance imaging (MRI) abnormality using voxel-based morphometry (VBM) and surface-based morphometry (SBM) analyses. Material and Methods Three-dimensional high-resolution T1-weighted imaging data from 19 individuals with neurosyphilis and 19 healthy controls were analyzed. A battery of neuropsychological tests was performed before each MRI examination. The differences of GM volume and cerebral cortical morphological data between the two groups were compared. The correlations between MRI metrics and neuropsychology/laboratory tests in the patient group were investigated. Results Regional decreased GM volumes in patients with neurosyphilis were found in the left frontal cortices (Rolandic operculum, middle frontal, and precentral) and bilateral temporal/occipital cortices (bilateral middle temporal, left lingual, and right middle occipital) ( P < 0.05, FDR correction). SBM analysis showed significant cortical thickness reduction in the right medial orbitofrontal lobe, and reduced gyrification index in the left insula in patients with neurosyphilis ( P < 0.05, FDR correction). Additionally, in the patient group, the GM volume in the middle frontal gyrus, the cortical thickness of right medial orbitofrontal lobe, and the gyrification index in the left insula were negatively correlated to the number connection test-A scores. The gyrification index was also negatively correlated to cerebrospinal fluid white blood cell count. Conclusion Early-stage neurosyphilis without conventional MRI abnormality presented regional GM volume reduction and cortical morphological changes, which might be related to cognitive impairment and intra-cranial infection. VBM and SBM analyses might be useful for understanding the underlying neural trait of neurosyphilis.
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Affiliation(s)
- Zi-Ning Lu
- Graduate School, Tianjin Medical University, Tianjin, PR China
- Department of radiology, Tianjin first central hospital, Tianjin, PR China
| | - Sheng-Juan Yao
- Department of radiology, Tianjin second people's hospital, Tianjin, PR China
| | - Yu Cao
- Department of radiology, Tianjin second people's hospital, Tianjin, PR China
| | - Yue Cheng
- Department of radiology, Tianjin first central hospital, Tianjin, PR China
| | - Xiao-Tian Li
- Department of radiology, Tianjin first central hospital, Tianjin, PR China
- School of Medicine, Nankai University, Tianjin, PR China
| | - Hong-Shuai Guo
- Tianjin Key Laboratory of Cognitive Computing and Application, College of Intelligence and Computing, Tianjin University, Tianjin, PR China
| | - Xiao-Dong Zhang
- Department of radiology, Tianjin first central hospital, Tianjin, PR China
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Perreault T, Ball A, Dommerholt J, Theiss R, Fernández-de-las-Peñas C, Butts R. Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications—A Scoping Review. J Clin Med 2022; 11:jcm11206039. [PMID: 36294360 PMCID: PMC9605351 DOI: 10.3390/jcm11206039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Intramuscular electrical stimulation (IMES) is a modality used by clinicians to treat myofascial pain. Recent studies have shown positive results for the use of IMES on pain outcomes, yet studies investigating the potential mechanisms of IMES directly to trigger points (TrPs) are lacking. We performed a scoping review of the literature to summarize the current evidence from human and animal studies on the mechanisms of IMES to the TrP location, and to identify gaps in the existing literature. Electronic literature searches were conducted across five databases from inception to 15 August 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Scopus and Cochrane Register of Controlled Trials. Four studies met our full criteria for inclusion in this review. Three studies assessed the effects of IMES to TrPs on human subjects with MPS, and only one study used an animal model with experimentally generated TrPs. Based on the results of the included studies, IMES within a TrP region was reported to normalize muscle blood flow, decrease endplate noise of the TrP and elicit antinociceptive effects, at least partially, through engaging supraspinal descending pain inhibitory systems. At present, no clinical implications can be determined on the use of IMES to TrPs due to the limited amount and quality of the available evidence. Further studies investigating the clinical effectiveness and also underlying mechanisms of IMES to TrPs are clearly needed.
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Affiliation(s)
- Thomas Perreault
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA
- Correspondence: ; Tel.: +1-603-740-2101
| | - Andrew Ball
- Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28216, USA
- Myopain Seminars, Bethesda, MD 20814, USA
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Robert Theiss
- Department of Physical Medicine and Rehabilitation, Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28203, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Raymond Butts
- Department of Rehabilitative Sciences, Gannon University, Ruskin, FL 33573, USA
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Altered Brain Activity and Effective Connectivity within the Nonsensory Cortex during Stimulation of a Latent Myofascial Trigger Point. Neural Plast 2022; 2022:4416672. [PMID: 35992300 PMCID: PMC9391196 DOI: 10.1155/2022/4416672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Myofascial trigger point (MTrP), an iconic characteristic of myofascial pain syndrome (MPS), can induce cerebral cortex changes including altered cortical excitability and connectivity. The corresponding characteristically reactive cortex is still ambiguous. Seventeen participants with latent MTrPs underwent functional near-infrared spectroscopy (fNIRS) to collect cerebral oxygenation hemoglobin (Δ[oxy-Hb]) signals. The Δ[oxy-Hb] signals of the left/right prefrontal cortex (L/R PFC), left/right motor cortex (L/R MC), and left/right occipital lobe (L/R OL) of the subjects were measured using functional near-infrared spectroscopy (fNIRS) in the resting state, nonmyofascial trigger point (NMTrP), state and MTrP state. The data investigated the latent MTrP-induced changes in brain activity and effective connectivity (EC) within the nonsensory cortex. The parameter wavelet amplitude (WA) was used to describe cortical activation, EC to show brain network connectivity, and main coupling direction (mCD) to exhibit the dominant connectivity direction in different frequency bands. An increasing trend of WA and a decreasing trend of EC values were observed in the PFC. The interregional mCD was primarily shifted from a unidirectional to bidirectional connection, especially from PFC to MC or OL, when responding to manual stimulation during the MTrP state compared with resting state and NMTrP state in the intervals III, IV, and V. This study demonstrates that the nonsensory cortex PFC, MC, and OL can participate in the cortical reactions induced by stimulation of a latent MTrP. Additionally, the PFC shows nonnegligible higher activation and weakened regulation than other brain regions. Thus, the PFC may be responsible for the central cortical regulation of a latent MTrP. This trial is registered with ChiCTR2100048433.
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Atilgan H, Doody M, Oliver DK, McGrath TM, Shelton AM, Echeverria-Altuna I, Tracey I, Vyazovskiy VV, Manohar SG, Packer AM. Human lesions and animal studies link the claustrum to perception, salience, sleep and pain. Brain 2022; 145:1610-1623. [PMID: 35348621 PMCID: PMC9166552 DOI: 10.1093/brain/awac114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022] Open
Abstract
The claustrum is the most densely interconnected region in the human brain. Despite the accumulating data from clinical and experimental studies, the functional role of the claustrum remains unknown. Here, we systematically review claustrum lesion studies and discuss their functional implications. Claustral lesions are associated with an array of signs and symptoms, including changes in cognitive, perceptual and motor abilities; electrical activity; mental state; and sleep. The wide range of symptoms observed following claustral lesions do not provide compelling evidence to support prominent current theories of claustrum function such as multisensory integration or salience computation. Conversely, the lesions studies support the hypothesis that the claustrum regulates cortical excitability. We argue that the claustrum is connected to, or part of, multiple brain networks that perform both fundamental and higher cognitive functions. As a multifunctional node in numerous networks, this may explain the manifold effects of claustrum damage on brain and behaviour.
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Affiliation(s)
- Huriye Atilgan
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Max Doody
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - David K. Oliver
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Thomas M. McGrath
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Andrew M. Shelton
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | | | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and Merton College, University of Oxford, Oxford OX3 9DU, UK
| | | | - Sanjay G. Manohar
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Adam M. Packer
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford OX1 3PT, UK
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10
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Plaut S. Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS One 2022; 17:e0263087. [PMID: 35171940 PMCID: PMC8849503 DOI: 10.1371/journal.pone.0263087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. METHODS Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. FINDINGS 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. CONCLUSIONS MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.
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Affiliation(s)
- Shiloh Plaut
- School of Medicine, St. George’s University of London, London, United Kingdom
- * E-mail:
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11
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Kang BX, Ma J, Shen J, Xu H, Wang HQ, Zhao C, Xie J, Zhong S, Gao CX, Xu XR, A XY, Gu XL, Xiao L, Xu J. Altered brain activity in end-stage knee osteoarthritis revealed by resting-state functional magnetic resonance imaging. Brain Behav 2022; 12:e2479. [PMID: 34967156 PMCID: PMC8785636 DOI: 10.1002/brb3.2479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is characterized by a degenerative change of knee cartilage and secondary bone hyperplasia, resulting in pain, stiffness, and abnormal walking gait. Long-term chronic pain causes considerable cortical plasticity alternations in patients. However, the brain structural and functional alterations associated with the pathological changes in knee joints of end-stage KOA patients remain unclear. This study aimed to analyze the structural and functional connectivity alterations in end-stage KOA to comprehensively understand the main brain-associated mechanisms underlying its development and progression. METHODS In this study, 37 patients with KOA and 37 demographically matched healthy controls (HCs) were enrolled. Alternations in gray matter (GM) volume in patients with KOA were determined using voxel-based morphometry. The region with the largest GM volume alteration was selected as the region of interest to calculate the voxel-wise resting-state functional connectivity (rs-FC) in the two groups. Pearson's correlation coefficient was used to analyze the correlation between clinical measures and GM volume alternations in patients with KOA. RESULTS Compared with HCs, patients with KOAs exhibited significantly decreased GM volumes in the left middle temporal gyrus (left-MTG) and the left inferior temporal gyrus. Results of the voxel-wise rs-FC analysis revealed that compared with HCs, patients with KOA had decreased left-MTG rs-FC to the right dorsolateral superior frontal gyrus, left middle frontal gyrus, and left medial superior frontal gyrus. GM volume in the left-MTG was negatively correlated with the Western Ontario and McMaster Universities Arthritis Index in patients with KOA (r = -0.393, p = .016). CONCLUSION Structural remodeling and functional connectivity alterations may be one of the central brain mechanisms associated with end-stage KOA.
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Affiliation(s)
- Bing-Xin Kang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Shen
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Xu
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Hai-Qi Wang
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chi Zhao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Xie
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Zhong
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen-Xin Gao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi-Rui Xu
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin-Yu A
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Li Gu
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lianbo Xiao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianguang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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12
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Makovac E, Venezia A, Hohenschurz-Schmidt D, Dipasquale O, Jackson JB, Medina S, O'Daly O, Williams SCR, McMahon SB, Howard MA. The association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey. J Physiol 2021; 599:5243-5260. [PMID: 34647321 DOI: 10.1113/jp282013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored. Here, we sought to determine brain regions mediating ANS and descending pain control associations. Thirty participants underwent conditioned pain modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between 'pressure-only' and 'pressure + cold' stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain were acquired. Heart rate variability (HRV) was simultaneously recorded. Normalised low-frequency HRV (LF-HRVnu) and the CPM score were negatively correlated; individuals with higher LF-HRVnu during pain reported reductions in pain during CPM. PAG-ventro-medial prefrontal cortex (vmPFC) and PAG-rostral ventromedial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-vmPFC functional connectivity mediated the strength of the LF-HRVnu-CPM association. CPM response magnitude was also negatively correlated with vmPFC GM volume. Our multi-modal approach, using behavioural, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments. KEY POINTS: Heart rate variability (HRV) is associated with descending pain modulation as measured by the conditioned pain modulation protocol (CPM). There is an association between CPM scores and the functional connectivity between the periaqueductal grey (PAG) and ventro-medial prefrontal cortex (vmPFC). CPM scores are also associated with vmPFC grey matter volume. The strength of functional connectivity between the PAG and vmPFC mediates the association between HRV and CPM. Our data provide new evidence of interactions between the autonomic nervous system and descending pain mechanisms.
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Affiliation(s)
- Elena Makovac
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | | - David Hohenschurz-Schmidt
- Department of Neuroimaging, King's College London, London, UK.,Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | | | - Jade B Jackson
- Department of Neuroimaging, King's College London, London, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sonia Medina
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, UK
| | | | - Stephen B McMahon
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
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13
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Pedersini P, Gobbo M, Bishop MD, Arendt-Nielsen L, Villafañe JH. Functional and structural neuroplastic changes related to sensitization proxies in patients with Osteoarthritis: a systematic review. PAIN MEDICINE 2021; 23:488-498. [PMID: 34633466 DOI: 10.1093/pm/pnab301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Several reports in literature have identified sensitization as a possible basis for the enhanced pain reactions associated with Osteoarthritis (OA). The aim of this current systematic review is to summarize functional and structural brain changes associated with surrogate sensitization parameters assessed in patients with OA-related pain. DESIGN Systematic review. SUBJECTS Patients with OA related pain. METHODS A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to December 2019. Articles were included if they assessed brain imaging and senzitisation parameters (quantitative sensory testing and questionnaires) in adults with OA related pain. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Five studies reporting on 138 patients were included in this review. The MINORS scale yielded mean scores of 8.5/16 and 12.3/24, for the cohort and case-control studies respectively. Four low-quality studies suggest a greater pain matrix activation associated with clinical measures of sensitization in patients with OA, while another study underlined the presence of structural changes (reduced gray matter volume) in the cortical areas involved in the nociceptive processing possible also related to sensitization. CONCLUSION This review shows conflicting evidence for structural and functional neuroplastic brain changes related to sensitization proxies in patients with OA.
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Affiliation(s)
- P Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Gobbo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M D Bishop
- Department of Physical Therapy, University of Florida, USA
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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14
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Duarte FCK, West DWD, Linde LD, Hassan S, Kumbhare DA. Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria. Curr Rheumatol Rep 2021; 23:69. [PMID: 34236529 DOI: 10.1007/s11926-021-01024-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW We discuss the need for a mechanism-based diagnostic framework with a focus on the development of objective measures (e.g., biomarkers) that can potentially be added to the diagnostic criteria of the syndrome. Potential biomarkers are discussed in relation to current knowledge on the pathophysiology of myofascial pain syndrome (MPS), including alterations in redox status, inflammation, and the myofascial trigger point (MTrP) biochemical milieu, as well as imaging and neurophysiological outcomes. Finally, we discuss the long-term goal of conducting a Delphi survey, to assess the influence of putative MPS biomarkers on clinician opinion, in order to ultimately develop new criteria for the diagnosis of MPS. RECENT FINDINGS Myofascial pain syndrome (MPS) is a prevalent healthcare condition associated with muscle weakness, impaired mood, and reduced quality of life. MPS is characterized by the presence of myofascial trigger points (MTrPs): stiff and discrete nodules located within taut bands of skeletal muscle that are painful upon palpation. However, physical examination of MTrPs often yields inconsistent results, and there is no gold standard by which to diagnose MPS. The current MPS diagnostic paradigm has an inherent subjectivity and the absence of correlation with the underlying pathophysiology. Recent advancements in ultrasound imaging, systemic biomarkers, MTrP-specific biomarkers, and the assessment of dysfunction in the somatosensorial system may all contribute to improved diagnostic effectiveness of MPS.
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Affiliation(s)
- Felipe C K Duarte
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Daniel W D West
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Lukas D Linde
- Inernational Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavid Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samah Hassan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Dinesh A Kumbhare
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. .,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, 550 University Ave, Toronto, Ontario, M5G 2A2, Canada.
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15
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Niddam DM, Wang SJ, Tsai SY. Pain sensitivity and the primary sensorimotor cortices: a multimodal neuroimaging study. Pain 2021; 162:846-855. [PMID: 32947544 DOI: 10.1097/j.pain.0000000000002074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT The primary somatosensory cortex (SI) is a critical part of the neural substrate underlying interindividual differences in pain sensitivity. Here, we investigated whether resting-state functional connectivity, gray matter density (GMD), and GABA and Glx (glutamate and glutamine) levels of the sensorimotor cortices were related to pain thresholds and whether such imaging measures could predict high and low pain sensitivity. Functional, structural, and spectroscopic magnetic resonance data were obtained from 48 healthy participants together with pain thresholds of the right index finger. Left and right sensorimotor networks (SMN) were extracted by means of independent component analysis, and GMD was measured within the combined SMN by means of voxel-based morphometry. Spectroscopic data were acquired from the bilateral sensorimotor cortices. Within the left SMN, functional connectivity to the right SI correlated positively with pain thresholds. In addition, GMD in the left SI and the GABA laterality index correlated positively with pain thresholds. A positive correlation was also found between the GABA laterality index and the left SMN connectivity to the right SI. Finally, the above mentioned functional connectivity and GMD measures could correctly predict high and low pain sensitivity in 83.7% of the study population. In summary, we showed that interindividual differences in pain sensitivity were related to the resting-state functional connectivity, interhemispheric GABA tone, and GMD of the sensorimotor cortices. Furthermore, high and low pain sensitivity could be predicted with high accuracy using imaging measures from the primary sensorimotor cortices.
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Affiliation(s)
- David M Niddam
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan.,Research Center for Mind, Brain and Learning, National Chengchi University, Taipei, Taiwan
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16
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Coppieters I, Cagnie B, De Pauw R, Meeus M, Timmers I. Enhanced amygdala-frontal operculum functional connectivity during rest in women with chronic neck pain: Associations with impaired conditioned pain modulation. Neuroimage Clin 2021; 30:102638. [PMID: 33812304 PMCID: PMC8053790 DOI: 10.1016/j.nicl.2021.102638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic neck pain is a leading cause of disability worldwide, affecting the lives of millions of people. Research investigating functional brain alterations in relation to somatosensory function is necessary to better understand mechanisms underlying pain development and maintenance in individuals with chronic neck pain, yet remains scarce. This case-control study aimed to examine resting-state functional connectivity alterations and associations with pain outcomes, self-reported central sensitization-related symptoms and quantitative sensory testing (QST) measures in patients with chronic non-traumatic (idiopathic/CINP) neck pain and chronic traumatic (whiplash associated/CWAD) neck pain compared to pain-free controls. METHODS Resting-state functional magnetic resonance images were acquired in 107 female participants (38 CINP, 37 CWAD, 32 healthy controls). After data pre-processing, seed-to-seed analyses were conducted focusing on resting-state functional connectivity involving pre-defined regions of interest that have previously been observed to be structurally or functionally altered and/or associated with pain-related measures in this patient population. RESULTS Findings demonstrate enhanced left amygdala functional coupling during rest with the left frontal operculum in women with CINP and CWAD compared to controls. This increased resting-state functional connectivity was associated with more self-reported symptoms related to central sensitization and decreased efficacy of conditioned pain modulation. Furthermore, enhanced connectivity between the left amygdala and left frontal orbital cortex, and between the left pallidum and the left frontal operculum was observed only in patients with CWAD compared to healthy controls. In patients, additional associations between local hyperalgesia and enhanced connectivity between the left superior parietal cortex and the left and right precentral gyrus were found. CONCLUSIONS In line with our hypotheses, patients with CWAD showed the most pronounced alterations in resting-state functional connectivity, encompassing subcortical limbic (amygdala) and basal ganglia (pallidum), and ventral frontal regions (frontal operculum, orbitofrontal cortex) when compared to CINP and controls. Findings are generally in line with the idea of a continuum, in absence of significant group differences across CINP and CWAD. Enhanced amygdala-frontal operculum functional connectivity was the most robust and only connectivity pair in the cluster that was associated with QST (i.e., dynamic QST; endogenous pain inhibition), and that was observed in both patient groups. In addition, independent of group differences, enhanced resting-state functional connectivity between superior parietal cortex (involved in attention) and primary motor cortex was associated with static QST (i.e., greater local hyperalgesia). Taken together, our findings show a key role for enhanced amygdala-ventral frontal circuitry in chronic neck pain, and its association with diminished endogenous pain inhibition further emphasizes the link between cognitive-affective and sensory modulations of pain in women with chronic non-traumatic and traumatic neck pain.
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Affiliation(s)
- Iris Coppieters
- Pain in Motion Research Group VUB (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, United States.
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17
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Tian Z, Yin T, Xiao Q, Dong X, Yang Y, Wang M, Ha G, Chen J, Liang F, Zeng F, Lan L. The Altered Functional Connectivity With Pain Features Integration and Interaction in Migraine Without Aura. Front Neurosci 2021; 15:646538. [PMID: 33746709 PMCID: PMC7969893 DOI: 10.3389/fnins.2021.646538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Migraine without aura (MwoA) is a primary type of migraine, a common disabling disorder, and a disabling neurological condition. The headache is a complex experience, a common form of pain, in which multiple sensory information dimensions are combined to provide a unified conscious event. Migraine ictal have unique neuroimage biomarkers, but the brain is also affected during the inter-ictal phase. According to the current studies, a hypothesis was constructed that the altered integration of pain spatial and intensity information impacts headache intensity in the inter-ictal period. Methods In this study, we applied theory-based region-to-region functional connectivity (FC) analyses to compare the differences in resting-state FC between MwoA participants and healthy controls with the pain integration hypothesis. After the correlation matrices between FC edges and clinical symptoms were constructed, the moderating effect and simple slope tests were investigated to explain whether and how the dysfunction of pain features discrimination affects the clinical symptoms. Results Functional connectivity analyses showed significantly decreased FC edges between the left dorsolateral superior frontal gyrus (SFGdor) and left insula, and an increased FC edge between the left SFGdor and bilateral angular gyrus. The correlation matrix showed no significant correlation between significantly altered FC edge and headache duration, frequency, Zung self-rating anxiety scale, and Zung self-rating depression scale. Only one significantly altered edge in the MwoA condition was significantly correlated with headache intensity. Moderating Module 1 and 2 manifested the moderator variable (altered rs-FC edge) moderated the link between the normal edges and headache intensity. Conclusion The pain features integration processes in migraineurs vary from HCs, related to the clinical symptoms during a migraine attack. Moreover, the clinical symptoms will be affected by one or more discrimination modules. And the spatial or intensity discrimination modules have a higher impact when combined with another module on clinical symptoms than the single module.
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Affiliation(s)
- Zilei Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingqing Xiao
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohui Dong
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunhong Yang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Menglin Wang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guodong Ha
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiyao Chen
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Lei Lan
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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18
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Martín-Corrales C, Bautista IV, Méndez-Mera JE, Fernández-Matías R, Achalandabaso-Ochoa A, Gallego-Izquierdo T, Nuñez-Nagy S, Pecos-Martín D. Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial. PAIN MEDICINE 2020; 21:2948-2957. [PMID: 33580803 DOI: 10.1093/pm/pnaa279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. DESIGN Randomized clinical trial. SETTING Physiotherapy and Pain Clinic of Alcala University. SUBJECTS Forty-six patients with chronic low back pain. METHODS Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. RESULTS Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. CONCLUSIONS In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.
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Affiliation(s)
| | | | | | | | | | - Tomás Gallego-Izquierdo
- Research Institute of Physiotherapy and Pain. Universidad de Alcalá, Alcalá, Spain.,Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain.,Physiotherapy and Pain Group, Universidad de Alcalá, Alcalá, Spain
| | - Susana Nuñez-Nagy
- Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain
| | - Daniel Pecos-Martín
- Research Institute of Physiotherapy and Pain. Universidad de Alcalá, Alcalá, Spain.,Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain.,Physiotherapy and Pain Group, Universidad de Alcalá, Alcalá, Spain
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19
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Lai KL, Niddam DM, Fuh JL, Chen WT, Wu JC, Wang SJ. Cortical morphological changes in chronic migraine in a Taiwanese cohort: Surface- and voxel-based analyses. Cephalalgia 2020; 40:575-585. [PMID: 32299230 DOI: 10.1177/0333102420920005] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous voxel- or surface-based morphometric analysis studies have revealed alterations in cortical structure in patients with chronic migraine, yet with inconsistent results. The discrepancies may be derived partly from the sample heterogeneity. Employing both methods in a clinically homogenous group may provide a clearer view. METHODS Structural MRI data from 30 prevention-naïve patients with chronic migraine without medication overuse headache or a history of major depression and 30 healthy controls were analyzed. Vertex-wise (surface-based) or voxel-wise (voxel-based) linear models were applied, after controlling for age and gender, to investigate between-group differences. Averaged cortical thicknesses and volumes from regions showing group differences were correlated with parameters related to clinical profiles. RESULTS Surface-based morphometry showed significantly thinner cortices in the bilateral insular cortex, caudal middle frontal gyrus, precentral gyrus, and parietal lobes in patients with chronic migraine relative to healthy controls. Additionally, the number of migraine days in the month preceding MRI examination was correlated negatively with right insular cortical thickness. Voxel-based morphometry (VBM) did not show any group differences or clinical correlations. CONCLUSION Patients with chronic migraine without medication overuse headache, major depression, or prior preventive treatment had reduced cortical thickness in regions within the pain-processing network. Compared to voxel-based morphometry, surface-based morphometry analysis may be more sensitive to subtle structural differences between healthy controls and patients with chronic migraine.
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Affiliation(s)
- Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - David M Niddam
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Ching Wu
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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20
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Boissoneault J, Penza CW, George SZ, Robinson ME, Bishop MD. Comparison of brain structure between pain-susceptible and asymptomatic individuals following experimental induction of low back pain. Spine J 2020; 20:292-299. [PMID: 31479781 PMCID: PMC6995409 DOI: 10.1016/j.spinee.2019.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Peripheral differences often do not adequately account for variation in reports of pain intensity in people with musculoskeletal pain. PURPOSE Here we sought to determine the extent to which structural differences in the brain (grey matter density) of pain free individuals might relate to subsequent pain (or lack thereof) after standardized peripheral muscle injury (ie, micro trauma from high intensity exercise). STUDY DESIGN This was an observational laboratory-based study that was a secondary analysis from a larger trial. METHODS Participants completed baseline testing (functional MRI and quantitative pain testing) followed by high intensity trunk exercise to induce delayed onset muscle soreness in the erector spinae. Forty-eight hours later, back pain intensity ratings were collected and all participants were re-imaged. Grey matter density was determined using voxel-based morphometry. The "asymptomatic" group (no reports of any pain within 48 hours after induction) to a 'pain' group (rating of pain at rest and movement pf>20 on a 101-point numeric rating scale). RESULTS Our results revealed several large clusters where, compared to participants with pain, asymptomatic participants had significant greater grey matter density. These brain regions included left medial frontal gyrus, left middle occipital gyrus, left middle temporal gyrus, left inferior frontal gyrus, and right superior frontal gyrus. CONCLUSIONS Lower grey matter density in brain regions previously linked to discriminative, emotional, and cognitive aspects of cortical processing are associated with reporting musculoskeletal pain after a standardized peripheral muscle injury. CLINICAL SIGNIFICANCE Cortical gray matter density of people without any pain may influence response to a standardized high intensity exercise protocol. This finding adds further support to the relevance of central factors in explaining the tremendous individual variability in pain report following acute musculoskeletal injury.
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Affiliation(s)
- Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Charles W Penza
- Physical Medicine and Rehabilitation, Miami Veteran's Affairs Health System, Miami, FL, USA
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, NC, USA
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Mark D Bishop
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA; Department of Physical Therapy, University of Florida, P.O. Box 100154, Gainesville, FL 32610, USA.
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21
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Naylor B, Hesam-Shariati N, McAuley JH, Boag S, Newton-John T, Rae CD, Gustin SM. Reduced Glutamate in the Medial Prefrontal Cortex Is Associated With Emotional and Cognitive Dysregulation in People With Chronic Pain. Front Neurol 2019; 10:1110. [PMID: 31849800 PMCID: PMC6903775 DOI: 10.3389/fneur.2019.01110] [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: 03/14/2019] [Accepted: 10/03/2019] [Indexed: 01/03/2023] Open
Abstract
A decrease in glutamate in the medial prefrontal cortex (mPFC) has been extensively found in animal models of chronic pain. Given that the mPFC is implicated in emotional appraisal, cognition and extinction of fear, could a potential decrease in glutamate be associated with increased pessimistic thinking, fear and worry symptoms commonly found in people with chronic pain? To clarify this question, 19 chronic pain subjects and 19 age- and gender-matched control subjects without pain underwent magnetic resonance spectroscopy. Both groups also completed the Temperament and Character, the Beck Depression and the State Anxiety Inventories to measure levels of harm avoidance, depression, and anxiety, respectively. People with chronic pain had significantly higher scores in harm avoidance, depression and anxiety compared to control subjects without pain. High levels of harm avoidance are characterized by excessive worry, pessimism, fear, doubt and fatigue. Individuals with chronic pain showed a significant decrease in mPFC glutamate levels compared to control subjects without pain. In people with chronic pain mPFC glutamate levels were significantly negatively correlated with harm avoidance scores. This means that the lower the concentration of glutamate in the mPFC, the greater the total scores of harm avoidance. High scores are associated with fearfulness, pessimism, and fatigue-proneness. We suggest that chronic pain, particularly the stress-induced release of glucocorticoids, induces changes in glutamate transmission in the mPFC, thereby influencing cognitive, and emotional processing. Thus, in people with chronic pain, regulation of fear, worry, negative thinking and fatigue is impaired.
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Affiliation(s)
- Brooke Naylor
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - James H McAuley
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Simon Boag
- School of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Sylvia M Gustin
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
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22
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Kodama K, Takamoto K, Nishimaru H, Matsumoto J, Takamura Y, Sakai S, Ono T, Nishijo H. Analgesic Effects of Compression at Trigger Points Are Associated With Reduction of Frontal Polar Cortical Activity as Well as Functional Connectivity Between the Frontal Polar Area and Insula in Patients With Chronic Low Back Pain: A Randomized Trial. Front Syst Neurosci 2019; 13:68. [PMID: 31798422 PMCID: PMC6863771 DOI: 10.3389/fnsys.2019.00068] [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: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Compression of myofascial trigger points (MTrPs) in muscles is reported to reduce chronic musculoskeletal pain. Although the prefrontal cortex (PFC) is implicated in development of chronic pain, the mechanisms of how MTrP compression at low back regions affects PFC activity remain under debate. In this study, we investigated effects of MTrP compression on brain hemodynamics and EEG oscillation in subjects with chronic low back pain. Methods The study was a prospective, randomized, parallel-group trial and an observer and subject-blinded clinical trial. Thirty-two subjects with chronic low back pain were divided into two groups: subjects with compression at MTrPs (n = 16) or those with non-MTrPs (n = 16). Compression at MTrP or non-MTrP for 30 s was applied five times, and hemodynamic activity (near-infrared spectroscopy; NIRS) and EEGs were simultaneously recorded during the experiment. Results The results indicated that compression at MTrPs significantly (1) reduced subjective pain (P < 0.05) and increased the pressure pain threshold (P < 0.05), (2) decreased the NIRS hemodynamic activity in the frontal polar area (pPFC) (P < 0.05), and (3) increased the current source density (CSD) of EEG theta oscillation in the anterior part of the PFC (P < 0.05). CSD of EEG theta oscillation was negatively correlated with NIRS hemodynamic activity in the pPFC (P < 0.05). Furthermore, functional connectivity in theta bands between the medial pPFC and insula cortex was significantly decreased in the MTrP group (P < 0.05). The functional connectivity between those regions was positively correlated with subjective low back pain (P < 0.05). Discussion The results suggest that MTrP compression at the lumbar muscle modulates pPFC activity and functional connectivity between the pPFC and insula, which may relieve chronic musculoskeletal pain. Trial registration This trial was registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000033913) on 27 August 2018, at https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038660.
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Affiliation(s)
- Kanae Kodama
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kouichi Takamoto
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan.,Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Shimonoseki, Japan
| | - Hiroshi Nishimaru
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Jumpei Matsumoto
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yusaku Takamura
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shigekazu Sakai
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Taketoshi Ono
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hisao Nishijo
- Department of System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
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23
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Niddam DM, Lee SH, Su YT, Chan RC. Altered cortical morphology in patients with chronic shoulder pain. Neurosci Lett 2019; 712:134515. [DOI: 10.1016/j.neulet.2019.134515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
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24
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Gray matter correlates of pressure pain thresholds and self-rated pain sensitivity: a voxel-based morphometry study. Pain 2019; 159:1359-1365. [PMID: 29557929 DOI: 10.1097/j.pain.0000000000001219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individual differences in sensitivity to pain are large and have clinical and scientific importance. Although heavily influenced by situational factors, they also relate to genetic factors and psychological traits, and are reflected by differences in functional activation in pain-related brain regions. Here, we used voxel-based morphometry to investigate if individual pain sensitivity is related to local gray matter volumes. Pain sensitivity was determined using (1) index finger pressure pain thresholds (PPTs) and (2) pain intensity ratings of imagined painful situations as assessed by the Pain Sensitivity Questionnaire (PSQ) in 501 population-based subjects participating in the BiDirect Study. Pain Sensitivity Questionnaire scores were positively associated with gray matter in 2 symmetrical clusters, with a focus on the parahippocampal gyrus, extending to the hippocampus, fusiform gyrus, BA19, putamen, and insula (P < 0.05 corrected), but the effect was small (R = 0.045-0.039). No negative associations with the PSQ and no associations with the PPT reached significance. Parahippocampal activation during pain and altered parahippocampal gray matter in chronic pain have been reported, which would be consistent with positive associations with PSQ scores. Alternatively, associations of PSQ scores with the parahippocampal and fusiform gray matter could relate to the visual imagination of painful situations required by the PSQ, not to pain sensitivity itself. Regarding PPTs, the present data obtained in a large sample strongly suggest an absence of associations of this parameter with gray matter volume. In conclusion, the present results argue against a strong association between pain sensitivity and local gray matter volumes.
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25
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Ong WY, Stohler CS, Herr DR. Role of the Prefrontal Cortex in Pain Processing. Mol Neurobiol 2018; 56:1137-1166. [PMID: 29876878 PMCID: PMC6400876 DOI: 10.1007/s12035-018-1130-9] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
The prefrontal cortex (PFC) is not only important in executive functions, but also pain processing. The latter is dependent on its connections to other areas of the cerebral neocortex, hippocampus, periaqueductal gray (PAG), thalamus, amygdala, and basal nuclei. Changes in neurotransmitters, gene expression, glial cells, and neuroinflammation occur in the PFC during acute and chronic pain, that result in alterations to its structure, activity, and connectivity. The medial PFC (mPFC) could serve dual, opposing roles in pain: (1) it mediates antinociceptive effects, due to its connections with other cortical areas, and as the main source of cortical afferents to the PAG for modulation of pain. This is a ‘loop’ where, on one side, a sensory stimulus is transformed into a perceptual signal through high brain processing activity, and perceptual activity is then utilized to control the flow of afferent sensory stimuli at their entrance (dorsal horn) to the CNS. (2) It could induce pain chronification via its corticostriatal projection, possibly depending on the level of dopamine receptor activation (or lack of) in the ventral tegmental area-nucleus accumbens reward pathway. The PFC is involved in biopsychosocial pain management. This includes repetitive transcranial magnetic stimulation, transcranial direct current stimulation, antidepressants, acupuncture, cognitive behavioral therapy, mindfulness, music, exercise, partner support, empathy, meditation, and prayer. Studies demonstrate the role of the PFC during placebo analgesia, and in establishing links between pain and depression, anxiety, and loss of cognition. In particular, losses in PFC grey matter are often reversible after successful treatment of chronic pain.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology and Ageing Research Programme, National University of Singapore, Singapore, 119260, Singapore.
| | | | - Deron R Herr
- Department of Pharmacology, National University of Singapore, Singapore, 119260, Singapore.
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26
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Niddam DM, Lai KL, Tsai SY, Lin YR, Chen WT, Fuh JL, Wang SJ. Neurochemical changes in the medial wall of the brain in chronic migraine. Brain 2017; 141:377-390. [DOI: 10.1093/brain/awx331] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/18/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- David M Niddam
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Municipal Gandau Hospital. Taipei, Taiwan
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
- Research Center for Mind, Brain and Learning, National Chengchi University, Taipei, Taiwan
| | - Yi-Ru Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Wei-Ta Chen
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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27
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Chong CD, Dumkrieger G, Schwedt TJ. Structural Co-Variance Patterns in Migraine: A Cross-Sectional Study Exploring the Role of the Hippocampus. Headache 2017; 57:1522-1531. [PMID: 28976002 PMCID: PMC5681397 DOI: 10.1111/head.13193] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/05/2017] [Accepted: 06/05/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To interrogate hippocampal morphology and structural co-variance patterns in migraine patients and to investigate whether structural co-variance patterns relate to migraine disease characteristics. BACKGROUND Migraine is associated with structural alterations in widespread cortical and subcortical regions associated with the sensory, cognitive, and affective components of pain processing. Recent studies have shown that migraine patients have differences in hippocampal structure and function relative to healthy control subjects, but whether hippocampal structure relates to disease characteristics including frequency of attacks, years lived with migraine and symptoms of allodynia remains unknown. Furthermore, this study investigated hippocampal volume co-variance patterns in migraineurs, an indirect measure of brain network connectivity. Here, we explore differences in hippocampal volume and structural co-variance patterns in migraine patients relative to healthy controls and examine whether these hippocampal measures relate to migraine disease burden. METHODS This study included 61 migraine patients and 57 healthy control subjects (healthy controls: median age = 34.0, IQR = 19.0; migraine patients: median age = 35.0, IQR = 17.5; P = .65). Regional brain volumes were automatically calculated using FreeSurfer version 5.3. Symptoms of allodynia were determined using the Allodynia Symptom Checklist 12 (ASC-12). Structural co-variance patterns were interrogated using pairwise correlations and group differences in correlation strength were estimated using Euclidian distance. A stepwise regression was used to investigate the relationship between structural co-variance patterns with migraine burden. RESULTS Migraine patients had less left hippocampal volume (healthy controls: left hippocampal volume = 4276.8 mm3 , SD = 425.3 mm3 , migraine patients: left hippocampal volume = 4089.5 mm3 , SD = 453.9 mm3 , P = .02) and less total (right plus left) hippocampal volume (healthy controls: total hippocampal volume= 8690.8 mm3 , SD = 855.1 mm3 ; migraine patients: total hippocampal volume = 8341.8 mm3 , SD = 917.9 mm3 ; P = .03) compared to healthy controls. Migraineurs had stronger structural covariance between the hippocampi and cortico-limbic regions in the frontal lobe (inferior opercular gyrus), temporal lobe (planum temporale, amygdala), parietal lobe (angular gyrus, precuneus), and the cerebellar white matter. Results of a stepwise regression showed that hippocampal volumes and the interactions between hippocampal volumes with the volumes of other cortico-limbic regions associate with migraine-related allodynia but not with headache frequency or years lived with migraine. CONCLUSION Migraineurs have less hippocampal volume and stronger hippocampal-cortico-limbic connectivity compared to healthy controls. Hippocampal volumes and measures of hippocampal volume connectivity with other cortico-limbic network regions associate with symptoms of allodynia.
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Affiliation(s)
| | - Gina Dumkrieger
- Mayo Clinic, Arizona, Department of Neurology
- Arizona State University, School of Computing Informatics and Decision Systems Engineering
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28
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Morikawa Y, Takamoto K, Nishimaru H, Taguchi T, Urakawa S, Sakai S, Ono T, Nishijo H. Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci 2017; 11:186. [PMID: 28442987 PMCID: PMC5386976 DOI: 10.3389/fnins.2017.00186] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/21/2017] [Indexed: 12/15/2022] Open
Abstract
Compression at myofascial trigger points (MTrPs), known as “ischemic compression,” has been reported to provide immediate relief of musculoskeletal pain and reduce the sympathetic activity that exacerbates chronic pain. We conducted a pilot study to investigate the possible involvement of the prefrontal cortex in pain relief obtained by MTrP compression in the present study, and analyzed the relationships among prefrontal hemodynamic activity, activity of the autonomic nervous system, and subjective pain in patients with chronic neck pain, with and without MTrP compression. Twenty-one female subjects with chronic neck pain were randomly assigned to two groups: MTrP compression (n = 11) or Non-MTrP compression (n = 10). Compression for 30 s was conducted 4 times. During the experiment, prefrontal hemodynamic activity [changes in Oxy-hemoglobin (Hb), Deoxy-Hb, and Total-Hb concentrations] and autonomic activity based on heart rate variability (HRV) were monitored by using near infrared spectroscopy (NIRS) and electrocardiography (ECG), respectively. The results indicated that MTrP compression significantly reduced subjective pain compared with Non-MTrP compression. The spectral frequency-domain analyses of HRV indicated that a low frequency (LF) component of HRV was decreased, and a high frequency (HF) component of HRV was increased during MTrP compression, while LF/HF ratio was decreased during MTrP compression. In addition, prefrontal hemodynamic activity was significantly decreased during MTrP compression compared with Non-MTrP compression. Furthermore, changes in autonomic activity were significantly correlated with changes in subjective pain and prefrontal hemodynamic activity. Along with previous studies indicating a role for sympathetic activity in the exacerbation of chronic pain, the present results suggest that MTrP compression in the neck region alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain.
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Affiliation(s)
- Yoshiki Morikawa
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Kouich Takamoto
- Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Hiroshi Nishimaru
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Toru Taguchi
- Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Susumu Urakawa
- Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Shigekazu Sakai
- Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Taketoshi Ono
- Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
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29
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The Role of Stress Regulation on Neural Plasticity in Pain Chronification. Neural Plast 2016; 2016:6402942. [PMID: 28053788 PMCID: PMC5178373 DOI: 10.1155/2016/6402942] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 01/27/2023] Open
Abstract
Pain, especially chronic pain, is one of the most common clinical symptoms and has been considered as a worldwide healthcare problem. The transition from acute to chronic pain is accompanied by a chain of alterations in physiology, pathology, and psychology. Increasing clinical studies and complementary animal models have elucidated effects of stress regulation on the pain chronification via investigating activations of the hypothalamic-pituitary-adrenal (HPA) axis and changes in some crucial brain regions, including the amygdala, prefrontal cortex, and hippocampus. Although individuals suffer from acute pain benefit from such physiological alterations, chronic pain is commonly associated with maladaptive responses, like the HPA dysfunction and abnormal brain plasticity. However, the causal relationship among pain chronification, stress regulation, and brain alterations is rarely discussed. To call for more attention on this issue, we review recent findings obtained from clinical populations and animal models, propose an integrated stress model of pain chronification based on the existing models in perspectives of environmental influences and genetic predispositions, and discuss the significance of investigating the role of stress regulation on brain alteration in pain chronification for various clinical applications.
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