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Medina S, O'Daly O, Howard MA, Feliu-Soler A, Luciano JV. Does practice make perfect? Functional connectivity of the salience network and somatosensory network predicts response to mind-body treatments for fibromyalgia. FRONTIERS IN PAIN RESEARCH 2024; 5:1245235. [PMID: 39328273 PMCID: PMC11425596 DOI: 10.3389/fpain.2024.1245235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2024] [Indexed: 09/28/2024] Open
Abstract
Background Mind-body treatments can improve coping mechanisms to deal with pain, improve the quality of life of patients with fibromyalgia syndrome (FMS), and reduce perceived pain in some cases. However, responses to these treatments are highly variable, the mechanisms underpinning them remain unclear, and reliable predictors of treatment response are lacking. We employed resting-state blood oxygen level-dependent (rsBOLD) functional magnetic resonance imaging (fMRI) to examine changes in brain functional connectivity (FC) following mind-body treatment that may relate to and predict pain relief. Methods We recruited patients with FMS who underwent either mindfulness-based stress reduction (MBSR; n = 18) or a psychoeducational program (FibroQoL; n = 22) and a treatment-as-usual FMS group (TAU; n = 18). We collected rsBOLD data, alongside subjective pain, anxiety, depression, and catastrophizing measures prior to and following treatments. We examined behavioral changes and FC changes in the salience network (SN) and sensorimotor network (SMN) and performed regression analyses to identify predictors for treatment response. Results The MBSR and FibroQoL groups experienced significant reductions in pain catastrophizing. After treatment, the FC of the sensorimotor cortex with the rest of the SMN became significantly reduced in the MBSR group compared to the TAU group. The FC between the SN and the SMN at baseline was negatively correlated with pain reductions following MBSR but positively correlated with pain reductions in the FibroQoL group. These results yielded large to very large effect sizes. Following MBSR, only for those patients with lower baseline SMN-SN FC, minutes of mindfulness practice were positively associated with clinical improvement (small to medium effect size). Conclusions Different mind-body treatments are underpinned by discrete brain networks. Measures of the functional interplay between SN and SMN have the potential as predictors of mind-body treatment response in patients with FMS.
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Affiliation(s)
- Sonia Medina
- Department of Neuroimaging, King's College London, London, United Kingdom
- Department of Health and Biomedical Sciences, University of Exeter, Exeter, United Kingdom
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, United Kingdom
| | - Matthew A Howard
- Department of Neuroimaging, King's College London, London, United Kingdom
| | - Albert Feliu-Soler
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Juan V Luciano
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Scheliga S, Dohrn MF, Kellermann T, Lampert A, Rolke R, Namer B, Peschke GZ, van den Braak N, Lischka A, Spehr M, Jo HG, Habel U. Painful stimulation increases functional connectivity between supplementary motor area and thalamus in patients with small fibre neuropathy. Eur J Pain 2024. [PMID: 39193929 DOI: 10.1002/ejp.4720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND The lead symptom of small fibre neuropathy (SFN) is neuropathic pain. Recent functional magnetic resonance imaging (fMRI) studies have indicated central changes in SFN patients of different etiologies. However, less is known about brain functional connectivity during acute pain processing in idiopathic SFN. METHODS We conducted fMRI with thermal heat pain application (left volar forearm) in 32 idiopathic SFN patients and 31 healthy controls. We performed functional connectivity analyses with right supplementary motor area (SMA), left insula, and left caudate nucleus (CN) as seed regions, respectively. Since pathogenic gain-of-function variants in voltage gated sodium channels (Nav) have been linked to SFN pathophysiology, explorative connectivity analyses were performed in a homogenous subsample of patients carrying rare heterozygous missense variants. RESULTS For right SMA, we found significantly higher connectivity with the right thalamus in SFN patients compared to controls. This connectivity correlated significantly with intraepidermal nerve fibre density, suggesting a link between peripheral and central pain processing. We found significantly reduced connections between right SMA and right middle frontal gyrus in patients with Nav variants. Likewise, connectivity between left CN and right frontal pole was decreased. CONCLUSIONS Aberrant functional connectivity in SFN is in line with previous research on other chronic pain syndromes. Functional connectivity changes may be linked to SFN, highlighting the need to determine if they result from peripheral changes causing abnormal somatosensory processing. This understanding may be crucial for assessing their impact on painful symptoms and therapy response. SIGNIFICANCE STATEMENT We found increased functional connectivity between SMA and thalamus during painful stimulation in patients with idiopathic SFN. Connectivity correlated significantly with intraepidermal nerve fibre density, suggesting a link between peripheral and central pain processing. Our findings emphasize the importance of investigating functional connectivity changes as a potential feature of SFN.
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Affiliation(s)
- Sebastian Scheliga
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Maike F Dohrn
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thilo Kellermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Straβe, Jülich, Germany
| | - Angelika Lampert
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Institute of Neurophysiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Roman Rolke
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Department of Palliative Medicine, Medical Faculty RWTH, Aachen University, Aachen, Germany
| | - Barbara Namer
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Institute of Neurophysiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Research Group Neuroscience, Interdisciplinary Centre for Clinical Research, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Greta Z Peschke
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nortje van den Braak
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Annette Lischka
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Marc Spehr
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Department of Chemosensation, RWTH Aachen University, Institute for Biology II, Aachen, Germany
| | - Han-Gue Jo
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- School of Computer Science & Engineering, Kunsan National University, Gunsan, Republic of Korea
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Scientific Center for Neuropathic Pain Aachen, SCNAachen, Uniklinik RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Straβe, Jülich, Germany
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Cheong Y, Lee S, Okazawa H, Kosaka H, Jung M. Effects of functional polymorphisms of opioid receptor mu 1 and catechol-O-methyltransferase on the neural processing of pain. Psychiatry Clin Neurosci 2024; 78:300-308. [PMID: 38403942 DOI: 10.1111/pcn.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024]
Abstract
AIM Pain is reconstructed by brain activities and its subjectivity comes from an interplay of multiple factors. The current study aims to understand the contribution of genetic factors to the neural processing of pain. Focusing on the single-nucleotide polymorphism (SNP) of opioid receptor mu 1 (OPRM1) A118G (rs1799971) and catechol-O-methyltransferase (COMT) val158met (rs4680), we investigated how the two pain genes affect pain processing. METHOD We integrated a genetic approach with functional neuroimaging. We extracted genomic DNA information from saliva samples to genotype the SNP of OPRM1 and COMT. We used a percept-related model, in which two different levels of perceived pain intensities ("low pain: mildly painful" vs "high pain: severely painful") were employed as experimental stimuli. RESULTS Low pain involves a broader network relative to high pain. The distinct effects of pain genes were observed depending on the perceived pain intensity. The effects of low pain were found in supramarginal gyrus, angular gyrus, and anterior cingulate cortex (ACC) for OPRM1 and in middle temporal gyrus for COMT. For high pain, OPRM1 affected the insula and cerebellum, while COMT affected the middle occipital gyrus and ACC. CONCLUSION OPRM1 primarily affects sensory and cognitive components of pain processing, while COMT mainly influences emotional aspects of pain processing. The interaction of the two pain genes was associated with neural patterns coding for high pain and neural activation in the ACC in response to pain. The proteins encoded by the OPRM1 and COMT may contribute to the firing of pain-related neurons in the human ACC, a critical center for subjective pain experience.
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Affiliation(s)
- Yongjeon Cheong
- Cognitive Science Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Seonkyoung Lee
- Cognitive Science Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Hidehiko Okazawa
- Research Centre for Child Mental Development, University of Fukui, Eiheiji, Fukui, Japan
- Division of Developmental Higher Brain Functions, Department of Child Development, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Hirotaka Kosaka
- Research Centre for Child Mental Development, University of Fukui, Eiheiji, Fukui, Japan
- Division of Developmental Higher Brain Functions, Department of Child Development, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Minyoung Jung
- Cognitive Science Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
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Caldichoury A, Garcia-Larrea L, Frot M. Focal changes in alpha oscillations during short-term memorization of pain: a high-density electroencephalogram study with source localization. Eur J Neurosci 2024; 59:2778-2791. [PMID: 38511229 DOI: 10.1111/ejn.16317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Memories of painful events constitute the basis for assessing patients' pain. This study explores the brain oscillatory activity during short-term memorization of a nociceptive stimulus. High-density EEG activity (128 electrodes) was recorded in 13 healthy subjects during a match-to-sample sensory discrimination task, whereby participants compared the intensity of a thumb-located electric shock (S2) with a prior stimulus to the same location (S1) delivered 8-10 s earlier. Stimuli were above or below the individual nociceptive threshold. EEG activity with intracortical source localization via LORETA source reconstruction was analysed during the inter-stimuli period and contrasted with a non-memory-related control task. The inter-stimulus memorization phase was characterized by a focal alpha-activity enhancement, significant during the nociceptive condition only, which progressed from bilateral occipital regions (cuneus and mid-occipital gyri) during the first encoding-memorization phase towards the right-superior and right mid-temporal gyri during the 2-4 s immediately preceding S2. Initial alpha enhancement in occipital areas/cuneus is consistent with rapid non-specific inhibition of task-irrelevant visual processing during initial stimulus encoding. Its transfer to the right-temporal regions was concomitant to the temporary upholding of the stimulus perceptual representation, previous to receiving S2, and suggests an active and local blockade of external interferences while these regions actively maintain internal information. These results add to a growing field indicating that alpha oscillations, while indicating local inhibitory processes, can also indirectly reveal active stimulus handling, including maintenance in short-term memory buffers, by objectivizing the filtering out of irrelevant and potentially disrupting inputs in brain regions engaged in internally driven operations.
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Affiliation(s)
- Argitxu Caldichoury
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Neurologique, Lyon, France
| | - Maud Frot
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
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Cisler JM, Dunsmoor JE, Privratsky AA, James GA. Decoding neural reactivation of threat during fear learning, extinction, and recall in a randomized clinical trial of L-DOPA among women with PTSD. Psychol Med 2024; 54:1091-1101. [PMID: 37807886 DOI: 10.1017/s0033291723002891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Laboratory paradigms are widely used to study fear learning in posttraumatic stress disorder (PTSD). Recent basic science models demonstrate that, during fear learning, patterns of activity in large neuronal ensembles for the conditioned stimuli (CS) begin to reinstate neural activity patterns for the unconditioned stimuli (US), suggesting a direct way of quantifying fear memory strength for the CS. Here, we translate this concept to human neuroimaging and test the impact of post-learning dopaminergic neurotransmission on fear memory strength during fear acquisition, extinction, and recall among women with PTSD in a re-analysis of previously reported data. METHODS Participants (N = 79) completed a context-dependent fear acquisition and extinction task on day 1 and extinction recall tests 24 h later. We decoded activity patterns in large-scale functional networks for the US, then applied this decoder to activity patterns toward the CS on day 1 and day 2. RESULTS US decoder output for the CS+ increased during acquisition and decreased during extinction in networks traditionally implicated in human fear learning. The strength of US neural reactivation also predicted individuals skin conductance responses. Participants randomized to receive L-DOPA (n = 43) following extinction on day 1 demonstrated less US neural reactivation on day 2 relative to the placebo group (n = 28). CONCLUSION These results support neural reactivation as a measure of memory strength between competing memories of threat and safety and further demonstrate the role of dopaminergic neurotransmission in the consolidation of fear extinction memories.
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Affiliation(s)
- Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute for Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute for Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - G Andrew James
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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6
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Chen X, Zhu M, Li W, Wang D, Liu J. Daoyin therapy in chronic neck pain: study protocol for a randomized controlled trial. BMC Complement Med Ther 2024; 24:123. [PMID: 38491439 PMCID: PMC10941558 DOI: 10.1186/s12906-024-04386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Daoyin therapy (DT), an ancient therapeutic approach with a history spanning thousands of years, has traditionally been employed to address musculoskeletal pain and psychosomatic disorders. However, the application of DT for chronic neck pain (CNP) has received limited attention in the existing literature, and systematic randomized clinical trials (RCTs) in this context remain scarce. This manuscript outlines an RCT protocol designed to investigate whether DT is more effective at alleviating CNP in adult individuals compared to other interventions. METHODS A 12-week RCT was conducted, with participants undergoing randomization into one of three groups: DT, Meditation + Fitness Exercise (M+FE), or a control group. Participants in the DT and M + FE groups attended their respective training classes three times per week for 12 weeks. Participants in the control group were required to attend health education workshops every 2 weeks. Following the 12-week intervention period, all participants underwent follow-up assessments at the 16th week. Outcome measures encompassed the Simplified Chinese Neck Pain and Disability Scale (SC-NPAD) and Visual Analog Scale (VAS) for pain assessment, Static Neck Posture Assessment (SNPA) to evaluate neck and shoulder posture and function, Short Form-36 (SF-36) to assess quality of life, and blood tests measuring 5-Hydroxytryptamine (5-HT), Norepinephrine/Noradrenaline (NE/NA), γ-aminobutyric acid (GABA), Adreno-Cortico-Tropic-Hormone (ACTH), β-Endorphin (β-EP), and Calcitonin-Gene-Related Peptide (CGRP) levels via high-performance liquid chromatography (HPLC), chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA), and radioimmunoassay (RIA). Brain activity changes were monitored through MRI scans. Repeated measures analyses of variance (ANOVAs) will be used to evaluate the outcomes at baseline, at the 12th week, and at the 16th week. Generalized Estimating Equation (GEE) models will be applied to analyze changes in outcomes over time and differences between groups. DISCUSSION This trial aims to evaluate the efficacy of DT in comparison to other interventions and explore the neuroendocrine mechanisms underlying its effects in adults with CNP. If the intervention and procedures demonstrate feasibility and acceptability, there are plans to conduct a more extensive controlled trial. This could potentially pave the way for the broader application of DT, not only in the context of CNP but also for other chronic diseases. TRIAL REGISTRATION This trial has been registered with the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400079571]).
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Affiliation(s)
- Xiangxu Chen
- Department of Traditional Chinese Sports and Health, College of Martial Arts, Shanghai University of Sport, No. 399 Changhai Street, Shanghai City, China
| | - Mingze Zhu
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Wei Li
- Department of Athletic Training and Instruction, College of Graduate, Guangzhou Sport University, No. 1268 Guangzhou Avenue Central, Guangzhou City, China
| | - Daan Wang
- Department of Physical Education and Health, Hainan Tropical Ocean University, No.1 Yucai Street, Sanya City, China
| | - Jing Liu
- Department of Traditional Chinese Sports and Health, College of Martial Arts, Shanghai University of Sport, No. 399 Changhai Street, Shanghai City, China.
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Xu Z, Soh Z, Kurota Y, Kimura Y, Hirano H, Sasaoka T, Yoshino A, Tsuji T. Neuroimaging-based evidence for sympathetic correlation between brain activity and peripheral vasomotion during pain anticipation. Sci Rep 2024; 14:3383. [PMID: 38337009 PMCID: PMC10858222 DOI: 10.1038/s41598-024-53921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
Anticipation of pain engenders anxiety and fear, potentially shaping pain perception and governing bodily responses such as peripheral vasomotion through the sympathetic nervous system (SNS). Sympathetic innervation of vascular tone during pain perception has been quantified using a peripheral arterial stiffness index; however, its innervation role during pain anticipation remains unclear. This paper reports on a neuroimaging-based study designed to investigate the responsivity and attribution of the index at different levels of anticipatory anxiety and pain perception. The index was measured in a functional magnetic resonance imaging experiment that randomly combined three visual anticipation cues and painful stimuli of two intensities. The peripheral and cerebral responses to pain anticipation and perception were quantified to corroborate bodily responsivity, and their temporal correlation was also assessed to identify the response attribution of the index. Contrasting with the high responsivity across levels of pain sensation, a low responsivity of the index across levels of anticipatory anxiety revealed its specificity across pain experiences. Discrepancies between the effects of perception and anticipation were validated across regions and levels of brain activity, providing a brain basis for peripheral response specificity. The index was also characterized by a 1-s lag in both anticipation and perception of pain, implying top-down innervation of the periphery. Our findings suggest that the SNS responds to pain in an emotion-specific and sensation-unbiased manner, thus enabling an early assessment of individual pain perception using this index. This study integrates peripheral and cerebral hemodynamic responses toward a comprehensive understanding of bodily responses to pain.
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Affiliation(s)
- Ziqiang Xu
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
| | - Yuta Kurota
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Yuya Kimura
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Harutoyo Hirano
- Department of Medical Equipment Engineering, Clinical Collaboration Unit, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takafumi Sasaoka
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
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Graeff P, Ruscheweyh R, Flanagin VL. Longitudinal changes in human supraspinal processing after RIII-feedback training to improve descending pain inhibition. Neuroimage 2023; 283:120432. [PMID: 37914092 DOI: 10.1016/j.neuroimage.2023.120432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/15/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023] Open
Abstract
The human body has the ability to influence its sensation of pain by modifying the transfer of nociceptive information at the spinal level. This modulation, known as descending pain inhibition, is known to originate supraspinally and can be activated by a variety of ways including positive mental imagery. However, its exact mechanisms remain unknown. We investigated, using a longitudinal fMRI design, the brain activity leading up and in response to painful electrical stimulation when applying positive mental imagery before and after undergoing a previously established RIII-feedback paradigm. Time course analysis of the time preceding painful stimulation shows increased haemodynamic activity during the application of the strategy in the PFC, ACC, insula, thalamus, and hypothalamus. Time course analysis of the reaction to painful stimulation shows decreased reaction post-training in brainstem and thalamus, as well as the insula and dorsolateral PFC. Our work suggests that feedback training increases activity in areas involved in pain inhibition, while simultaneously decreasing the reaction to painful stimuli in brain areas related to pain processing, which points to an activation of decreased spinal nociception. We further suggest that the insula and the thalamus may play a more important role in pain modulation than previously assumed.
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Affiliation(s)
- Philipp Graeff
- Research Training Group (RTG) 2175 perception in Context and Its Neural Basis, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Ruth Ruscheweyh
- Research Training Group (RTG) 2175 perception in Context and Its Neural Basis, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany; Department of Neurology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Virginia L Flanagin
- Research Training Group (RTG) 2175 perception in Context and Its Neural Basis, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital Munich, Ludwig-Maximilians-University, 81377 Munich, Germany.
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Frisaldi E, Shaibani A, Benedetti F, Pagnini F. Placebo and nocebo effects and mechanisms associated with pharmacological interventions: an umbrella review. BMJ Open 2023; 13:e077243. [PMID: 37848293 PMCID: PMC10582987 DOI: 10.1136/bmjopen-2023-077243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES This review aimed to summarise the existing knowledge about placebo and nocebo effects associated with pharmacological interventions and their mechanisms. DESIGN Umbrella review, adopting the Assessment of Multiple Systematic Reviews 2 tool for critical appraisal. DATA SOURCES MEDLINE/PubMed, Scopus, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trial were searched in September 2022, without any time restriction, for systematic reviews, narrative reviews, original articles. Results were summarised through narrative synthesis, tables, 95% CI. OUTCOME MEASURES Mechanisms underlying placebo/nocebo effects and/or their effect sizes. RESULTS The databases search identified 372 studies, for a total of 158 312 participants, comprising 41 systematic reviews, 312 narrative reviews and 19 original articles. Seventy-three per cent of the examined systematic reviews were of high quality.Our findings revealed that mechanisms underlying placebo and/or nocebo effects have been characterised, at least in part, for: pain, non-noxious somatic sensation, Parkinson's disease, migraine, sleep disorders, intellectual disability, depression, anxiety, dementia, addiction, gynaecological disorders, attention-deficit hyperactivity disorder, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal disorders, skin diseases, influenza and related vaccines, oncology, obesity, physical and cognitive performance. Their magnitude ranged from 0.08 to 2.01 (95% CI 0.37 to 0.89) for placebo effects and from 0.32 to 0.90 (95% CI 0.24 to 1.00) for nocebo effects. CONCLUSIONS This study provides a valuable tool for clinicians and researchers, identifying both results ready for clinical practice and gaps to address in the near future. FUNDING Università Cattolica del Sacro Cuore, Milan, Italy with the 'Finanziamento Ponte 2022' grant. PROSPERO REGISTRATION NUMBER CRD42023392281.
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Affiliation(s)
- Elisa Frisaldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aziz Shaibani
- Muscle and Nerve Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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10
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Caston RM, Smith EH, Davis TS, Singh H, Rahimpour S, Rolston JD. Characterization of spatiotemporal dynamics of binary and graded tonic pain in humans using intracranial recordings. PLoS One 2023; 18:e0292808. [PMID: 37844101 PMCID: PMC10578592 DOI: 10.1371/journal.pone.0292808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
Pain is a complex experience involving sensory, emotional, and cognitive aspects, and multiple networks manage its processing in the brain. Examining how pain transforms into a behavioral response can shed light on the networks' relationships and facilitate interventions to treat chronic pain. However, studies using high spatial and temporal resolution methods to investigate the neural encoding of pain and its psychophysical correlates have been limited. We recorded from intracranial stereo-EEG (sEEG) electrodes implanted in sixteen different brain regions of twenty patients who underwent psychophysical pain testing consisting of a tonic thermal stimulus to the hand. Broadband high-frequency local field potential amplitude (HFA; 70-150 Hz) was isolated to investigate the relationship between the ongoing neural activity and the resulting psychophysical pain evaluations. Two different generalized linear mixed-effects models (GLME) were employed to assess the neural representations underlying binary and graded pain psychophysics. The first model examined the relationship between HFA and whether the patient responded "yes" or "no" to whether the trial was painful. The second model investigated the relationship between HFA and how painful the stimulus was rated on a visual analog scale. GLMEs revealed that HFA in the inferior temporal gyrus (ITG), superior frontal gyrus (SFG), and superior temporal gyrus (STG) predicted painful responses at stimulus onset. An increase in HFA in the orbitofrontal cortex (OFC), SFG, and striatum predicted pain responses at stimulus offset. Numerous regions, including the anterior cingulate cortex, hippocampus, IFG, MTG, OFC, and striatum, predicted the pain rating at stimulus onset. However, only the amygdala and fusiform gyrus predicted increased pain ratings at stimulus offset. We characterized the spatiotemporal representations of binary and graded painful responses during tonic pain stimuli. Our study provides evidence from intracranial recordings that the neural encoding of psychophysical pain changes over time during a tonic thermal stimulus, with different brain regions being predictive of pain at the beginning and end of the stimulus.
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Affiliation(s)
- Rose M. Caston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Elliot H. Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, United States of America
| | - Tyler S. Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shervin Rahimpour
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - John D. Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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11
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Murillo C, Coppieters I, Cagnie B, Bernaers L, Bontinck J, Meeus M, Timmers I. Neural processing of pain-related distress to neck-specific movements in people with chronic whiplash-associated disorders. Pain 2023; 164:1954-1964. [PMID: 36943244 DOI: 10.1097/j.pain.0000000000002890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Abstract
ABSTRACT Pain-related distress contributes to long-term disability in chronic whiplash-associated disorders. Recently, neuroimaging studies have revealed altered neural responses to viewing pictures of movements associated with back pain in key regions for threat and affective processing. In this study, we examined neural correlates of imagining neck-specific movements designed to elicit pain-related distress in individuals with whiplash-associated disorders (n = 63) when compared with that in sex-matched pain-free controls (n = 32). In the scanner, participants were presented with neck-specific movement-related pictures divided into 3 categories (high fear, moderate-fear, and neutral control pictures) and asked to imagine how they would feel if they were performing the movement. Whole-brain analyses revealed greater differential activation (high-fear vs neutral) in individuals with whiplash-associated disorders when compared with that in pain-free controls in 6 clusters including right and left postcentral gyri, left parietal operculum, dorsal precuneus, left superior frontal gyrus/anterior cingulate cortex, and posterior cingulate cortex/ventral precuneus. For the contrast moderate-fear vs neutral, patients showed greater differential activation than controls in the right and left posterolateral cerebellum. Activation patterns in the precuneus and posterior cingulate cortex were negatively associated with pain-related fear, but no other correlations were observed. Together, the findings suggest that when conceptualizing neck-specific movements associated with pain, people with chronic whiplash-associated disorders may predict-and potentially amplify-their sensory and affective consequences and therewith trigger dysfunctional affective and/or behavioral responses. Herewith, we provide new insights into the neural mechanisms underlying chronic pain in people with whiplash-associated disorders, pointing towards a complex interplay between cognitive/affective and sensorimotor circuitry.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Antwerp, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Antwerp, Belgium
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
| | - Lisa Bernaers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
| | - Jente Bontinck
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Antwerp, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Antwerp, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Maastricht, the Netherlands
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12
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Rossettini G, Campaci F, Bialosky J, Huysmans E, Vase L, Carlino E. The Biology of Placebo and Nocebo Effects on Experimental and Chronic Pain: State of the Art. J Clin Med 2023; 12:4113. [PMID: 37373806 DOI: 10.3390/jcm12124113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: In recent years, placebo and nocebo effects have been extensively documented in different medical conditions, including pain. The scientific literature has provided strong evidence of how the psychosocial context accompanying the treatment administration can influence the therapeutic outcome positively (placebo effects) or negatively (nocebo effects). (2) Methods: This state-of-the-art paper aims to provide an updated overview of placebo and nocebo effects on pain. (3) Results: The most common study designs, the psychological mechanisms, and neurobiological/genetic determinants of these phenomena are discussed, focusing on the differences between positive and negative context effects on pain in experimental settings on healthy volunteers and in clinical settings on chronic pain patients. Finally, the last section describes the implications for clinical and research practice to maximize the medical and scientific routine and correctly interpret the results of research studies on placebo and nocebo effects. (4) Conclusions: While studies on healthy participants seem consistent and provide a clear picture of how the brain reacts to the context, there are no unique results of the occurrence and magnitude of placebo and nocebo effects in chronic pain patients, mainly due to the heterogeneity of pain. This opens up the need for future studies on the topic.
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Affiliation(s)
| | - Francesco Campaci
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL 32211, USA
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Elisa Carlino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
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13
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Morellini L, Izzo A, Celeghin A, Palermo S, Morese R. Sensory processing sensitivity and social pain: a hypothesis and theory. Front Hum Neurosci 2023; 17:1135440. [PMID: 37388415 PMCID: PMC10303917 DOI: 10.3389/fnhum.2023.1135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
Sensory-processing sensitivity (SPS) defined, as a personality trait, seems to be characterized by emotional sensitivity, and stronger reactivity to both external and internal stimuli. SPS can represent a risk factor for developing clinical conditions during childhood and adolescence. This personality trait is not to be considered a pathological clinical condition, however, can expose to greater environmental vulnerability. In particular, the recent studies about SPS can be contextualized to social situations that evoke traumatic and stressful emotional responses such as social exclusion. We hypothesize that highly sensitive people (HSP) are more vulnerable to social exclusion and social pain. This hypothesis could help structure new educational and intervention models designed to improve coping strategies and promote HSP's psychophysical and social well-being.
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Affiliation(s)
- Lucia Morellini
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Alessia Izzo
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | | | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rosalba Morese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
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14
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Caston RM, Smith EH, Davis TS, Singh H, Rahimpour S, Rolston JD. Characterization of spatiotemporal dynamics of binary and graded tonic pain in humans using intracranial recordings. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.08.531576. [PMID: 36945412 PMCID: PMC10028876 DOI: 10.1101/2023.03.08.531576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Pain is a complex experience involving sensory, emotional, and cognitive aspects, and multiple networks manage its processing in the brain. Examining how pain transforms into a behavioral response can shed light on the networks' relationships and facilitate interventions to treat chronic pain. However, studies using high spatial and temporal resolution methods to investigate the neural encoding of pain and its psychophysical correlates have been limited. We recorded from intracranial stereo-EEG (sEEG) electrodes implanted in sixteen different brain regions of twenty patients who underwent psychophysical pain testing consisting of a tonic thermal stimulus to the hand. Broadband high-frequency local field potential amplitude (HFA; 70-150 Hz) was isolated to investigate the relationship between the ongoing neural activity and the resulting psychophysical pain evaluations. Two different generalized linear mixed-effects models (GLME) were employed to assess the neural representations underlying binary and graded pain psychophysics. The first model examined the relationship between HFA and whether the patient responded "yes" or "no" to whether the trial was painful. The second model investigated the relationship between HFA and how painful the stimulus was rated on a visual analog scale. GLMEs revealed that HFA in the inferior temporal gyrus (ITG), superior frontal gyrus (SFG), and superior temporal gyrus (STG) predicted painful responses at stimulus onset. An increase in HFA in the orbitofrontal cortex (OFC), SFG, and striatum predicted pain responses at stimulus offset. Numerous regions including the anterior cingulate cortex, hippocampus, IFG, MTG, OFC, and striatum, predicted the pain rating at stimulus onset. However, only the amygdala and fusiform gyrus predicted increased pain ratings at stimulus offset. We characterized the spatiotemporal representations of binary and graded painful responses during tonic pain stimuli. Our study provides evidence from intracranial recordings that the neural encoding of psychophysical pain changes over time during a tonic thermal stimulus, with different brain regions being predictive of pain at the beginning and end of the stimulus.
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Affiliation(s)
- Rose M Caston
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, University of Utah, 84112
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, 84112
- Interdepartmental Program in Neuroscience, University of Utah, 84112
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, 84112
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 02115
| | - Shervin Rahimpour
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, University of Utah, 84112
| | - John D Rolston
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 02115
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15
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Barjola P, Peláez I, Ferrera D, González-Gutiérrez JL, Velasco L, Peñacoba-Puente C, López-López A, Fernandes-Magalhaes R, Mercado F. Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients. Front Hum Neurosci 2022; 16:943976. [PMID: 36248693 PMCID: PMC9562711 DOI: 10.3389/fnhum.2022.943976] [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: 05/14/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.
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16
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Abstract
SignificanceWe often willingly experience pain to reach a goal. However, potential pain can also prevent reckless action. How do we consider future pain when deciding on the best course of action? To date, the precise neural mechanisms underlying the valuation of future pain remain unknown. Using functional MRI, we derive a whole-brain signature of the value of future pain capable of predicting participants' choices to accept pain in exchange for a reward. We show that this signature is characterized by a distributed pattern of activity with clear contributions from structures encoding reward and salience, notably the ventral and dorsal striatum. These findings highlight how the brain assigns value to future pain when choosing the best course of action.
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17
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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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18
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Nahman-Averbuch H, Schneider VJ, Lee GR, Peugh JL, Hershey AD, Powers SW, de Zambotti M, Coghill RC, King CD. New insight into the neural mechanisms of migraine in adolescents: Relationships with sleep. Headache 2022; 62:668-680. [PMID: 35467018 DOI: 10.1111/head.14299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This case-control study examines if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolescents with migraine compared to healthy adolescents. BACKGROUND Adolescents with migraine have different functional connectivity of the amygdala compared to individuals without migraine. Sleep is often disturbed in adolescents with migraine, and could contribute to the alterations in functional connectivity. METHODS Twenty adolescents with migraine and 20 healthy controls were recruited from Cincinnati Children's Hospital. Participants completed surveys about their headaches and overall sleep quality, sleep hygiene, and perceived sleep difficulties (Insomnia Severity Scale [ISI]); completed wrist-worn actigraphy; and underwent a magnetic resonance imaging scan. RESULTS Adolescents with migraine differed from healthy controls only in perceived difficulty in sleep initiation and maintenance (ISI: 8.5 ± 4.7 and 4.5 ± 3.7 [mean ± standard deviation], -4.00 [95% confidence: -6.7 to -1.3], p = 0.005) and had greater functional connectivity between the amygdala and the posterior cingulate cortex, precuneus, dorsolateral prefrontal, sensorimotor, and the occipital cortexes. The differences in functional connectivity of the amygdala were not mediated by the subjective/objective sleep measures (ISI/wake minutes after sleep onset). CONCLUSIONS Adolescents with migraine have greater connectivity between the amygdala and areas involved in sensory, affective, and cognitive aspects of pain. These alterations may not be due to higher levels of sleep difficulties in adolescents with migraine, suggesting that both amygdala and sleep alterations may play an independent role in migraine pathophysiology. This advances the understanding of the mechanisms underlying pediatric migraine and can potentially advance migraine management.
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Affiliation(s)
- Hadas Nahman-Averbuch
- Division of Clinical and Translational Research and Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victor J Schneider
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory R Lee
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew D Hershey
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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19
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Hewitt D, Newton-Fenner A, Henderson J, Fallon NB, Brown C, Stancak A. Intensity-dependent modulation of cortical somatosensory processing during external, low-frequency peripheral nerve stimulation in humans. J Neurophysiol 2022; 127:1629-1641. [PMID: 35611988 PMCID: PMC9190739 DOI: 10.1152/jn.00511.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
External low-frequency peripheral nerve stimulation (LFS) has been proposed as a novel method for neuropathic pain relief. Previous studies have reported that LFS elicits long-term depression-like effects on human pain perception when delivered at noxious intensities, whereas lower intensities are ineffective. To shed light on cortical regions mediating the effects of LFS, we investigated changes in somatosensory-evoked potentials (SEPs) during four LFS intensities. LFS was applied to the radial nerve (600 pulses, 1 Hz) of 24 healthy participants at perception (1 times), low (5 times), medium (10 times), and high intensities (15 times detection threshold). SEPs were recorded during LFS, and averaged SEPs in 10 consecutive 1-min epochs of LFS were analyzed using source dipole modeling. Changes in resting electroencephalography (EEG) were investigated after each LFS block. Source activity in the midcingulate cortex (MCC) decreased linearly during LFS, with greater attenuation at stronger LFS intensities, and in the ipsilateral operculo-insular cortex during the two lowest LFS stimulus intensities. Increased LFS intensities resulted in greater augmentation of contralateral primary sensorimotor cortex (SI/MI) activity. Stronger LFS intensities were followed by increased α (alpha, 9-11 Hz) band power in SI/MI and decreased θ (theta, 3-5 Hz) band power in MCC. Intensity-dependent attenuation of MCC activity with LFS is consistent with a state of long-term depression. Sustained increases in contralateral SI/MI activity suggests that effects of LFS on somatosensory processing may also be dependent on satiation of SI/MI. Further research could clarify if the activation of SI/MI during LFS competes with nociceptive processing in neuropathic pain.NEW & NOTEWORTHY Somatosensory-evoked potentials during low-frequency stimulation of peripheral nerves were examined at graded stimulus intensities. Low-frequency stimulation was associated with decreased responsiveness in the midcingulate cortex and increased responsiveness in primary sensorimotor cortex. Greater intensities were associated with increased midcingulate cortex θ band power and decreased sensorimotor cortex α band power. Results further previous evidence of an inhibition of somatosensory processing during and after low-frequency stimulation and point toward a potential augmentation of activity in somatosensory processing regions.
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Affiliation(s)
- Danielle Hewitt
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Alice Newton-Fenner
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom,2Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - Jessica Henderson
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Nicholas B. Fallon
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Christopher Brown
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Andrej Stancak
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom,2Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
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20
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Mao Y, Chen C, Falahpour M, MacNiven KH, Heit G, Sharma V, Alataris K, Liu TT. Effects of Sub-threshold Transcutaneous Auricular Vagus Nerve Stimulation on Cingulate Cortex and Insula Resting-state Functional Connectivity. Front Hum Neurosci 2022; 16:862443. [PMID: 35496068 PMCID: PMC9048677 DOI: 10.3389/fnhum.2022.862443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive alternative to vagus nerve stimulation (VNS) with implantable devices, has shown promise in treating disorders such as depression, migraine, and insomnia. Studies of these disorders with resting-state functional magnetic resonance imaging (MRI) (rsfMRI) have found sustained changes in resting-state functional connectivity (rsFC) in patients treated with low frequency (1-20 Hz) taVNS. A recent study has reported reductions in pain scores in patients with rheumatoid arthritis after a 12-week treatment of high-frequency (20 kHz) sub-threshold taVNS. However, no studies to date have examined the effects of high-frequency sub-threshold taVNS on rsFC. The objective of this study was to determine whether high-frequency sub-threshold taVNS induces changes in rsFC using seed regions from the cingulate cortex and insula, brain regions that play a key role in interoception and processing of pain. With a single-blind placebo-controlled repeated measures experimental design, rsfMRI scans were acquired before and after 15 min of either sub-threshold taVNS treatment or a sham control. Significant taVNS-related changes in functional connections to the cingulate cortex were detected between the anterior cingulate cortex and right superior temporal gyrus and between the midcingulate cortex and right inferior parietal lobule. In addition, significant changes in functional connections to the insula were detected between the posterior insula and right precuneus and between the anterior insula and right cuneus gyrus. These results suggest that high-frequency sub-threshold taVNS can lead to sustained effects on the rsFC of brain regions involved in interoception and processing of pain in a cohort of healthy subjects. This study lays the foundation for future rsfMRI studies of high-frequency sub-threshold taVNS in clinical populations.
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Affiliation(s)
- Yixiang Mao
- Center for Functional MRI, University of California San Diego, La Jolla, CA, United States
| | - Conan Chen
- Center for Functional MRI, University of California San Diego, La Jolla, CA, United States
| | - Maryam Falahpour
- Center for Functional MRI, University of California San Diego, La Jolla, CA, United States
| | - Kelly H. MacNiven
- Department of Psychology, Stanford University, Stanford, CA, United States
- Nēsos Corporation, Redwood City, CA, United States
| | - Gary Heit
- Nēsos Corporation, Redwood City, CA, United States
- Department of Neurosurgery, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Vivek Sharma
- Nēsos Corporation, Redwood City, CA, United States
| | | | - Thomas T. Liu
- Center for Functional MRI, University of California San Diego, La Jolla, CA, United States
- Departments of Radiology, Psychiatry, and Bioengineering, University of California San Diego, La Jolla, CA, United States
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21
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Günther V, Jahn S, Webelhorst C, Bodenschatz CM, Bujanow A, Mucha S, Kersting A, Hoffmann KT, Egloff B, Lobsien D, Suslow T. Coping With Anxiety: Brain Structural Correlates of Vigilance and Cognitive Avoidance. Front Psychiatry 2022; 13:869367. [PMID: 35463500 PMCID: PMC9021612 DOI: 10.3389/fpsyt.2022.869367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Individuals differ in their dispositional coping behavior when they are confronted with anxiety-provoking situations. Cognitive avoidance is characterized by a withdrawal from threatening information, whereas vigilance denotes the intensive search for threat-related information. Functional neuroimaging studies indicate alterations in brain responsivity to emotional stimuli as a function of cognitive avoidant and vigilant coping, but findings are partially discrepant. Studies on structural correlates of coping styles are scarce. Materials and Methods By using structural magnetic resonance imaging, the present study examined the relationship between brain gray matter volume and coping strategies in 114 healthy individuals. Individual differences in vigilance and cognitive avoidance were measured by the Mainz Coping Inventory. Results Exploratory whole-brain analyses were conducted. Cognitive avoidant coping significantly predicted reduced gray matter volume in the bilateral thalamus, whereas vigilant coping was associated with volumetric increases in the bilateral thalamus. These relationships remained significant when controlling for a potential influence of age, sex, depressive symptoms, and trait anxiety. Discussion Our findings indicate that dispositional strategies to deal with anxiety-provoking situations are related to volumetric alterations in the thalamus, a brain structure that has been implicated in the mediation of attentional processes and alertness, and the anticipation of harm. The dispositional tendency to monitor the environment for potential threats (i.e., vigilance), appears to be associated with volumetric increases in the thalamus, whereas the dispositional inclination to divert one's attention away from distressing stimuli (i.e., cognitive avoidance) seems to go along with reductions in thalamic gray matter density.
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Affiliation(s)
- Vivien Günther
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Salome Jahn
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Carolin Webelhorst
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Charlott Maria Bodenschatz
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Anna Bujanow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Simone Mucha
- Department of Neuroradiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Boris Egloff
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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22
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Liu X, Gu L, Liu J, Hong S, Luo Q, Wu Y, Yang J, Jiang J. MRI Study of Cerebral Cortical Thickness in Patients with Herpes Zoster and Postherpetic Neuralgia. J Pain Res 2022; 15:623-632. [PMID: 35250306 PMCID: PMC8894103 DOI: 10.2147/jpr.s352105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To measure the changes in cerebral cortical thickness in patients with herpes zoster (HZ) and postherpetic neuralgia (PHN) by surface-based morphometry (SBM) and further estimate its correlation with clinical scores. Materials and Methods Twenty-nine HZ patients, 30 PHN patients and 30 well-matched healthy controls (HCs) were included. Magnetic resonance imaging (MRI) data from all subjects were collected and then analyzed by SBM. The changes in cortical thickness among the HZ, PHN and HC groups were analyzed by ANOVA and correlated with clinical scores. Results The thickness of the bilateral primary visual cortex (V1, V2) and right primary visual cortex (V3), left somatosensory cortex (L3A), right anterior cingulate gyrus and medial prefrontal cortex (RS32) increased in PHN group, and the thickness the left insular and frontal opercular cortex (LFOP4), left motor cortex (L3B), and right superior temporal visual cortex (RSTV) were decreased in the HZ and PHN groups compared to the HC group. The thickness measurements of RS32, LFOP4, and (L3B) in HZ and PHN patients were correlated with the duration of disease. In HZ and PHN patients, the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores were significantly positively correlated. Conclusion Changes in cortical thickness in the areas related to sensory, motor, and cognitive/emotional changes in patients with PHN affect the neuroplasticity process of the brain, which may be the reason for the transformation of HZ into PHN and provide a possible explanation for the neuropathological mechanism of pain persistence in PHN patients.
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Affiliation(s)
- Xian Liu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Lili Gu
- Department of Pain, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Jiaqi Liu
- Department of Radiology, The Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Shunda Hong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Qing Luo
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Ying Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Jiaojiao Yang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Correspondence: Jian Jiang, Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People’s Republic of China, Tel +86 791 8869 3825, Email
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23
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Patient-clinician brain concordance underlies causal dynamics in nonverbal communication and negative affective expressivity. Transl Psychiatry 2022; 12:44. [PMID: 35091536 PMCID: PMC8799700 DOI: 10.1038/s41398-022-01810-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Patient-clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient-clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how pain-related, directional facial communication between patients and clinicians is associated with brain-to-brain concordance. Patient-clinician dyads interacted in a pain-treatment context, during synchronous assessment of brain activity (fMRI hyperscanning) and online video transfer, enabling face-to-face social interaction. In-scanner videos were used for automated individual facial action unit (AU) time-series extraction. First, an interpretable machine-learning classifier of patients' facial expressions, from an independent fMRI experiment, significantly distinguished moderately painful leg pressure from innocuous pressure stimuli. Next, we estimated neural-network causality of patient-to-clinician directional information flow of facial expressions during clinician-initiated treatment of patients' evoked pain. We identified a leader-follower relationship in which patients predominantly led the facial communication while clinicians responded to patients' expressions. Finally, analyses of dynamic brain-to-brain concordance showed that patients' mid/posterior insular concordance with the clinicians' anterior insula cortex, a region identified in previously published data from this study1, was associated with therapeutic alliance, and self-reported and objective (patient-to-clinician-directed causal influence) markers of negative-affect expressivity. These results suggest a role of patient-clinician concordance of the insula, a social-mirroring and salience-processing brain node, in mediating directional dynamics of pain-directed facial communication during therapeutic encounters.
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24
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Xu H, Chen Y, Tao Y, Zhang Y, Zhao T, Wang M, Fan L, Zheng Y, Guo C. Modulation effect of acupuncture treatment on chronic neck and shoulder pain in female patients: Evidence from periaqueductal gray-based functional connectivity. CNS Neurosci Ther 2022; 28:714-723. [PMID: 35048524 PMCID: PMC8981480 DOI: 10.1111/cns.13803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/16/2022] Open
Abstract
Aims Chronic neck and shoulder pain (CNSP) is a common neurological disorder, which females are more likely to suffer from. The periaqueductal gray (PAG) plays a key role in the descending modulation of pain. This study aimed to investigate altered PAG‐based functional connectivity (FC) in female patients with CNSP related to healthy controls (HCs) and the effect of acupuncture for female patients with CNSP using PAG‐based FC biomarkers. Methods PAG‐based FC value was calculated based on resting‐state functional images and then compared between patients with CNSP at pre‐acupuncture, post‐acupuncture, and HCs. Then, correlational analyses were performed to examine the relationships between increased PAG‐based FC strength and improved clinical parameters in patients after acupuncture treatment. Results Before acupuncture treatment, compared to HCs, patients with CSNP showed altered PAG‐based FC with widely distributed brain regions, including the left medial superior frontal gyrus, bilateral posterior insula (pIns), and cingulate gyrus. After treatment, patients with CNSP exhibited specially improved PAG‐pIns FC compared to that before treatment, and no significant difference was observed in the increased PAG‐pIns FC strength between HCs and patients with CNSP after treatment. Furthermore, pain catastrophizing reduction was significantly correlated with the increased PAG‐pIns FC strength in patients after treatment. Conclusion The effect of acupuncture treatment may relate to the increased PAG‐pIns FC, which significantly correlated with pain catastrophizing reduction after treatment. These findings shed important mechanistic information on the role of therapeutic approaches in treating chronic neck and shoulder pain.
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Affiliation(s)
- Hui Xu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Yilin Chen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Yin Tao
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Yiwen Zhang
- Department of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Teng Zhao
- Department of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.,Department of Ultrasound, Xi'an Gaoxin Hospital, Xi'an, China
| | - Mi Wang
- Department of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lihua Fan
- Department of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yunsong Zheng
- Department of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chenguang Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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25
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Inter-individual differences in pain anticipation and pain perception in migraine: Neural correlates of migraine frequency and cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio. PLoS One 2021; 16:e0261570. [PMID: 34929017 PMCID: PMC8687546 DOI: 10.1371/journal.pone.0261570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/05/2021] [Indexed: 01/03/2023] Open
Abstract
Previous studies targeting inter-individual differences in pain processing in migraine mainly focused on the perception of pain. Our main aim was to disentangle pain anticipation and perception using a classical fear conditioning task, and investigate how migraine frequency and pre-scan cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio as an index of neurobiological stress response would relate to neural activation in these two phases. Functional Magnetic Resonance Imaging (fMRI) data of 23 participants (18 females; mean age: 27.61± 5.36) with episodic migraine without aura were analysed. We found that migraine frequency was significantly associated with pain anticipation in brain regions comprising the midcingulate and caudate, whereas pre-scan cortisol-to DHEA-S ratio was related to pain perception in the pre-supplementary motor area (pre-SMA). Both results suggest exaggerated preparatory responses to pain or more general to stressors, which may contribute to the allostatic load caused by stressors and migraine attacks on the brain.
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26
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Seamans JK, Floresco SB. Event-based control of autonomic and emotional states by the anterior cingulate cortex. Neurosci Biobehav Rev 2021; 133:104503. [PMID: 34922986 DOI: 10.1016/j.neubiorev.2021.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
Despite being an intensive area of research, the function of the anterior cingulate cortex (ACC) remains somewhat of a mystery. Human imaging studies implicate the ACC in various cognitive functions, yet surgical ACC lesions used to treat emotional disorders have minimal lasting effects on cognition. An alternative view is that ACC regulates autonomic states, consistent with its interconnectivity with autonomic control regions and that stimulation evokes changes in autonomic/emotional states. At the cellular level, ACC neurons are highly multi-modal and promiscuous, and can represent a staggering array of task events. These neurons nevertheless combine to produce highly event-specific ensemble patterns that likely alter activity in downstream regions controlling emotional and autonomic tone. Since neuromodulators regulate the strength of the ensemble activity patterns, they would regulate the impact these patterns have on downstream targets. Through these mechanisms, the ACC may determine how strongly to react to the very events its ensembles represent. Pathologies arise when specific event-related representations gain excessive control over autonomic/emotional states.
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Affiliation(s)
- Jeremy K Seamans
- Depts. of Psychiatry, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6B2T5, Canada.
| | - Stan B Floresco
- Depts. of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6B2T5, Canada
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27
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You B, Wen H, Jackson T. Identifying resting state differences salient for resilience to chronic pain based on machine learning multivariate pattern analysis. Psychophysiology 2021; 58:e13921. [PMID: 34383330 DOI: 10.1111/psyp.13921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Studies have documented behavior differences between more versus less resilient adults with chronic pain (CP), but the presence and nature of underlying neurophysiological differences have received scant attention. In this study, we attempted to identify regions of interest (ROIs) in which resting state (Rs) brain activity discriminated more from less resilient CP subgroups based on multiple kernel learning (MKL). More and less resilient community-dwellers with chronic musculoskeletal pain (70 women, 39 men) engaged in structural and functional magnetic resonance imaging (MRI) scans, wherein MKL assessed Rs activity based on amplitude of low frequency fluctuations (ALFF), fractional amplitudes of low frequency fluctuations (fALFF), and regional homogeneity (ReHo) modalities to identify ROIs most salient for discriminating more versus less resilient subgroups. Compared to classification based on single modalities, multi-modal classification based on combined fALFF and ReHo features achieved a substantially higher classification accuracy rate (79%). Brain regions with the best discriminative power included those implicated in pain processing, reward, executive function, goal-directed action, emotion regulation and resilience to mood disorders though variation trends were not consistent between more and less resilient subgroups. Results revealed patterns of Rs activity that serve as possible biomarkers for resilience to chronic musculoskeletal pain.
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Affiliation(s)
- Beibei You
- Key Laboratory of Cognition and Personality (Ministry of Education), Faculty of Psychology, Southwest University, Chongqing, China.,School of Nursing, Guizhou Medical University, Guizhou, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), Faculty of Psychology, Southwest University, Chongqing, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, China
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28
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Cortical thickness, gyrification and sulcal depth in trigeminal neuralgia. Sci Rep 2021; 11:16322. [PMID: 34381144 PMCID: PMC8357824 DOI: 10.1038/s41598-021-95811-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/31/2021] [Indexed: 01/03/2023] Open
Abstract
Neuroimaging studies have documented brain structural alterations induced by chronic pain, particularly in gray matter volume. However, the effects of trigeminal neuralgia (TN), a severe paroxysmal pain disorder, on cortical morphology are not yet known. In this study, we recruited 30 TN patients and 30 age-, and gender-matched healthy controls (HCs). Using Computational Anatomy Toolbox (CAT12), we calculated and compared group differences in cortical thickness, gyrification, and sulcal depth with two-sample t tests (p < 0.05, multiple comparison corrected). Relationships between altered cortical characteristics and pain intensity were investigated with correlation analysis. Compared to HCs, TN patients exhibited significantly decreased cortical thickness in the left inferior frontal, and left medial orbitofrontal cortex; decreased gyrification in the left superior frontal cortex; and decreased sulcal depth in the bilateral superior frontal (extending to anterior cingulate) cortex. In addition, we found significantly negative correlations between the mean cortical thickness in left medial orbitofrontal cortex and pain intensity, and between the mean gyrification in left superior frontal cortex and pain intensity. Chronic pain may be associated with abnormal cortical thickness, gyrification and sulcal depth in trigeminal neuralgia. These morphological changes might contribute to understand the underlying neurobiological mechanism of trigeminal neuralgia.
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29
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Guarnera A, Bottino F, Napolitano A, Sforza G, Cappa M, Chioma L, Pasquini L, Rossi-Espagnet MC, Lucignani G, Figà-Talamanca L, Carducci C, Ruscitto C, Valeriani M, Longo D, Papetti L. Early alterations of cortical thickness and gyrification in migraine without aura: a retrospective MRI study in pediatric patients. J Headache Pain 2021; 22:79. [PMID: 34294048 PMCID: PMC8296718 DOI: 10.1186/s10194-021-01290-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Migraine is the most common neurological disease, with high social-economical burden. Although there is growing evidence of brain structural and functional abnormalities in patients with migraine, few studies have been conducted on children and no studies investigating cortical gyrification have been conducted on pediatric patients affected by migraine without aura. Methods Seventy-two pediatric patients affected by migraine without aura and eighty-two controls aged between 6 and 18 were retrospectively recruited with the following inclusion criteria: MRI exam showing no morphological or signal abnormalities, no systemic comorbidities, no abnormal neurological examination. Cortical thickness (CT) and local gyrification index (LGI) were obtained through a dedicated algorithm, consisting of a combination of voxel-based and surface-based morphometric techniques. The statistical analysis was performed separately on CT and LGI between: patients and controls; subgroups of controls and subgroups of patients. Results Patients showed a decreased LGI in the left superior parietal lobule and in the supramarginal gyrus, compared to controls. Female patients presented a decreased LGI in the right superior, middle and transverse temporal gyri, right postcentral gyrus and supramarginal gyrus compared to male patients. Compared to migraine patients younger than 12 years, the ≥ 12-year-old subjects showed a decreased CT in the superior and middle frontal gyri, pre- and post-central cortex, paracentral lobule, superior and transverse temporal gyri, supramarginal gyrus and posterior insula. Migraine patients experiencing nausea and/or vomiting during headache attacks presented an increased CT in the pars opercularis of the left inferior frontal gyrus. Conclusions Differences in CT and LGI in patients affected by migraine without aura may suggest the presence of congenital and acquired abnormalities in migraine and that migraine might represent a vast spectrum of different entities. In particular, ≥ 12-year-old pediatric patients showed a decreased CT in areas related to the executive function and nociceptive networks compared to younger patients, while female patients compared to males showed a decreased CT of the auditory cortex compared to males. Therefore, early and tailored therapies are paramount to obtain migraine control, prevent cerebral reduction of cortical thickness and preserve executive function and nociception networks to ensure a high quality of life.
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Affiliation(s)
- Alessia Guarnera
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Francesca Bottino
- Medical Physics Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Giorgia Sforza
- Pediatric Headache Center, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Laura Chioma
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.,Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 10065, New York City, NY, USA
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Lorenzo Figà-Talamanca
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Chiara Carducci
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133, Rome, Italy
| | - Massimiliano Valeriani
- Pediatric Headache Center, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, 9220, Aalborg, Denmark
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Laura Papetti
- Pediatric Headache Center, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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30
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Koenen LR, Pawlik RJ, Icenhour A, Petrakova L, Forkmann K, Theysohn N, Engler H, Elsenbruch S. Associative learning and extinction of conditioned threat predictors across sensory modalities. Commun Biol 2021; 4:553. [PMID: 33976383 PMCID: PMC8113515 DOI: 10.1038/s42003-021-02008-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
The formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.
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Affiliation(s)
- Laura R Koenen
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert J Pawlik
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Adriane Icenhour
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Liubov Petrakova
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Katarina Forkmann
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany.
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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When my wrongs are worse than yours: Behavioral and neural asymmetries in first-person and third-person perspectives of accidental harms. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2021. [DOI: 10.1016/j.jesp.2021.104102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The Integrity of the Substructure of the Corpus Callosum in Patients With Right Classic Trigeminal Neuralgia. J Craniofac Surg 2021; 32:632-636. [PMID: 33704998 DOI: 10.1097/scs.0000000000007082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Patients with classic trigeminal neuralgia (CTN) have abnormalities in white matter integrity of the corpus callosum (CC). However, in CTN patients, it is unclear whether the CC substructure region is affected to varying degrees. MATERIAL AND METHODS A total of 22 patients with CTN and 22 healthy controls (HC) with matching age, gender, and education were selected. All subjects underwent 3.0 T magnetic resonance diffusion tensor imaging and high resolution T1-weighted imaging. The CC was reconstructed by DTI technology, which was divided into three substructure regions: genu, body, and splenium. Group differences in multiple diffusion metrics, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD), were compared between CTN patients and HC, and correlations between the white matter change and disease duration and VAS in CTN patients were assessed. RESULTS Compared with HC group, CTN patients had extensive damage to the CC white matter. The FA of the genu (P = 0.04) and body (P = 001) parts decreased, while RD (P = 0.003; P = 0.02) and MD (P = 0.002; P = 0.04) increased. In addition, the authors observed that the disease duration and VAS of CTN patients were negatively correlated with FA. CONCLUSION The corpus callosum substructure region has extensive damage in chronic pain, and the selective microstructural integrity damage was particularly manifested by changes in axons and myelin sheath in the genu and body of corpus callosum.
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Abend R, Bajaj MA, Harrewijn A, Matsumoto C, Michalska KJ, Necka E, Palacios-Barrios EE, Leibenluft E, Atlas LY, Pine DS. Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy. J Psychiatry Neurosci 2021; 46:E212-E221. [PMID: 33703868 PMCID: PMC8061736 DOI: 10.1503/jpn.200110] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Threat anticipation engages neural circuitry that has evolved to promote defensive behaviours; perturbations in this circuitry could generate excessive threat-anticipation response, a key characteristic of pathological anxiety. Research into such mechanisms in youth faces ethical and practical limitations. Here, we use thermal stimulation to elicit pain-anticipatory psychophysiological response and map its correlates to brain structure among youth with anxiety and healthy youth. Methods Youth with anxiety (n = 25) and healthy youth (n = 25) completed an instructed threat-anticipation task in which cues predicted nonpainful or painful thermal stimulation; we indexed psychophysiological response during the anticipation and experience of pain using skin conductance response. High-resolution brain-structure imaging data collected in another visit were available for 41 participants. Analyses tested whether the 2 groups differed in their psychophysiological cue-based pain-anticipatory and pain-experience responses. Analyses then mapped psychophysiological response magnitude to brain structure. Results Youth with anxiety showed enhanced psychophysiological response specifically during anticipation of painful stimulation (b = 0.52, p = 0.003). Across the sample, the magnitude of psychophysiological anticipatory response correlated negatively with the thickness of the dorsolateral prefrontal cortex (pFWE < 0.05); psychophysiological response to the thermal stimulation correlated positively with the thickness of the posterior insula (pFWE < 0.05). Limitations Limitations included the modest sample size and the cross-sectional design. Conclusion These findings show that threat-anticipatory psychophysiological response differentiates youth with anxiety from healthy youth, and they link brain structure to psychophysiological response during pain anticipation and experience. A focus on threat anticipation in research on anxiety could delineate relevant neural circuitry.
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Affiliation(s)
- Rany Abend
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Mira A Bajaj
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Anita Harrewijn
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Chika Matsumoto
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Kalina J Michalska
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Elizabeth Necka
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Esther E Palacios-Barrios
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Ellen Leibenluft
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Lauren Y Atlas
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Daniel S Pine
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
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Seamans JK. The anterior cingulate cortex and event-based modulation of autonomic states. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 158:135-169. [PMID: 33785144 DOI: 10.1016/bs.irn.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In spite of being an intensive area of research focus, the anterior cingulate cortex (ACC) remains somewhat of an enigma. Many theories have focused on its role in various aspects of cognition yet surgically precise lesions of the ACC, used to treat severe emotional disorders in human patients, typically have no lasting effects on cognition. An alternative view is that the ACC has a prominent role in regulating autonomic states. This view is consistent with anatomical data showing that a main target of the ACC are regions involved in autonomic control and with the observation that stimulation of the ACC evokes changes in autonomic states in both animals and humans. From an electrophysiological perspective, ACC neurons appear able to represent virtually any event or internal state, even though there is not always a strong link between these representations and behavior. Ensembles of neurons form robust contextual representations that strongly influence how specific events are encoded. The activity patterns associated with these contextually-based event representations presumably impact activity in downstream regions that control autonomic state. As a result, the ACC may regulate the autonomic and perhaps emotional reactions to events it is representing. This event-based control of autonomic tone by the ACC would likely arise during all types of cognitive and affective processes, without necessarily being critical for any of them.
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Affiliation(s)
- Jeremy K Seamans
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Chien JH, Colloca L, Korzeniewska A, Meeker TJ, Bienvenu OJ, Saffer MI, Lenz FA. Behavioral, Physiological and EEG Activities Associated with Conditioned Fear as Sensors for Fear and Anxiety. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6751. [PMID: 33255916 PMCID: PMC7728331 DOI: 10.3390/s20236751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Anxiety disorders impose substantial costs upon public health and productivity in the USA and worldwide. At present, these conditions are quantified by self-report questionnaires that only apply to behaviors that are accessible to consciousness, or by the timing of responses to fear- and anxiety-related words that are indirect since they do not produce fear, e.g., Dot Probe Test and emotional Stroop. We now review the conditioned responses (CRs) to fear produced by a neutral stimulus (conditioned stimulus CS+) when it cues a painful laser unconditioned stimulus (US). These CRs include autonomic (Skin Conductance Response) and ratings of the CS+ unpleasantness, ability to command attention, and the recognition of the association of CS+ with US (expectancy). These CRs are directly related to fear, and some measure behaviors that are minimally accessible to consciousness e.g., economic scales. Fear-related CRs include non-phase-locked phase changes in oscillatory EEG power defined by frequency and time post-stimulus over baseline, and changes in phase-locked visual and laser evoked responses both of which include late potentials reflecting attention or expectancy, like the P300, or contingent negative variation. Increases (ERS) and decreases (ERD) in oscillatory power post-stimulus may be generalizable given their consistency across healthy subjects. ERS and ERD are related to the ratings above as well as to anxious personalities and clinical anxiety and can resolve activity over short time intervals like those for some moods and emotions. These results could be incorporated into an objective instrumented test that measures EEG and CRs of autonomic activity and psychological ratings related to conditioned fear, some of which are subliminal. As in the case of instrumented tests of vigilance, these results could be useful for the direct, objective measurement of multiple aspects of the risk, diagnosis, and monitoring of therapies for anxiety disorders and anxious personalities.
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Affiliation(s)
- Jui-Hong Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD 21201-1595, USA;
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD 21201-1595, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287-7713, USA;
| | - Timothy J. Meeker
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - O. Joe Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287-7713, USA;
| | - Mark I. Saffer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
| | - Fred A. Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287-7713, USA; (J.-H.C.); (T.J.M.); (M.I.S.)
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Sambuco N, Costa VD, Lang PJ, Bradley MM. Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock. J Affect Disord 2020; 276:1142-1148. [PMID: 32791350 PMCID: PMC7490761 DOI: 10.1016/j.jad.2020.07.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 explicitly states that the neural system model of specific phobia is centered on the amygdala. However, this hypothesis is predominantly supported by human studies on animal phobia, whereas visual cuing of other specific phobias, such as dental fear, do not consistently show amygdala activation. Considering that fear of anticipated pain is one of the best predictors of dental phobia, the current study investigated neural and autonomic activity of pain anticipation in individuals varying in the degree of fear of dental pain. METHOD Functional brain activity (fMRI) was measured in women (n = 31) selected to vary in the degree of self-reported fear of dental pain when under the threat of shock, in which one color signaled the possibility of receiving a painful electric shock and another color signaled safety. RESULTS Enhanced functional activity during threat, compared to safety, was found in regions including anterior insula and anterior/mid cingulate cortex. Importantly, threat reactivity in the anterior insula increased as reported fear of pain increased and further predicted skin conductance changes during pain anticipation. LIMITATIONS The sample was comprised of women. CONCLUSIONS Individual differences in fear of pain vary with activation in the anterior insula, rather than with the amygdala, indicating that fear is not uniquely associated with amygdala activation. Whereas coping techniques such as emotion regulation have been found to vary with activation in a frontal-amygdala circuit when confronted with visual cues, precision psychiatry may need to target specific brain circuits to diagnose and treat different types of specific phobia.
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Affiliation(s)
- Nicola Sambuco
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL.
| | - Vincent D Costa
- Department of Behavioral Neuroscience, Oregon Health & Science University
| | - Peter J Lang
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
| | - Margaret M Bradley
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
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Amanzio M, Howick J, Bartoli M, Cipriani GE, Kong J. How Do Nocebo Phenomena Provide a Theoretical Framework for the COVID-19 Pandemic? Front Psychol 2020; 11:589884. [PMID: 33192929 PMCID: PMC7661580 DOI: 10.3389/fpsyg.2020.589884] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is a major health issue, which leads to psychological and behavioural changes. In particular, among various negative feelings, fear seems to be one of the main emotional reactions that can be as contagious as the virus itself. The actual pandemic is likely to function as an important stressor, especially in terms of chronic anxiety and lack of control over the succession of unforeseeable environmental events. In this direction, the psychological impact of previous quarantine measures showed important negative psychological effects, including post-traumatic stress symptoms (PTTS) with long-lasting effects. The presence of psychological discomfort and disturbances due to negative contextual factors can be studied using the nocebo phenomenon as a possible theoretical explanatory framework. Although in the absence of studies linking nocebo to Covid-19 and data-driven evidence, the context of the actual pandemic may be seen as a fertile ground for amplified discomfort and anxiety. The media provide dramatic and negative descriptions and often present conflicting sources of information, which can lead to physical and mental health problems, diminishing response to treatment. This can be worse when supported by conspiracy theories or misinformation. The aim of this perspective review is to propose a new theoretical framework for the COVID-19 pandemic, which should be supported by future empirical studies. In particular, the negative contextual factors, which can predispose individuals to psychological distress and the onset of the nocebo phenomena will be presented here, in order to suggest possible guidelines to mitigate the devastating effects of COVID-19.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | | | | | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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Moazzami K, Wittbrodt MT, Alkhalaf M, Lima BB, Nye JA, Mehta PK, Quyyumi AA, Vaccarino V, Bremner JD, Shah AJ. Association Between Mental Stress-Induced Inferior Frontal Cortex Activation and Angina in Coronary Artery Disease. Circ Cardiovasc Imaging 2020; 13:e010710. [PMID: 32772572 PMCID: PMC7422935 DOI: 10.1161/circimaging.120.010710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The inferior frontal lobe is an important area of the brain involved in the stress response, and higher activation with acute mental stress may indicate a more severe stress reaction. However, it is unclear if activation of this region with stress correlates with angina in individuals with coronary artery disease. METHODS Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire's angina frequency subscale at baseline and 2 years follow-up. RESULTS We analyzed 148 individuals with coronary artery disease (mean age [SD] 62 [8] years; 69% male, and 35.8% Black). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline ([Formula: see text], 13.7 [95% CI, 6.3-21.7]; P=0.008) and 11.6 units during follow-up ([Formula: see text], 11.6 [95% CI, 4.1-19.2]; P=0.01) in a model adjusted for baseline demographics. Mental stress-induced ischemia and activation of other brain pain processing regions (thalamus, insula, and amygdala) accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively. CONCLUSIONS Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Matthew T Wittbrodt
- Department of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA
| | - Mhmtjamil Alkhalaf
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Bruno B Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences (J.A.N., J.D.B.), Emory University School of Medicine, Atlanta, GA
| | - Puja K Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA.,Department of Radiology and Imaging Sciences (J.A.N., J.D.B.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, GA (J.D.B., A.J.S.)
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, GA (J.D.B., A.J.S.)
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Le TM, Zhornitsky S, Zhang S, Li CSR. Pain and reward circuits antagonistically modulate alcohol expectancy to regulate drinking. Transl Psychiatry 2020; 10:220. [PMID: 32636394 PMCID: PMC7341762 DOI: 10.1038/s41398-020-00909-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023] Open
Abstract
Expectancy of physical and social pleasure (PSP) promotes excessive drinking despite the potential aversive effects of misuse, suggesting an imbalance in the response to reward and pain in alcohol seeking. Here, we investigated the competing roles of the reward and pain circuits in PSP expectancy and problem drinking in humans. Using fMRI data during resting (n = 180) and during alcohol cue exposure (n = 71), we examined the antagonistic effects of the reward-related medial orbitofrontal cortex (mOFC) and pain-related periaqueductal gray (PAG) connectivities on PSP expectancy and drinking severity. The two regions' connectivity maps and strengths were characterized to assess their shared substrates and net relationship with PSP expectancy. We evaluated mediation and path models to further delineate how mOFC and PAG connectivities interacted through the shared substrates to differentially impact expectancy and alcohol use. During resting, whole-brain regressions showed mOFC connectivity in positive and PAG connectivity in negative association with PSP scores, with convergence in the precentral gyrus (PrCG). Notably, greater PAG-PrCG relative to mOFC-PrCG connectivity strength predicted lower PSP expectancy. During the alcohol cue exposure task, the net strength of the PAG vs. mOFC cue-elicited connectivity with the occipital cortex again negatively predicted PSP expectancy. Finally, mediation and path models revealed that the PAG and mOFC connectivities indirectly and antagonistically modulated problem drinking via their opposing influences on expectancy and craving. Thus, the pain and reward circuits exhibit functional antagonism such that the mOFC connectivity increases expectancy of drinking pleasure whereas the PAG serves to counter that effect.
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Affiliation(s)
- Thang M Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA.
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06520, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, 06520, USA
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Zarei SP, Briscese L, Capitani S, Rossi B, Carboncini MC, Santarcangelo EL, Motie Nasrabadi A. Hypnotizability-Related Effects of Pain Expectation on the Later Modulation of Cortical Connectivity. Int J Clin Exp Hypn 2020; 68:306-326. [PMID: 32510271 DOI: 10.1080/00207144.2020.1762196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined hypnotizability-related modulation of the cortical network following expected and nonexpected nociceptive stimulation. The electroencephalogram (EEG) was recorded in 9 high (highs) and 8 low (lows) hypnotizable participants receiving nociceptive stimulation with (W1) and without (noW) a visual warning preceding the stimulation by 1 second. W1 and noW were compared to baseline conditions to assess the presence of any later effect and between each other to assess the effects of expectation. The studied EEG variables measured local and global features of the cortical connectivity. With respect to lows, highs exhibited scarce differences between experimental conditions. The hypnotizability-related differences in the later processing of nociceptive information could be relevant to the development of pain-related individual traits. Present findings suggest a lower impact of nociceptive stimulation in highs than in lows.
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Affiliation(s)
| | - Lucia Briscese
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Italy
| | - Simone Capitani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Italy
| | - Bruno Rossi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Italy
| | - Maria C Carboncini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Italy
| | - Enrica L Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Italy
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41
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Biosimilars in pediatric rheumatology and their introduction into routine care. Clin Immunol 2020; 216:108447. [PMID: 32360950 DOI: 10.1016/j.clim.2020.108447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022]
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Kravvariti E, Kitas GD, Sfikakis PP. The role of the Nocebo effect in the use of biosimilars in routine rheumatology clinical practice. Mediterr J Rheumatol 2020; 30:63-68. [PMID: 32524080 PMCID: PMC7280873 DOI: 10.31138/mjr.30.1.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D Kitas
- Clinical Research Unit, Dudley Group NHS Foundation Trust, Dudley, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
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Rossettini G, Camerone EM, Carlino E, Benedetti F, Testa M. Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Arch Physiother 2020; 10:11. [PMID: 32537245 PMCID: PMC7288522 DOI: 10.1186/s40945-020-00082-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background Placebo and nocebo effects embody psychoneurobiological phenomena where behavioural, neurophysiological, perceptive and cognitive changes occur during the therapeutic encounter in the healthcare context. Placebo effects are produced by a positive healthcare context; while nocebo effects are consequences of negative healthcare context. Historically, placebo, nocebo and context-related effects were considered as confounding elements for clinicians and researchers. In the last two decades this attitude started to change, and the understanding of the value of these effects has increased. Despite the growing interest, the knowledge and the awareness of using the healthcare context to trigger placebo and nocebo effects is currently limited and heterogeneous among physiotherapists, reducing their translational value in the physiotherapy field. Objectives To introduce the placebo, nocebo and context-related effects by: (1) presenting their psychological models; (2) describing their neurophysiological mechanisms; (3) underlining their impact for the physiotherapy profession; and (4) tracing lines for future researches. Conclusion Several psychological mechanisms are involved in placebo, nocebo and context-related effects; including expectation, learning processes (classical conditioning and observational learning), reinforced expectations, mindset and personality traits. The neurophysiological mechanisms mainly include the endogenous opioid, the endocannabinoid and the dopaminergic systems. Neuroimaging studies have identified different brain regions involved such as the dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, the periaqueductal gray and the dorsal horn of spine. From a clinical perspective, the manipulation of the healthcare context with the best evidence-based therapy represents an opportunity to trigger placebo effects and to avoid nocebo effects respecting the ethical code of conduct. From a managerial perspective, stakeholders, organizations and governments should encourage the assessment of the healthcare context aimed to improve the quality of physiotherapy services. From an educational perspective, placebo and nocebo effects are professional topics that should be integrated in the university program of health and medical professions. From a research perspective, the control of placebo, nocebo and context-related effects offers to the scientific community the chance to better measure the impact of physiotherapy on different outcomes and in different conditions through primary studies.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
| | - Eleonora Maria Camerone
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy.,Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Fabrizio Benedetti
- Department of Neuroscience, University of Turin Medical School, Turin, Italy.,Plateau Rosà Laboratories, Plateau Rosà Laboratories, Zermatt, Switzerland
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
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Abstract
The power of placebos is commonly associated with the placebo effect. In contrast, detrimental effects related to the use of a placebo are little studied and less well recognized. This chapter covers the nocebo and lessebo effects defined, respectively, as expectation of harm in the form of adverse events in a placebo arm and reduction of therapeutic benefit due to the uncertainty of being allocated to placebo. The lessebo effect is a more recent concept and has been described only in depression, schizophrenia and Parkinson's disease. The nocebo response was evaluated in many neurological diseases, including epilepsy, multiple sclerosis, Parkinson's disease, Alzheimer's disease, restless leg syndrome, among others. Meta-analyses of randomized controlled trials in these conditions reveal a significant variability of the magnitude of the nocebo response and that factors related to study design, study participants or neurological disease can be associated with a nocebo response, although with the opposing findings across conditions. The knowledge about neurobiological mechanisms of the nocebo effect is poor for neurological diseases, and most of the information has been generated in pain. Functional neuroimaging suggests the existence of a distinct network for the anticipation and the experience of a hyperalgesia nocebo response. Different types of neurotransmitters have been involved, including cholecystokinin, dopamine and opioids. Recognizing the potential impact of nocebo and lessebo effects, mitigating strategies are in development with application to clinical research and clinical practice, such as a contextualized informed consent process, alternative study designs and enhancement of patient-physician communication.
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Affiliation(s)
- Tiago A Mestre
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
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Aldemir A, Yucel K, Güven H, Kamaşak B, Dilli A, Acer N, Çomoğlu S. Structural neuroimaging findings in migraine patients with restless legs syndrome. Neuroradiology 2020; 62:1301-1313. [PMID: 32488307 DOI: 10.1007/s00234-020-02451-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE One out of three migraine patients might have accompanying restless legs syndrome (RLS). In our study, we aimed to compare the volumes of the brain structures of migraineurs with and without RLS. METHODS We had 37 female patients with migraine and 17 females as the control group. Nineteen migraineurs had no RLS (RLS0) and 18 migraineurs had comorbidity of RLS (RLS1). The volumes of the brain structures were obtained by manual measurements, volBrain, and voxel-based morphometry (VBM). Manually, we measured caudate and putamen volumes. We used age, years of education, depression, anxiety scores, and total intracranial volume as covariates. RESULTS According to VBM analyses, the volumes of the left superior occipital gyrus and precuneus were increased, and the substantia nigra and cuneus were decreased in the RLS1 group compared with the RLS0 group. RLS1 patients had larger superior temporal gyrus, Brodmann area 38, and left insula, and RLS0 patients had larger Brodmann area 22, right superior temporal gyrus, and Heschl gyrus compared with controls. Migraine and RLS0 patients had a smaller corpus callosum anteriorly, whereas RLS1 patients had a smaller splenium. Caudate volumes were larger in migraine patients via the three techniques. There was a positive relation between the caudate and putamen volumes and attack frequency. CONCLUSIONS Comorbidity of RLS might be a confounding factor in structural neuroimaging studies in migraine. Deficits in the visual network seem to be related to accompanying RLS; deficits in the auditory network are particularly related to migraine.
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Affiliation(s)
- Arzu Aldemir
- Department of Neurology, Acıbadem Hospital, Eskişehir, Turkey
| | - Kaan Yucel
- Department of Anatomy, Aksaray University Medical School, Aksaray, Turkey.
| | - Hayat Güven
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Kamaşak
- Department of Anatomy, Ahi Evran University Medical School, Kırşehir, Turkey
| | - Alper Dilli
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Niyazi Acer
- Department of Anatomy, Erciyes University Medical School, Kayseri, Turkey
| | - Selçuk Çomoğlu
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Nocebo hyperalgesia can be induced by classical conditioning without involvement of expectancy. PLoS One 2020; 15:e0232108. [PMID: 32379766 PMCID: PMC7205230 DOI: 10.1371/journal.pone.0232108] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
Influential theoretical accounts take the position that classical conditioning can induce placebo effects through conscious expectancies. In the current study two different conditioning procedures (hidden and open) were used to separate expectancy from conditioning in order to reveal the role of expectancy in the formation of nocebo hyperalgesia. Eighty-seven healthy females were randomly assigned to three groups (hidden conditioning, open conditioning, and control). Participants were selected according to the Fear of Pain Questionnaire scores and assigned to two subgroups: high and low level of fear of pain (trait). They received electrocutaneous pain stimuli preceded by either an orange or blue color. During the conditioning phase, one color was paired with pain stimuli of moderate intensity (control stimuli) and the other color was paired with pain stimuli of high intensity (nocebo stimuli) in both hidden and open conditioning groups. Only participants in the open conditioning group were informed about this association, however just before the testing phase the expectancy of hyperalgesia induced in this way was withdrawn. In the control group, both colors were followed by control pain stimuli. During the testing phase all participants received a series of stimuli of the same intensity, regardless of the preceding color. Participants rated pain intensity, expectancy of pain intensity and fear (state). We found that nocebo hyperalgesia was induced by hidden rather than open conditioning. The hidden conditioning procedure did not produce conscious expectancies related to pain. Nocebo hyperalgesia was induced in participants with low and high fear of pain and there was no difference in the magnitude of the nocebo effect between both groups. Nocebo hyperalgesia was not predicted by the fear of upcoming painful stimuli.
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Anticipation and violated expectation of pain are influenced by trait rumination: An fMRI study. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 19:56-72. [PMID: 30251186 PMCID: PMC6344394 DOI: 10.3758/s13415-018-0644-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Rumination – as a stable tendency to focus repetitively on feelings related to distress – represents a transdiagnostic risk factor. Theories suggest altered emotional information processing as the key mechanism of rumination. However, studies on the anticipation processes in relation to rumination are scarce, even though expectation in this process is demonstrated to influence the processing of emotional stimuli. In addition, no published study has investigated violated expectation in relation to rumination yet. In the present study we examined the neural correlates of pain anticipation and perception using a fear conditioning paradigm with pain as the unconditioned stimulus in healthy subjects (N = 30). Rumination was assessed with the 10-item Ruminative Response Scale (RRS). Widespread brain activation – extending to temporal, parietal, and occipital lobes along with activation in the cingulate cortex, insula, and putamen – showed a positive correlation with rumination, supporting our hypothesis that trait rumination influences anticipatory processes. Interestingly, with violated expectation (when an unexpected, non-painful stimulus follows a pain cue compared to when an expected, painful stimulus follows the same pain cue) a negative association between rumination and activation was found in the posterior cingulate cortex, which is responsible for change detection in the environment and subsequent behavioral modification. Our results suggest that rumination is associated with increased neural response to pain perception and pain anticipation, and may deteriorate the identification of an unexpected omission of aversive stimuli. Therefore, targeting rumination in cognitive behavioral therapy of chronic pain could have a beneficial effect.
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Druart L, Graham Longsworth S, Rolland C, Dolgopoloff M, Terrisse H, Bosson JL, Pinsault N. Can an Open-Label Placebo Be as Effective as a Deceptive Placebo? Methodological Considerations of a Study Protocol. MEDICINES (BASEL, SWITZERLAND) 2020; 7:medicines7010003. [PMID: 31906435 PMCID: PMC7168289 DOI: 10.3390/medicines7010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 06/02/2023]
Abstract
Background: Placebo has been studied for many years and is ever-present in healthcare. In clinical practice, its use is limited by ethical issues raised by the deception entailed by its administration. Objective: To investigate whether, when given detailed information about pain and underlying placebo mechanisms, subjects will have a response similar to that of those subjected to a procedure in which they receive a conventional placebo treatment. Methods: The study is designed as a non-inferiority randomized, parallel with a nested crossover trial. In addition, 126 subjects without any known pathology will be included. They will be randomized into two groups. Each subject will undergo three Cold Pressor Tests (CPT): calibration, condition of interest (deceptive placebo or educated placebo), and control. Our main judgment criterion will be the comparison in pain intensity experienced on the visual analog scale between the two CPTs with placebo conditions. Results: This study will allow us to rule on the non-inferiority of an "educated" placebo compared to a deceptive placebo in the context of an acute painful stimulation. It is another step towards the understanding of open-label placebo and its use in clinical practice. Conclusions: This study has been approved by the ethics committee in France (2017-A01643-50) and registered on ClinicalTrials.gov (NCT03934138).
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Affiliation(s)
- Leo Druart
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - SaraEve Graham Longsworth
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Carole Rolland
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Maïa Dolgopoloff
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
| | - Hugo Terrisse
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Jean-Luc Bosson
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Nicolas Pinsault
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
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Insula Activity to Visceral Stimulation and Endocrine Stress Responses as Associated With Alexithymia in Patients With Irritable Bowel Syndrome. Psychosom Med 2020; 82:29-38. [PMID: 31609924 DOI: 10.1097/psy.0000000000000729] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Few studies have investigated associations between alexithymia and physiological mechanisms in psychosomatic diseases. We examined associations between alexithymia and 1) perception and brain processing of visceral stimulation and 2) the endocrine responses to corticotrophin-releasing hormone (CRH) in healthy individuals and patients with irritable bowel syndrome (IBS). METHODS The study included 29 patients with IBS and 35 age- and sex-matched healthy controls (HCs). Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Brain responses to rectal distention and its anticipation were measured by functional magnetic resonance imaging and analyzed at a voxel-level threshold of puncorrected < .001 combined with a cluster-level threshold of pFWE-corrected < .05. On a different day, plasma adrenocorticotropic hormone and cortisol responses after intravenous CRH administration were measured. RESULTS TAS-20 scores did not differ significantly between patients with IBS and HCs (p = .18). TAS-20 scores correlated positively with the individual rectal discomfort thresholds (βrobust = 0.49, p = .03) and negatively with the rating of fear before rectal distention (βrobust = -1.63, p = .04) in patients with IBS but not in HCs. Brain responses to rectal distention in the right insula and other brain regions were positively associated with TAS-20 scores to a greater extent in patients with IBS than in HCs. Individuals with higher TAS-20 scores (both patients with IBS and HCs) demonstrated stronger adrenocorticotropic hormone responses to CRH administration (F(4,224) = 3.54, p = .008). CONCLUSION Higher alexithymia scores are associated with stronger physiological responses, but lower anticipatory fear ratings and higher discomfort thresholds, particularly in patients with IBS.
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50
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Egorova N, Benedetti F, Gollub RL, Kong J. Between placebo and nocebo: Response to control treatment is mediated by amygdala activity and connectivity. Eur J Pain 2019; 24:580-592. [PMID: 31770471 DOI: 10.1002/ejp.1510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/08/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In experimental placebo and nocebo studies, neutral control treatments are often administered for comparison with active treatments, but are of little interest, as, on average, they result in little change. Yet, when considered at an individual level, they fluctuate between baseline and subsequent measurements and may reveal important information about participants' placebo/nocebo responding tendencies. METHODS In a paradigm involving application of creams paired with positive, negative and neutral expectations, some subjects rated identical stimuli in the neutral condition as more painful while others as less painful after treatment with inert cream. We divided subjects into two groups based on the median split in these pre-post responses in the neutral control condition, and investigated (a) fMRI signal differences (post minus pre) between the two groups in neutral condition, and (b) seed-based resting state connectivity of the bilateral amygdala, known to be involved in emotional self-regulation, as well as ambiguous stimulus processing and aversive learning. RESULTS The results suggested that subjects who rated the same pain stimuli after treatment with explicitly neutral cream as more painful showed stronger fMRI activation of the amygdala during the experiment and had higher connectivity between the left amygdala and the striatum at rest. Neutral pre-post changes predicted behavioural placebo/nocebo response in this and two independent datasets. CONCLUSION These findings suggest that measuring pre-post change in the neutral control condition might provide important information about subjects' individual differences in placebo/nocebo response. SIGNIFICANCE Pre-post changes in pain ratings in neutral conditions are modulated by amygdala activity and connectivity and can be used to predict placebo/nocebo responses.
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Affiliation(s)
- Natalia Egorova
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Fabrizio Benedetti
- University of Turin, Turin, Italy.,Plateau Rosà Labs, Plateau Rosà, Switzerland
| | - Randy L Gollub
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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