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van der Miesen MM, Vossen CJ, Joosten EA. Habituation to Pain in Patients with Chronic Pain: Clinical Implications and Future Directions. J Clin Med 2023; 12:4305. [PMID: 37445339 DOI: 10.3390/jcm12134305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
In this review, the latest insights into habituation to pain in chronic pain are summarized. Using a systematic search, results of studies on the evidence of habituation to (experimental) pain in migraine, chronic low back pain, fibromyalgia, and a variety of chronic pain indications are presented. In migraine, reduced habituation based on self-report and the EEG-based N1 and N2-P2 amplitude is reported, but the presence of contradictory results demands further replication in larger, well-designed studies. Habituation to pain in chronic low back pain seems not to differ from controls, with the exception of EEG measures. In fibromyalgia patients, there is some evidence for reduced habituation of the N2-P2 amplitude. Our analysis shows that the variability between outcomes of studies on habituation to pain is high. As the mechanisms underlying habituation to pain are still not fully understood and likely involve several pathways, it is now too early to conclude that habituation to pain is related to clinical outcomes and can be used as a diagnostic marker. The review ends with a discussion on future directions for research including the use of standard outcome measures to improve comparisons of habituation to pain in patients and controls, as well as a focus on individual differences.
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Affiliation(s)
- Maite M van der Miesen
- Department of Anesthesiology and Pain Management, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Catherine J Vossen
- Department of Anesthesiology and Pain Management, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Elbert A Joosten
- Department of Anesthesiology and Pain Management, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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Büyükbayraktar ZÇ, Kuruca TÖ. The effects of orthodontic treatment type, depression, and treatment need on perceived pain intensity. APOS TRENDS IN ORTHODONTICS 2023. [DOI: 10.25259/apos_21_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objectives:
The objectives of this study were to evaluate how orthodontic treatment type, treatment need, and depression affect perceived pain intensity (PPI).
Material and Methods:
This prospective study included 172 patients (80 girls and 92 boys, mean age 14.32 ± 1.57 years) treated at the Sivas Cumhuriyet University Faculty of Dentistry, Department of Orthodontics. The patients were divided into three groups: the first group was treated with fixed orthodontic appliances, the second group was treated with twin blocks, and the third group was treated with rapid maxillary expansion and reverse headgear (RME/RH). Data were collected and classified with the Index of Orthodontic Treatment Need-Dental Health Component (DHC), Children’s Depression Scale, and Visual Analog Scale. PPI was recorded in the 1st week (T0), 2nd week (T1), the 1st month (T2), 2nd month (T3), 3rd month (T4), and the 6th month (T5).
Results:
PPI was higher in boys at T1 (P = 0.005) compared with girls. There was a significant difference of PPI between the treatment groups at T2 (P = 0.036), T3 (P = 0.012), T4 (P = 0.000), and T5 (P = 0.006). A statistically significant positive correlation was found between DHC and PPI at T3 (r = 0.182; P = 0.000), T4 (r = 0.161; P = 0.03), and T5 (r = 0.189; P = 0.000) time periods. There was no significant correlation between depression and PPI.
Conclusion:
Girls were more resistant to pain than boys. The type of treatment and the need for treatment both had an effect on PPI. Further studies are needed to investigate the effects of psychological states on PPI during orthodontic treatment.
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Lia EN, Papassidero PC, Coelho EB, Dach F, Alexandre-Santos L, Trevisan AC, Santos LELE, Silvah JH, Lanchote VL, Pasqua OD, Wichert-Ana L. Neurobiological substrates of chronic low back pain (CLBP): a brain [ 99mTc]Tc-ECD SPECT study. Eur J Hybrid Imaging 2022; 6:26. [PMID: 36404393 PMCID: PMC9676153 DOI: 10.1186/s41824-022-00145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent neuroimaging studies have demonstrated pathological mechanisms related to cerebral neuroplasticity in chronic low back pain (CLBP). Few studies have compared cerebral changes between patients with and without pain in the absence of an experimentally induced stimulus. We investigated the neurobiological substrates associated with chronic low back pain using [99mTc]Tc-ECD brain SPECT and correlated rCBF findings with the numeric rating scale (NRS) of pain and douleur neuropathique en 4 questions (DN4). Ten healthy control volunteers and fourteen patients with neuropathic CLBP due to lumbar disc herniation underwent cerebral SPECT scans. A quantitative comparison of rCBF findings between patients and controls was made using the Statistical Parametric Mapping (SPM), revealing clusters of voxels with a significant increase or decrease in rCBF. The intensity of CLBP was assessed by NRS and by DN4. RESULTS The results demonstrated an rCBF increase in clusters A (occipital and posterior cingulate cortex) and B (right frontal) and a decrease in cluster C (superior parietal lobe and middle cingulate cortex). NRS scores were inversely and moderately correlated with the intensity of rCBF increase in cluster B, but not to rCBF changes in clusters A and C. DN4 scores did not correlate with rCBF changes in all three clusters. CONCLUSIONS This study will be important for future therapeutic studies that aim to validate the association of rCBF findings with the pharmacokinetic and pharmacodynamic profiles of therapeutic challenges in pain.
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Affiliation(s)
- Erica Negrini Lia
- grid.7632.00000 0001 2238 5157Department of Dentistry, School of Health Sciences, University of Brasilia (UnB), Brasilia, DF Brazil
| | - Priscila Colavite Papassidero
- grid.11899.380000 0004 1937 0722Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Eduardo Barbosa Coelho
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Fabíola Dach
- grid.11899.380000 0004 1937 0722Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Leonardo Alexandre-Santos
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Ana Carolina Trevisan
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Lucas Emmanuel Lopes e Santos
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Jose Henrique Silvah
- grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil
| | - Vera Lúcia Lanchote
- grid.11899.380000 0004 1937 0722Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Oscar Della Pasqua
- grid.83440.3b0000000121901201Clinical Pharmacology and Therapeutics, School of Life and Medical Sciences, University College London, London, UK
| | - Lauro Wichert-Ana
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil ,grid.11899.380000 0004 1937 0722Nuclear Medicine and PET/CT Laboratory, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP Brazil ,Seção de Medicina Nuclear, Hospital das Clínicas – FMRP – USP, Av. Bandeirantes, 3900, CEP: 14048-900 Ribeirão Preto, SP Brasil
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Zhang G, Ma J, Lu W, Zhan H, Zhang X, Wang K, Hu Y, Wang X, Peng W, Yue S, Cai Q, Liang W, Wu W. Comorbid depressive symptoms can aggravate the functional changes of the pain matrix in patients with chronic back pain: A resting-state fMRI study. Front Aging Neurosci 2022; 14:935242. [PMID: 35923542 PMCID: PMC9340779 DOI: 10.3389/fnagi.2022.935242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The purposes of this study are to explore (1) whether comorbid depressive symptoms in patients with chronic back pain (CBP) affect the pain matrix. And (2) whether the interaction of depression and CBP exacerbates impaired brain function. Methods Thirty-two patients with CBP without comorbid depressive symptoms and thirty patients with CBP with comorbid depressive symptoms were recruited. All subjects underwent functional magnetic resonance imaging (fMRI) scans. The graph theory analysis, mediation analysis, and functional connectivity (FC) analysis were included in this study. All subjects received the detection of clinical depressive symptoms and pain-related manifestations. Result Compared with the CBP group, subjects in the CBP with comorbid depressive symptoms (CBP-D) group had significantly increased FC in the left medial prefrontal cortex and several parietal cortical regions. The results of the graph theory analyses showed that the area under the curve of small-world property (t = −2.175, p = 0.034), gamma (t = −2.332, p = 0.023), and local efficiency (t = −2.461, p = 0.017) in the CBP-D group were significantly lower. The nodal efficiency in the ventral posterior insula (VPI) (t = −3.581, p = 0.0007), and the network efficiency values (t = −2.758, p = 0.008) in the pain matrix were significantly lower in the CBP-D group. Both the topological properties and the FC values of these brain regions were significantly correlated with self-rating depression scale (SDS) scores (all FDR corrected) but not with pain intensity. Further mediation analyses demonstrated that pain intensity had a mediating effect on the relationship between SDS scores and Pain Disability Index scores. Likewise, the SDS scores mediated the relationship between pain intensity and PDI scores. Conclusion Our study found that comorbid depressive symptoms can aggravate the impairment of pain matrix function of CBP, but this impairment cannot directly lead to the increase of pain intensity, which may be because some brain regions of the pain matrix are the common neural basis of depression and CBP.
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Affiliation(s)
- Guangfang Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Pain, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Junqin Ma
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weirong Lu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hongrui Zhan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Physical Medicine and Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xuefei Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kangling Wang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yingxuan Hu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianglong Wang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiwei Peng
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Shouwei Yue
- Department of Rehabilitation Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Qingxiang Cai
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Qingxiang Cai,
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Wen Liang,
| | - Wen Wu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Wen Wu,
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de Oliveira Franco Á, da Silveira Alves CF, Vicuña P, Bandeira J, de Aratanha MA, Torres ILS, Fregni F, Caumo W. Hyper-connectivity between the left motor cortex and prefrontal cortex is associated with the severity of dysfunction of the descending pain modulatory system in fibromyalgia. PLoS One 2022; 17:e0247629. [PMID: 35622879 PMCID: PMC9140239 DOI: 10.1371/journal.pone.0247629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/20/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction The association between descending pain modulatory system (DPMS) dysfunction and fibromyalgia has been previously described, but more studies are required on its relationship with aberrant functional connectivity (FC) between the motor and prefrontal cortices. Objectives The objective of this cross-sectional observational study was to compare the intra- and interhemispheric FC between the bilateral motor and prefrontal cortices in women with fibromyalgia, comparing responders and nonresponders to the conditioned pain modulation (CPM) test. Methods A cross-sectional sample of 37 women (23 responders and 14 nonresponders to the CPM test) with fibromyalgia diagnosed according to the American College of Rheumatology criteria underwent a standardized clinical assessment and an FC analysis using functional near-infrared spectroscopy. DPMS function was inferred through responses to the CPM test, which were induced by hand immersion in cold water (0–1°C). A multivariate analysis of covariance for main effects between responders and nonresponders was conducted using the diagnosis of multiple psychiatric disorders and the use of opioid and nonopioid analgesics as covariates. In addition, we analyzed the interaction between the CPM test response and the presence of multiple psychiatric diagnoses. Results Nonresponders showed increased FC between the left motor cortex (lMC) and the left prefrontal cortex (lPFC) (t = −2.476, p = 0.01) and right prefrontal cortex (rPFC) (t = −2.363, p = 0.02), even when both were considered as covariates in the regression analysis (lMC–lPFC: β = −0.127, t = −2.425, p = 0.021; lMC–rPFC: β = −0.122, t = −2.222, p = 0.033). Regarding main effects, a significant difference was only observed for lMC–lPFC (p = 0.035). A significant interaction was observed between the psychiatric disorders and nonresponse to the CPM test in lMC−lPFC (β = −0.222, t = −2.275, p = 0.03) and lMC−rPFC (β = −0.211, t = −2.2, p = 0.035). Additionally, a significant interaction was observed between the CPM test and FC in these two region-of-interest combinations, despite the psychiatric diagnoses (lMC−lPFC: β = −0.516, t = −2.447, p = 0.02; lMC−rPFC: β = −0.582, t = −2.805, p = 0.008). Conclusions Higher FC between the lMC and the bilateral PFC may be a neural marker of DPMS dysfunction in women with fibromyalgia, although its interplay with psychiatric diagnoses also seems to influence this association.
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Affiliation(s)
- Álvaro de Oliveira Franco
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Camila Fernanda da Silveira Alves
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Paul Vicuña
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Janete Bandeira
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Iraci L. S. Torres
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Translational Nucleus: Pain Pharmacology and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- * E-mail:
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De Paepe AL, Crombez G. Attentional interference by pain in a dishabituation procedure: an experimental investigation. Pain 2022; 163:e725-e737. [PMID: 34772898 DOI: 10.1097/j.pain.0000000000002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The ability to habituate to pain may be adaptive, and it may enable us to pursue valuable goals despite the pain. In this study, we experimentally investigated this idea using the primary task paradigm in which participants had to identify the color of a circle (blue or yellow) as quickly as possible while ignoring painful or tactile distractors that are presented on some of the trials. In the first experiment, we were interested whether the attentional interference effect because of the presentation of the distractors and its habituation would differ between painful and tactile distractor stimuli. In the second experiment, we investigated dishabituation (ie, the phenomenon that the introduction of a different stimulus results in an increase of the decremented response to the original stimulus). We expected habituation of the attentional interference to occur both in the tactile and the painful distractor condition, but to be less complete in the painful condition. Moreover, we hypothesized that the dishabituation would be stronger for the painful than for the tactile distractors. We did find evidence for an interference effect because of the presence of distractors. We also found habituation of attentional interference. However, the interference and its habituation were no different for tactile and painful distractors. Moreover, we did not find evidence for dishabituation. These are the first studies of their kind. Implications and guidelines for future research are formulated.
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Affiliation(s)
- Annick L De Paepe
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Kim DJ, Job A, Gokarakonda S, Huang C, Chekuri L, Carbajal JM, Cáceda R. Synergistic effect of chronic pain and nonsuicidal self-harm on pain sensitivity. Eur Arch Psychiatry Clin Neurosci 2022; 272:371-380. [PMID: 34152490 PMCID: PMC10375839 DOI: 10.1007/s00406-021-01283-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
Abnormalities in pain processing have been observed in patients with chronic pain conditions and in individuals who engage in self-harm, specifically nonsuicidal self-injurious behaviors (NSSI). Both increased and decreased pain sensitivity have been described in chronic pain patients, while decreased pain sensitivity is consistently observed in individuals with NSSI. The objective of the study was to identify the differential effects of chronic pain and NSSI on experimental pain sensitivity, specifically pressure pain threshold, in depressed patients. Moreover, the role that hopelessness may play between depression severity and pain sensitivity was also examined. Depressed patients with and without chronic pain, and with and without lifetime self-harm behaviors were analyzed into four groups. Group 1 (N = 42) included depressed patients with both Chronic pain ( +) and Self-harm ( +), Group 2 (N = 53) included depressed patients with Chronic pain ( +) but no Self-harm (-), Group 3 (N = 64) included depressed patients without Chronic pain (-), but Self-harm ( +), and Group 4 (N = 81) included depressed patients with neither Chronic pain (-) nor Self-harm (-). Healthy controls (N = 45) were also recruited from the community. Depressed patients with both Chronic pain ( +) and Self-harm ( +) reported higher pressure pain threshold measures when compared with the other groups. Mediation analysis indicated that hopelessness mediates the relationship between depression severity and pressure pain threshold. Our findings suggest that a multiprong approach including adequate mental health services and pain control for depressed patients with comorbid chronic pain and nonsuicidal self-harm is needed to yield effective outcomes.
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Affiliation(s)
- Diane J Kim
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony, Brook University, HSC T10-020, Stony Brook, NY, 11794, USA
| | - Asha Job
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony, Brook University, HSC T10-020, Stony Brook, NY, 11794, USA
| | - Srinivasa Gokarakonda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chuan Huang
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony, Brook University, HSC T10-020, Stony Brook, NY, 11794, USA.,Department of Radiology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Lackshminarayana Chekuri
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jessica M Carbajal
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony, Brook University, HSC T10-020, Stony Brook, NY, 11794, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony, Brook University, HSC T10-020, Stony Brook, NY, 11794, USA. .,Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, NY, USA.
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8
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Kim DJ, Mirmina J, Narine S, Wachtel J, Carbajal JM, Fox H, Cáceda R. Altered physical pain processing in different psychiatric conditions. Neurosci Biobehav Rev 2021; 133:104510. [PMID: 34952034 DOI: 10.1016/j.neubiorev.2021.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 01/07/2023]
Abstract
Several reports indicate either increased or decreased pain sensitivity associated with psychiatric disorders. Chronic pain is highly prevalent in many of these conditions. We reviewed the literature regarding experimental pain sensitivity in patients with major depression, bipolar disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and schizophrenia. Electronic searches were performed to identify studies comparing experimental pain in patients with these conditions and controls. Across 31 depression studies, reduced pain threshold was noted except for ischemic stimuli, where increased pain tolerance and elevated sensitivity to ischemic pain was observed. A more pervasive pattern of low pain sensitivity was found across 20 schizophrenia studies. The majority of PTSD studies (n = 20) showed no significant differences compared with controls. The limited number of bipolar disorder (n = 4) and anxiety (n = 9) studies precluded identification of clear trends. Wide data variability was observed. Awareness of psychiatric patients' pain perception abnormalities is needed for active screening and addressing physical comorbidities, in order to enhance quality of life, life expectancy and mental health.
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Affiliation(s)
- Diane J Kim
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Julianne Mirmina
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Serah Narine
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Jonathan Wachtel
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Jessica M Carbajal
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Helen Fox
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, New York, USA.
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Tagliaferri SD, Ng SK, Fitzgibbon BM, Owen PJ, Miller CT, Bowe SJ, Belavy DL. Relative contributions of the nervous system, spinal tissue and psychosocial health to non-specific low back pain: Multivariate meta-analysis. Eur J Pain 2021; 26:578-599. [PMID: 34748265 DOI: 10.1002/ejp.1883] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Nervous system, psychosocial and spinal tissue biomarkers are associated with non-specific low back pain (nsLBP), though relative contributions are unclear. DATABASES AND DATA TREATMENT MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain-free controls were included. For multivariate meta-analysis, two of three domains were required in each study. Random-effects pairwise and multivariate meta-analyses were performed. GRADE approach assessed evidence certainty. Newcastle-Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain-free controls. RESULTS Of 4519 unique records identified, 33 studies (LBP = 1552, referents = 1322) were meta-analysed. Psychosocial state (Hedges' g [95%CI]: 0.90 [0.69-1.10], p < 0.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13-0.49], p < 0.001; difference: 0.61 [0.36-0.86], p < 0.001) and spine imaging biomarkers (0.55 [0.37-0.73], p < 0.001; difference: 0.36 [0.04-0.67], p = 0.027). The relationship between domains changes depending on if pain duration is acute or chronic. CONCLUSIONS Psychosocial effect sizes in nsLBP are greater than that for spinal imaging and nervous system biomarkers. Limitations include cross-sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability. STUDY REGISTRATION PROSPERO-CRD42020159188. SIGNIFICANCE Spinal imaging (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system (e.g. quantitative sensory tests, structural and functional brain measures) biomarkers contribute to non-specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the 'non-specific' label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
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Affiliation(s)
- Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Sin-Ki Ng
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Steven J Bowe
- Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Victoria, Australia
| | - Daniel L Belavy
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.,Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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10
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Personalized behavior management as a replacement for medications for pain control and mood regulation. Sci Rep 2021; 11:20297. [PMID: 34645900 PMCID: PMC8514566 DOI: 10.1038/s41598-021-99803-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a ‘resource matching’ hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual (‘out-of-touch-with-reality’) behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational (‘in-touch-with-reality’) behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual ‘resource’ of the pain experience from its ‘feeding’ to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.
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11
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Observation of Nociceptive Processing: Effect of Intra-Epidermal Electric Stimulus Properties on Detection Probability and Evoked Potentials. Brain Topogr 2021; 34:139-153. [PMID: 33459925 PMCID: PMC7892744 DOI: 10.1007/s10548-020-00816-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/25/2020] [Indexed: 12/30/2022]
Abstract
Monitoring nociceptive processing is a current challenge due to a lack of objective measures. Recently, we developed a method for simultaneous tracking of psychophysical detection probability and brain evoked potentials in response to intra-epidermal stimulation. An exploratory investigation showed that we could quantify nociceptive system behavior by estimating the effect of stimulus properties on the evoked potential (EP). The goal in this work was to accurately measure nociceptive system behavior using this method in a large group of healthy subjects to identify the locations and latencies of EP components and the effect of single- and double-pulse stimuli with an inter-pulse interval of 10 or 40 ms on these EP components and detection probability. First, we observed the effect of filter settings and channel selection on the EP. Subsequently, we compared statistical models to assess correlation of EP and detection probability with stimulus properties, and quantified the effect of stimulus properties on both outcome measures through linear mixed regression. We observed lateral and central EP components in response to intra-epidermal stimulation. Detection probability and central EP components were positively correlated to the amplitude of each pulse, regardless of the inter-pulse interval, and negatively correlated to the trial number. Both central and lateral EP components also showed strong correlation with detection. These results show that both the observed EP and the detection probability reflect the various steps of processing of a nociceptive stimulus, including peripheral nerve fiber recruitment, central synaptic summation, and habituation to a repeated stimulus.
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12
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Xu A, Larsen B, Henn A, Baller EB, Scott JC, Sharma V, Adebimpe A, Basbaum AI, Corder G, Dworkin RH, Edwards RR, Woolf CJ, Eickhoff SB, Eickhoff CR, Satterthwaite TD. Brain Responses to Noxious Stimuli in Patients With Chronic Pain: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2032236. [PMID: 33399857 PMCID: PMC7786252 DOI: 10.1001/jamanetworkopen.2020.32236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Functional neuroimaging is a valuable tool for understanding how patients with chronic pain respond to painful stimuli. However, past studies have reported heterogenous results, highlighting opportunities for a quantitative meta-analysis to integrate existing data and delineate consistent associations across studies. OBJECTIVE To identify differential brain responses to noxious stimuli in patients with chronic pain using functional magnetic resonance imaging (fMRI) while adhering to current best practices for neuroimaging meta-analyses. DATA SOURCES All fMRI experiments published from January 1, 1990, to May 28, 2019, were identified in a literature search of PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, PsycINFO, and SCOPUS. STUDY SELECTION Experiments comparing brain responses to noxious stimuli in fMRI between patients and controls were selected if they reported whole-brain results, included at least 10 patients and 10 healthy control participants, and used adequate statistical thresholding (voxel-height P < .001 or cluster-corrected P < .05). Two independent reviewers evaluated titles and abstracts returned by the search. In total, 3682 abstracts were screened, and 1129 full-text articles were evaluated. DATA EXTRACTION AND SYNTHESIS Thirty-seven experiments from 29 articles met inclusion criteria for meta-analysis. Coordinates reporting significant activation differences between patients with chronic pain and healthy controls were extracted. These data were meta-analyzed using activation likelihood estimation. Data were analyzed from December 2019 to February 2020. MAIN OUTCOMES AND MEASURES A whole-brain meta-analysis evaluated whether reported differences in brain activation in response to noxious stimuli between patients and healthy controls were spatially convergent. Follow-up analyses examined the directionality of any differences. Finally, an exploratory (nonpreregistered) region-of-interest analysis examined differences within the pain network. RESULTS The 37 experiments from 29 unique articles included a total of 511 patients and 433 controls (944 participants). Whole-brain meta-analyses did not reveal significant differences between patients and controls in brain responses to noxious stimuli at the preregistered statistical threshold. However, exploratory analyses restricted to the pain network revealed aberrant activity in patients. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, preregistered, whole-brain analyses did not reveal aberrant fMRI activity in patients with chronic pain. Exploratory analyses suggested that subtle, spatially diffuse differences may exist within the pain network. Future work on chronic pain biomarkers may benefit from focus on this core set of pain-responsive areas.
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Affiliation(s)
- Anna Xu
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Alina Henn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen University, Aachen, Germany
| | - Erica B. Baller
- Department of Psychiatry, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard University, Boston, Massachusetts
| | - J. Cobb Scott
- Department of Psychiatry, University of Pennsylvania, Philadelphia
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA (Veterans Affairs) Medical Center, Philadelphia, Pennsylvania
| | - Vaishnavi Sharma
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Azeez Adebimpe
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | | | - Gregory Corder
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts
| | - Simon B. Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour Sections, Research Centre Jülich, Jülich, Germany
| | - Claudia R. Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour Sections, Research Centre Jülich, Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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13
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Wei XY, Chen H, Guo C, Tan WL, Zhan SH. The Instant and Sustained Effect of Electroacupuncture in Postgraduate Students with Depression: An fMRI Study. Neuropsychiatr Dis Treat 2021; 17:873-883. [PMID: 33776442 PMCID: PMC7989050 DOI: 10.2147/ndt.s307083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTION This study was a primary study to evaluate the instant and sustained effect of electroacupuncture (EA) at GV20 (Baihui) in postgraduate students with mild depression by using a special flexible head coil. METHODS A total of 20 postgraduate students with mild depression underwent EA stimulation at GV20 and 3 phases of resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Phase I: Preparation (before needle insertion); Phase II: during EA; Phase III: 15 minutes after needle removal. The Rs-fMRI data were processed using DPABI and SPSS 25. RESULTS 1) ReHo values showed significantly differences in the right posterior cingulate cortex, right calcarine gyrus, right angular gyrus, right precuneus, right cuneus, and bilateral postcentral gyri among Phase I, Phase II and Phase III; 2) Relative to the Phase I, increased brain activity in the Phase II was observed in the bilateral postcentral gyri, right calcarine gyrus, right cuneus. Compared with the Phase II, decreased brain activity in the Phase III was observed in the right precuneus, right posterior cingulate cortex, right angular gyrus. Relative to the Phase I, Significantly increased brain activity in the Phase III was observed in the right calcarine gyrus, right cuneus, and bilateral postcentral gyri. While decreased ReHo values were found in the right posterior cingulate cortex, right angular gyrus, right precuneus; and 3) Correlation analysis showed that the ReHo values of multiple brain regions in Phase I and Phase III were significantly correlated with the VAS and HRSD-17 scores. CONCLUSION This study focuses on the instant and sustained effect in postgraduate students with depression. Our study showed that instant effect produced by EA stimulation at GV20 firstly induced changes in somatosensory and visual area, and then, sustained effect (Phase III) have a higher intensity and more extensive than instant effects. Meanwhile, we provide a visualization way to study the instant effects of head acupoints by using a flexible head coil.
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Affiliation(s)
- Xiang-Yu Wei
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Cui Guo
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Wen-Li Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Song-Hua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
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14
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Differential neural processing of unpleasant sensory stimulation in patients with major depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:557-565. [PMID: 32279144 PMCID: PMC7981307 DOI: 10.1007/s00406-020-01123-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD.
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15
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Weng LM, Wu B, Chen CC, Wang J, Peng MS, Zhang ZJ, Wang XQ. Association of Chronic Low Back Pain With Personal Space Regulation. Front Psychiatry 2021; 12:719271. [PMID: 34975558 PMCID: PMC8714678 DOI: 10.3389/fpsyt.2021.719271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background: While most previous studies regarding patients with chronic low back pain (CLBP) mainly focused on pain, disability, psychological damage, and intervention measures, the effect of CLBP on personal space remains unclear. The study aimed to assess the personal space of patients with CLBP and healthy controls, explored the differences between the two groups, and examined whether pain, dysfunction, anxiety, and depression affected the personal space regulation. Methods: The cross-sectional study recruited 24 patients with CLBP and 24 healthy controls at Shanghai Shangti Orthopedic Hospital and Shanghai University of Sport, Shanghai, China, from December 2018 to January 2019. A stop-distance paradigm was applied to measure the comfortable and uncomfortable distance under four conditions. A self-rating anxiety scale (SAS) and a self-rating depression scale (SDS) were used to examine the anxiety and depression levels of all participants. The pain intensity and dysfunction in the CLBP group were evaluated by the numeric rating scale and Roland-Morris questionnaire (RMDQ), respectively. Results: When approaching another individual or when being approached, the interpersonal distance under all the conditions in the CLBP group significantly differed from that in the healthy control group with larger space distances (p < 0.01). Gender had a significant main effect on the regulation of personal space in patients with CLBP (p < 0.05). The average pain intensity, scores on RMDQ, SAS, and SDS had a significant positive correlation with the interpersonal distance under the Same or Opposite Gender condition (p < 0.05). Conclusion: People with CLBP show an atypical personal space behavior and indeed have a greater interpersonal distance to strangers. The higher the pain intensity, dysfunction, anxiety, and depression, the greater the interpersonal distance in patients with CLBP. In the future, the effect and underlying neural mechanisms of pain and negative emotions on social withdrawal in patients should be examined.
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Affiliation(s)
- Lin-Man Weng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Bao Wu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Chang-Cheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Juan Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Meng-Si Peng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
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16
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Eken A, Çolak B, Bal NB, Kuşman A, Kızılpınar SÇ, Akaslan DS, Baskak B. Hyperparameter-tuned prediction of somatic symptom disorder using functional near-infrared spectroscopy-based dynamic functional connectivity. J Neural Eng 2019; 17:016012. [DOI: 10.1088/1741-2552/ab50b2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med 2019; 131:438-444. [DOI: 10.1080/00325481.2019.1663705] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Panagiotis Zis
- Department of Neurology, Medical School, University of Cyprus, Aglantzia, Nicosia, Cyprus
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18
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Bilek E, Zang Z, Wolf I, Henrich F, Moessnang C, Braun U, Treede RD, Magerl W, Meyer-Lindenberg A, Tost H. Neural network-based alterations during repetitive heat pain stimulation in major depression. Eur Neuropsychopharmacol 2019; 29:1033-1040. [PMID: 31320209 DOI: 10.1016/j.euroneuro.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/30/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
The current study aimed to identify alterations in brain activation and connectivity related to nociceptive processing and pain sensitization in major depressive disorder (MDD), using repetitive heat pain stimulation during functional magnetic resonance imaging (fMRI) in 37 MDD patients and 33 healthy controls. Regional activation did not differ between groups, but functional connectivity was significantly decreased in MDD in a neural network connecting frontal, temporal and occipital areas (family-wise error-corrected pFWE = 0.045). Supporting analyses suggested a significant association between network connectivity and trait neuroticism (p = 0.007) but not with the clinical state or familiar risk of MDD (all p values > 0.13). Our data relate a network-based phenotype for altered pain processing and antinociceptive control to MDD and encourage future studies on the shared intermediate neural psychological risk architecture of MDD and chronic pain.
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Affiliation(s)
- Edda Bilek
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Isabella Wolf
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florian Henrich
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Urs Braun
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Walter Magerl
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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19
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Calvo Lobo C, Vilar-Fernández JM, Losa-Iglesias ME, López-López D, Rodríguez-Sanz D, Palomo-López P, Becerro-de Bengoa-Vallejo R. Depression Symptoms Among Older Adults With and Without Subacute Low Back Pain. Rehabil Nurs 2019; 44:47-51. [PMID: 30586021 DOI: 10.1097/rnj.0000000000000137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Lumbago, or low back pain (LBP), is a common musculoskeletal complaint among older adults that may also be associated with depression. The study objective was to investigate differences in Beck Depression Inventory depression symptoms scores among older adult patients with and without LBP. DESIGN This was a case-control study. METHODS A total of 152 older adult patients, recruited at an outpatient healthcare clinic (47 men, 105 women; 74.81 ± 6.9 years), were classified as having subacute LBP (n = 76) or non-LBP (n = 76) according to clinic records. FINDINGS Beck Depression Inventory scores (mean ± SD) among LBP patients (10.93 ± 6.18) were significantly higher compared to the non-LBP group (7.62 ± 5.70; p = .000085), whose scores indicated no depression symptoms. CONCLUSION Subacute LBP may represent a potential risk for increased depression among older adults. CLINICAL RELEVANCE Early detection of depression will assist rehabilitation nurses in prescribing the beneficial physical rehabilitation and exercise programs or provide the information and treatment recommendations to older adults with subacute LBP and their families. Also, it should be part of a nursing staff prevention strategy for patients who suffer this common musculoskeletal disorder.
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Affiliation(s)
- César Calvo Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | | | | | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, A Coruña, Spain
| | - David Rodríguez-Sanz
- Department of Physical Therapy and Podiatry, Physical Therapy and Health Sciences, Research Group, Universidad Europea de Madrid, Madrid
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20
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Xiang A, Yu Y, Jia X, Ma H, Liu H, Zhang Y, Rong J, Liu S. The low-frequency BOLD signal oscillation response in the insular associated to immediate analgesia of ankle acupuncture in patients with chronic low back pain. J Pain Res 2019; 12:841-850. [PMID: 30881095 PMCID: PMC6400126 DOI: 10.2147/jpr.s189390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The present study evaluated the modulation effect of a painless acupuncture technique, ankle acupuncture (AA), on resting-state functional change in patients with chronic low back pain (CLBP). Patients and methods Fourteen participants diagnosed with CLBP received AA and underwent one brain functional image scan after tactile stimulation and another one following the insertion of the needle. The needling sensations and clinical pain intensities were evaluated after the end of each functional image scan. The significance levels of Visual Analog Scales/Scores (VASs) before and after acupuncture were determined using paired t-test. The brain areas showing differences in the amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) between the two scans were identified. We also explored the relationship between mean ALFF values in brain areas identified and VAS scores based on Pearson correlation coefficient. Results A complete-case analysis was performed on 12 participants. Neither different needling sensations nor any local sensations during the two scans was found. The clinical findings indicated that the scores of VAS scores were significantly lower after AA intervention (P<0.001). Compared with those after tactile stimulation, ALFF decreased in the left insular and increased in the left precuneus and right precentral gyrus, and fALFF decreased in the left insular, during retaining of AA (corrected). Moreover, there was a positive correlation found between mean ALFF change in the left insular and that of VAS values (P<0.05). Conclusion The present study demonstrated the low-frequency BOLD signal oscillation response in the left insular in brain activity was associated with an immediate analgesia of AA in patients with CLBP, which provides new insights into intrinsic connections between low-frequency brain signals and analgesic effects of acupuncture.
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Affiliation(s)
- Anfeng Xiang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China,
| | - Yang Yu
- Department of Psychiatry, the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xize Jia
- Center for Cognition and Brain Disorders, Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, China
| | - Huibin Ma
- School of Information and Electronics Technology, Jiamusi University, Heilongjiang, China.,Integrated Medical Research School, Jiamusi University, Heilongjiang, China
| | - Hui Liu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China,
| | - Yu Zhang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China,
| | - Jun Rong
- Department of Sports Rehabilitation, Hangzhou Red Cross Hospital, Zhejiang, China,
| | - Sheng Liu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China,
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21
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22
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Bauch EM, Andreou C, Rausch VH, Bunzeck N. Neural Habituation to Painful Stimuli Is Modulated by Dopamine: Evidence from a Pharmacological fMRI Study. Front Hum Neurosci 2017; 11:630. [PMID: 29311880 PMCID: PMC5742644 DOI: 10.3389/fnhum.2017.00630] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Abstract
In constantly changing environments, it is crucial to adaptively respond to threatening events. In particular, painful stimuli are not only processed in terms of their absolute intensity, but also with respect to their context. While contextual pain processing can simply entail the repeated processing of information (i.e., habituation), it can, in a more complex form, be expressed through predictions of magnitude before the delivery of nociceptive information (i.e., adaptive coding). Here, we investigated the brain regions involved in the adaptation to nociceptive electrical stimulation as well as their link to dopaminergic neurotransmission (placebo/haloperidol). The main finding is that haloperidol changed the habituation to the absolute pain intensity over time. More precisely, in the placebo condition, activity in left postcentral gyrus and midcingulate cortex increased linearly with pain intensity only in the beginning of the experiment and subsequently habituated. In contrast, when the dopaminergic system was blocked by haloperidol, a linear increase with pain intensity was present throughout the entire experiment. Finally, there were no adaptive coding effects in any brain regions. Together, our findings provide novel insights into the nature of pain processing by suggesting that dopaminergic neurotransmission plays a specific role for the habituation to painful stimuli over time.
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Affiliation(s)
- Eva M Bauch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Medical School Hamburg (MSH), University of Applied Science and Medical University, Hamburg, Germany
| | - Christina Andreou
- Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Vanessa H Rausch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico Bunzeck
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Psychology I, University of Lübeck, Lübeck, Germany
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23
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Educational achievement and traits emotional stability and agreeableness as predictors of the occurrence of backache in adulthood. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Dayan L, Hochberg U, Nahman-Averbuch H, Brill S, Ablin JN, Jacob G. Increased Sympathetic Outflow Induces Adaptation to Acute Experimental Pain. Pain Pract 2017. [PMID: 28627793 DOI: 10.1111/papr.12606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are interrelationships between the autonomic nervous system and pain. This study aims to explore the effect of different autonomic manipulations on pain perception and modulation. METHODS Twenty healthy subjects (10 men and 10 women, mean age 25 ± 3 years) participated in this single-blinded, semi-randomized, controlled study, which included 2 study visits. Warm detection thresholds, heat pain thresholds, conditioned pain modulation (CPM), and pain adaptation were tested before and after administration of phenylephrine, clonidine, yohimbine, and saline. RESULTS Changes in heart rate and blood pressure were found after all the pharmacological interventions. The only effect on pain measures was that yohimbine enhanced pain adaptation capacity while phenylephrine reduced it (P = 0.032). Several significant correlations were found between autonomic and pain parameters; greater decreases in heart rate after phenylephrine were associated with reduced pain ratings (r2 = 0.288, P = 0.018). In addition, enhanced pain adaptation was associated with higher total vascular resistance (r2 = 0.442, P = 0.01). CONCLUSIONS Different effects of acute autonomic manipulations on experimental pain were found: an increase in sympathetic tone induced by yohimbine led to reduced pain sensitivity; a decrease in sympathetic tone with no effect on vagal-parasympathetic tone induced by phenylephrine led to reduction in pain adaptation capacity; and a decrease in sympathetic tone and increase in vagal parasympathetic tone by clonidine led to no change in pain adaptation capacity. While increased sympathetic outflow does facilitate pain adaptation, activation of either the sympathetic or parasympathetic limbs of the autonomic nervous system does not affect pain thresholds or CPM. Finally, a correlation exists between nociception and cardiovascular parameters only due to baroreflex activation.
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Affiliation(s)
- Lior Dayan
- Department of Anesthesia and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Hochberg
- Department of Anesthesia and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Silviu Brill
- Department of Anesthesia and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob N Ablin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Giris Jacob
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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25
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Abstract
The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI.
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Affiliation(s)
- Katherine T Martucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab (SNAPL), 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304-1345, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab (SNAPL), 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304-1345, USA.
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26
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Calvo-Lobo C, Vilar Fernández JM, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Palomo López P, López López D. Relationship of depression in participants with nonspecific acute or subacute low back pain and no-pain by age distribution. J Pain Res 2017; 10:129-135. [PMID: 28138263 PMCID: PMC5238758 DOI: 10.2147/jpr.s122255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Nonspecific low back pain (LBP) is the most prevalent musculoskeletal condition in various age ranges and is associated with depression. The aim of this study was to determine the Beck Depression Inventory (BDI) scores in participants with nonspecific LBP and no-pain by age distribution. METHODS A case-control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the following age categories: 19-24 (n=11), 25-39 (n=66), 40-64 (n=90), 65-79 (n=124), and ≥80 (n=41) years was recruited from domiciliary visits and an outpatient clinic. The BDI scores were self-reported in participants with nonspecific acute or subacute (≤3 months) LBP (n=166) and no-pain (n=166). RESULTS The BDI scores, mean ± standard deviation, showed statistically significant differences (p<0.001) between participants with nonspecific acute or subacute LBP (9.590±6.370) and no-pain (5.825±5.113). Significantly higher BDI scores were obtained from participants with nonspecific acute and subacute LBP in those aged 40-64 years (p<0.001; 9.140±6.074 vs 4.700±3.777) and 65-79 years (p<0.001; 10.672±6.126 vs 6.210±5.052). Differences were not significant in younger patients aged 19-24 (p=0.494; 5.000±2.646 vs 8.250±7.498), 25-39 (p=0.138; 5.440±5.245 vs 3.634±4.397), and in those aged ≥80 years (p=0.094; 13.625±6.1331 vs 10.440±5.591). CONCLUSION Participants with nonspecific acute and subacute LBP present higher BDI depression scores, influenced by age distribution. Specifically, patients in the age range from 40 to 80 years with LBP could require more psychological care in addition to any medical or physical therapy. Nevertheless, physical factors, different outcomes, and larger sample size should be considered in future studies.
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Affiliation(s)
- Cesar Calvo-Lobo
- Physical Therapy Department, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid
| | | | | | | | - David Rodríguez-Sanz
- Physical Therapy & Health Sciences Research Group, Facultad de Ciencias de la Salud, el Ejercicio y el Deporte, Universidad Europea de Madrid, Madrid
| | | | - Daniel López López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, A Coruña, Spain
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27
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Thompson T, Correll CU, Gallop K, Vancampfort D, Stubbs B. Is Pain Perception Altered in People With Depression? A Systematic Review and Meta-Analysis of Experimental Pain Research. THE JOURNAL OF PAIN 2016; 17:1257-1272. [PMID: 27589910 DOI: 10.1016/j.jpain.2016.08.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 12/23/2022]
Abstract
Although clinical studies suggest depressed patients may be more vulnerable to pain, experimental research is equivocal. This meta-analysis aimed to clarify whether depression is associated with altered pain perception in response to noxious stimulation and to identify factors that might influence this association. A search of major electronic databases was conducted to identify experimental studies investigating pain response in depressed participants versus healthy control participants using established pain outcome measures. Random effects meta-analysis of standardized mean differences was conducted on data from 32 studies (N = 1,317). For high-intensity noxious stimulation, overall pain tolerance was similar across depressed and control groups (Hedges g = .09, P = .71, studies = 10). For low-intensity stimulation, a small, but statistically significant higher mean sensory threshold (g = .35, P = .01, studies = 9) and pain threshold (g = .32, P = .02, studies = 25) was observed in depressed participants, suggesting diminished pain. However, considerable heterogeneity in the direction and magnitude of effects was observed, indicating a likely condition-specific effect of depression on pain. Subgroup analysis found that pain threshold/tolerance was increased in depression for exteroceptive (cutaneous) stimulation but decreased for interoceptive (ischemic) stimulation, but that substantial heterogeneity remained. Overall, results provide some support for altered pain processing in depression, but suggest this link is dependent upon modality and additional, unidentified factors. PERSPECTIVE This meta-analysis of experimental studies suggests potential effects of depression on pain perception are variable and likely to depend upon multiple factors. The contrasting pattern for ischemic versus other noxious stimuli suggests that stimulus modality is a key factor, which could help explain discrepancies across clinical and experimental findings.
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Affiliation(s)
- Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom.
| | - Christoph U Correll
- Zucker Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, New York
| | | | - Davy Vancampfort
- UPC Z.org, KU Leuven, Kortenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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28
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Reilly CC, Jolley CJ, Elston C, Moxham J, Rafferty GF. Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis. ERJ Open Res 2016; 2:00057-2015. [PMID: 27730171 PMCID: PMC5005154 DOI: 10.1183/23120541.00057-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/17/2016] [Indexed: 12/16/2022] Open
Abstract
The electromyogram recorded from the diaphragm (EMGdi) and parasternal intercostal muscle using surface electrodes (sEMGpara) provides a measure of neural respiratory drive (NRD), the magnitude of which reflects lung disease severity in stable cystic fibrosis. The aim of this study was to explore perception of NRD and breathlessness in both healthy individuals and patients with cystic fibrosis. Given chronic respiratory loading and increased NRD in cystic fibrosis, often in the absence of breathlessness at rest, we hypothesised that patients with cystic fibrosis would be able to tolerate higher levels of NRD for a given level of breathlessness compared to healthy individuals during exercise. 15 cystic fibrosis patients (mean forced expiratory volume in 1 s (FEV1) 53.5% predicted) and 15 age-matched, healthy controls were studied. Spirometry was measured in all subjects and lung volumes measured in the cystic fibrosis patients. EMGdi and sEMGpara were recorded at rest and during incremental cycle exercise to exhaustion and expressed as a percentage of maximum (% max) obtained from maximum respiratory manoeuvres. Borg breathlessness scores were recorded at rest and during each minute of exercise. EMGdi % max and sEMGpara % max and associated Borg breathlessness scores differed significantly between healthy subjects and cystic fibrosis patients at rest and during exercise. The relationship between EMGdi % max and sEMGpara % max and Borg score was shifted to the right in the cystic fibrosis patients, such that at comparable levels of EMGdi % max and sEMGpara % max the cystic fibrosis patients reported significantly lower Borg breathlessness scores compared to the healthy individuals. At Borg score 1 (clinically significant increase in breathlessness from baseline) corresponding levels of EMGdi % max (20.2±12% versus 32.15±15%, p=0.02) and sEMGpara % max (18.9±8% versus 29.2±15%, p=0.04) were lower in the healthy individuals compared to the cystic fibrosis patients. In the cystic fibrosis patients EMGdi % max at Borg score 1 was related to the degree of airways obstruction (FEV1) (r=−0.664, p=0.007) and hyperinflation (residual volume/total lung capacity) (r=0.710, p=0.03). This relationship was not observed for sEMGpara % max. These data suggest that compared to healthy individuals, patients with cystic fibrosis can tolerate much higher levels of NRD before increases in breathlessness from baseline become clinically significant. EMGdi % max and sEMGpara % max provide physiological tools with which to elucidate factors underlying inter-individual differences in breathlessness perception. Patients with CF can tolerate higher levels of NRD before breathlessness becomes clinically significanthttp://ow.ly/Xp2q3
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Affiliation(s)
- Charles C Reilly
- King's College London, Faculty of Life Sciences and Medicine, London, UK; King's College Hospital, Physiotherapy, London, UK
| | - Caroline J Jolley
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | | | - John Moxham
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Gerrard F Rafferty
- King's College London, Faculty of Life Sciences and Medicine, London, UK
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29
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Sex differences in the relationships between parasympathetic activity and pain modulation. Physiol Behav 2016; 154:40-8. [DOI: 10.1016/j.physbeh.2015.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/20/2015] [Accepted: 11/05/2015] [Indexed: 12/23/2022]
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30
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Nocebo context modulates long-term habituation to heat pain and influences functional connectivity of the operculum. Pain 2015; 156:2222-2233. [DOI: 10.1097/j.pain.0000000000000297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Abstract
Recent neuroimaging studies suggest that the brain adapts with pain, as well as imparts risk for developing chronic pain. Within this context, we revisit the concepts for nociception, acute and chronic pain, and negative moods relative to behavior selection. We redefine nociception as the mechanism protecting the organism from injury, while acute pain as failure of avoidant behavior, and a mesolimbic threshold process that gates the transformation of nociceptive activity to conscious pain. Adaptations in this threshold process are envisioned to be critical for development of chronic pain. We deconstruct chronic pain into four distinct phases, each with specific mechanisms, and outline current state of knowledge regarding these mechanisms: the limbic brain imparting risk, and the mesolimbic learning processes reorganizing the neocortex into a chronic pain state. Moreover, pain and negative moods are envisioned as a continuum of aversive behavioral learning, which enhance survival by protecting against threats.
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Affiliation(s)
- Marwan N Baliki
- Department of Physiology, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA.
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA; Department of Anesthesia, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA.
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32
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[Imaging techniques and pain]. Schmerz 2015; 29:539-43. [PMID: 26351124 DOI: 10.1007/s00482-015-0053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the last 15 years, functional brain imaging techniques have provided critical insights into cortical, subcortical and even spinal mechanisms involved in pain perception and pain modulation in humans. The pivotal contribution of brain imaging studies conducted in Germany have thereby been internationally acknowledged. One of the key challenges for the next decade is to shift the focus from studies in healthy volunteers to different clinical populations suffering from chronic pain to characterize CNS mechanisms, as well as neurobiological predictors and resilience factors of pain chronification. Ultimately, the knowledge gained by this work may help identify individual or syndrome-specific CNS changes as biomarkers to make therapeutic decisions.
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Schmidt K, Schunke O, Forkmann K, Bingel U. Enhanced short-term sensitization of facial compared with limb heat pain. THE JOURNAL OF PAIN 2015; 16:781-90. [PMID: 26043953 DOI: 10.1016/j.jpain.2015.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/05/2015] [Accepted: 05/18/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Habituation and sensitization are important features of individual sensitivity to repetitive noxious stimulation and have been investigated in numerous studies. However, it is unclear whether these phenomena vary depending on the site of stimulation. Here we compared short-term and long-term effects of painful heat stimulation on the forehead and limb using an established longitudinal heat pain paradigm performed over 8 consecutive days in 36 healthy volunteers. Participants were randomized into 2 groups; participants received repetitive heat pain stimulation either on the left volar forearm or on the left side of the forehead. Our data show a comparable degree of habituation over the course of 8 days in both groups. However, participants in the trigeminal stimulation group exhibited stronger within-session sensitization (indexed by a higher within-session increase in pain intensity ratings) than those who received the forearm stimulation. Furthermore, over the course of the experiment we found a correlation between habituation and anxiety, showing less habituation in participants with higher trait anxiety scores. Our findings are in line with somatotopic differences in response to painful stimulation and a higher proneness of trigeminal pain to sensitization processes, which might be explained by the biological relevance of the head and facial area for vital functions. The contribution of this sensitivity to the development and maintenance of clinical facial pain and headache disorders warrants further investigation. PERSPECTIVE This study uses psychophysical methods to evaluate the differences in long-term habituation and short-term sensitization to heat pain between the trigeminal and spinal systems. We found stronger sensitization for trigeminal compared with nociceptive stimuli on the forearm. The contribution of this sensitivity to clinical pain states warrants further investigation.
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Affiliation(s)
- Katharina Schmidt
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
| | - Odette Schunke
- University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Katarina Forkmann
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrike Bingel
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
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34
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Han C, Pae CU. Pain and depression: a neurobiological perspective of their relationship. Psychiatry Investig 2015; 12:1-8. [PMID: 25670939 PMCID: PMC4310906 DOI: 10.4306/pi.2015.12.1.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/13/2014] [Accepted: 03/13/2014] [Indexed: 11/25/2022] Open
Abstract
Remarkable progresses have been achieved regarding the understanding of the neurobiological bases of pain and depression. The principal role of neurotransmitters, neuromodulators, and neurohormones has been proposed in the development of pain and depression. With the progression of molecular biology, an intricate interaction among biological factors accountable to the development and management of pain and depression has been also shown in a numerous preclinical and clinical researches. This mini-review will briefly describe the current issues and future research direction for better understanding of the relationship between pain and depression.
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Affiliation(s)
- Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Republic of Korea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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35
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Martucci KT, Ng P, Mackey S. Neuroimaging chronic pain: what have we learned and where are we going? FUTURE NEUROLOGY 2014; 9:615-626. [PMID: 28163658 PMCID: PMC5289824 DOI: 10.2217/fnl.14.57] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advances in neuroimaging have helped illuminate our understanding of how the brain works in the presence of chronic pain, which often persists with unknown etiology or after the painful stimulus has been removed and any wounds have healed. Neuroimaging has enabled us to make great progress in identifying many of the neural mechanisms that contribute to chronic pain, and to pinpoint the specific regions of the brain that are activated in the presence of chronic pain. It has provided us with a new perception of the nature of chronic pain in general, leading researchers to move toward a whole-brain approach to the study and treatment of chronic pain, and to develop novel technologies and analysis techniques, with real potential for developing new diagnostics and more effective therapies. We review the use of neuroimaging in the study of chronic pain, with particular emphasis on magnetic resonance imaging.
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Affiliation(s)
- Katherine T Martucci
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Pamela Ng
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
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