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Gilliam JR, Sahu PK, Vendemia JMC, Silfies SP. Association between seated trunk control and cortical sensorimotor white matter brain changes in patients with chronic low back pain. PLoS One 2024; 19:e0309344. [PMID: 39208294 PMCID: PMC11361694 DOI: 10.1371/journal.pone.0309344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024] Open
Abstract
Trunk control involves integration of sensorimotor information in the brain. Individuals with chronic low back pain (cLBP) have impaired trunk control and show differences in brain structure and function in sensorimotor areas compared with healthy controls (HC). However, the relationship between brain structure and trunk control in this group is not well understood. This cross-sectional study aimed to compare seated trunk control and sensorimotor white matter (WM) structure in people with cLBP and HC and explore relationships between WM properties and trunk control in each group. Thirty-two people with cLBP and 35 HC were tested sitting on an unstable chair to isolate trunk control; performance was measured using the 95% confidence ellipse area (CEA95) of center-of-pressure tracing. A WM network between cortical sensorimotor regions of interest was derived using probabilistic tractography. WM microstructure and anatomical connectivity between cortical sensorimotor regions were assessed. A mixed-model ANOVA showed that people with cLBP had worse trunk control than HC (F = 12.96; p < .001; ηp2 = .091). There were no differences in WM microstructure or anatomical connectivity between groups (p = 0.564 to 0.940). In the cLBP group, WM microstructure was moderately correlated (|r| = .456 to .565; p ≤ .009) with trunk control. Additionally, the cLBP group demonstrated stronger relationships between anatomical connectivity and trunk control (|r| = .377 to .618 p < .034) compared to the HC group. Unique to the cLBP group, WM connectivity between right somatosensory and left motor areas highlights the importance of interhemispheric information exchange for trunk control. Parietal areas associated with attention and spatial reference frames were also relevant to trunk control. These findings suggest that people with cLBP adopt a more cortically driven sensorimotor integration strategy for trunk control. Future research should replicate these findings and identify interventions to effectively modulate this strategy.
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Affiliation(s)
- John R. Gilliam
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Pradeep K. Sahu
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Jennifer M. C. Vendemia
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Sheri P. Silfies
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
- Physical Therapy Program, University of South Carolina, Columbia, SC, United States of America
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Neumann N, Domin M, Lotze M. Gray matter volume of limbic brain structures during the development of chronic back pain: a longitudinal cohort study. Pain 2024:00006396-990000000-00686. [PMID: 39167465 DOI: 10.1097/j.pain.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/25/2024] [Indexed: 08/23/2024]
Abstract
ABSTRACT This study set out to investigate in a population-based longitudinal cohort, whether chronification of back pain (BP) is related to structural gray matter changes in corticolimbic brain structures. Gray matter volume (GMV) was measured in participants with chronic BP (CBP, n = 168) and controls without chronic pain (n = 323) at 2 time points with an interval of 7 years (baseline t1, follow-up t2). Over this time period, participants with CBP showed an increase of GMV in the left ventral striatum, whereas controls showed a decrease. By contrast, participants with CBP had a GMV decrease in the left parahippocampal gyrus. Within the CBP group, pain duration was negatively associated with GMV in the left caudate. Those with emerging CBP had less GMV in the right entorhinal area, right amygdala, and left medial frontal cortex. Additional variables differing between those who had BP at t1 and later developed CBP or not were pain intensity, body mass index, and depression score. In sum, these findings are in accordance with the notion that limbic brain properties are both predisposing risk factors and drivers of brain reorganization during the development of CBP.
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Affiliation(s)
- Nicola Neumann
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
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Mei J, Hu Y. Degree centrality-based resting-state functional magnetic resonance imaging explores central mechanisms in lumbar disc herniation patients with chronic low back pain. Front Neurol 2024; 15:1370398. [PMID: 38919971 PMCID: PMC11197982 DOI: 10.3389/fneur.2024.1370398] [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: 01/15/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Objective To investigate the central mechanism of lumbar disc herniation in patients with chronic low back pain (LDHCP) using resting-state functional magnetic resonance imaging (rs-fMRI) utilizing the Degree Centrality (DC) method. Methods Twenty-five LDHCP and twenty-two healthy controls (HCs) were enrolled, and rs-fMRI data from their brains were collected. We compared whole-brain DC values between the LDHCP and HC groups, and examined correlations between DC values within the LDHCP group and the Visual Analogue Score (VAS), Oswestry Dysfunction Index (ODI), and disease duration. Diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curve analysis. Results LDHCP patients exhibited increased DC values in the bilateral cerebellum and brainstem, whereas decreased DC values were noted in the left middle temporal gyrus and right post-central gyrus when compared with HCs. The DC values of the left middle temporal gyrus were positively correlated with VAS (r = 0.416, p = 0.039) and ODI (r = 0.405, p = 0.045), whereas there was no correlation with disease duration (p > 0.05). Other brain regions showed no significant correlations with VAS, ODI, or disease duration (p > 0.05). Furthermore, the results obtained from ROC curve analysis demonstrated that the Area Under the Curve (AUC) for the left middle temporal gyrus was 0.929. Conclusion The findings indicated local abnormalities in spontaneous neural activity and functional connectivity in the bilateral cerebellum, bilateral brainstem, left middle temporal gyrus, and right postcentral gyrus among LDHCP patients.
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Affiliation(s)
| | - Yong Hu
- Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Ito A, Yang S, Shinto E, Shinto A, Toyofuku A, Kurata J. Interhemispheric and Corticothalamic White-Matter Dysfunction Underlies Affective Morbidity and Impaired Pain Modulation in Chronic Pain. Anesth Analg 2024:00000539-990000000-00827. [PMID: 38837907 DOI: 10.1213/ane.0000000000006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Although patients with chronic pain show behavioral signs of impaired endogenous pain modulation, responsible cerebral networks have yet to be anatomically delineated. We used diffusion tensor imaging (DTI) to examine the white-matter alterations in patients with chronic pain compared with healthy subjects. We further measured thermal pain modulatory responses using the offset analgesia (OA) paradigm. We tested whether the white-matter indices be associated with psychophysical parameters reflecting morbidity and modulatory responses of pain in patients, and whether they could serve as diagnostic biomarkers of chronic pain. METHODS Twenty-six patients with chronic pain and 18 age- and gender-matched healthy controls were enrolled. After completing psychophysical questionnaires, they underwent OA measurement and whole-brain DTI in a 3 Tesla magnetic resonance imaging scanner. Fractional anisotropy (FA) and radial diffusivity (RD) of the white-matter were computed and compared between the groups with tract-based spatial statistics using the FMRIB Software Library (FSL) software. Correlations were sought among white-matter indices, thermal pain responses, and psychophysical parameters. The white-matter indices and OA-related parameters were tested whether they distinguish patients from controls by receiver operating characteristic analysis. RESULTS During OA, patients showed a shorter latency to the maximum (maximum visual analog scale [VAS] latency, 16.0 ± 3.7 vs 18.9 ± 3.1 second [mean ± standard deviation, SD]; P = .032) but a longer latency to the minimum pain (OA latency, 15.6 ± 3.5 vs 11.1 ± 4.2 seconds; P = .004) than controls. They showed a smaller mean FA (0.44 ± 0.12 vs 0.45 ± 0.11; P = .012) and a larger mean RD of the global white-matter (0.00057 ± 0.00002 vs 0.00056 ± 0.00002; P = .038) than controls, at specific areas including the corpus callosum, anterior thalamic radiation, and forceps major. FA of the splenium of the corpus callosum was associated with maximum VAS latency (r = 0.493) and OA latency (r = -0.552). The Pain Catastrophizing Scale scores showed strong negative correlations with FA across those specific areas (r = -0.405). Those latencies during OA and white-matter metrics distinguished patients from controls (P < .05). CONCLUSIONS Patients with chronic pain showed dysfunction of the white matter concerned with interhemispheric communication of sensorimotor information as well as descending corticothalamic modulation of pain in association with affective morbidity and altered temporal dynamics of pain perception. We suggest that an impaired interhemispheric modulation of pain, through the corpus callosum, might be a novel cerebral mechanism in chronification of pain.
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Affiliation(s)
- Atsushi Ito
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Sushuang Yang
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Eri Shinto
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Shinto
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Akira Toyofuku
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Jiro Kurata
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
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Mei YD, Gao H, Chen WF, Zhu W, Gu C, Zhang JP, Tao JM, Hua XY. Research on the multidimensional brain remodeling mechanisms at the level of brain regions, circuits, and networks in patients with chronic lower back pain caused by lumbar disk herniation. Front Neurosci 2024; 18:1357269. [PMID: 38516315 PMCID: PMC10956359 DOI: 10.3389/fnins.2024.1357269] [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: 12/17/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Chronic lower back pain (cLBP), frequently attributed to lumbar disk herniation (LDH), imposes substantial limitations on daily activities. Despite its prevalence, the neural mechanisms underlying lower back pain remain incompletely elucidated. Functional magnetic resonance imaging (fMRI) emerges as a non-invasive modality extensively employed for investigating neuroplastic changes in neuroscience. In this study, task-based and resting-state fMRI methodologies are employed to probe the central mechanisms of lower back pain. Methods The study included 71 chronic lower back pain patients (cLBP group) due to LDH and 80 age, gender, and education-matched healthy volunteers (HC group). The subjects are mainly middle-aged and elderly individuals. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Scores (JOA) were recorded. Resting-state and task-based fMRI data were collected. Results/discussion No significant differences were observed in age, gender, and education level between the two groups. In the cLBP group during task execution, there was diffuse and reduced activation observed in the primary motor cortex and supplementary motor area. Additionally, during resting states, notable changes were detected in brain regions, particularly in the frontal lobe, primary sensory area, primary motor cortex, precuneus, and caudate nucleus, accompanied by alterations in Amplitude of Low Frequency Fluctuation, Regional Homogeneity, Degree Centrality, and functional connectivity. These findings suggest that chronic lower back pain may entail reduced excitability in sensory-motor areas during tasks and heightened activity in the sensory-motor network during resting states, along with modified functional connectivity in various brain regions.
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Affiliation(s)
- Yuan-Dong Mei
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Hang Gao
- Department of Rehabilitation, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Fei Chen
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Wei Zhu
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Chen Gu
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Jun-Peng Zhang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji-Ming Tao
- Department of Rehabilitation, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kong Q, Li T, Reddy S, Hodges S, Kong J. Brain stimulation targets for chronic pain: Insights from meta-analysis, functional connectivity and literature review. Neurotherapeutics 2024; 21:e00297. [PMID: 38237403 PMCID: PMC10903102 DOI: 10.1016/j.neurot.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 02/16/2024] Open
Abstract
Noninvasive brain stimulation (NIBS) techniques have demonstrated their potential for chronic pain management, yet their efficacy exhibits variability across studies. Refining stimulation targets and exploring additional targets offer a possible solution to this challenge. This study aimed to identify potential brain surface targets for NIBS in treating chronic pain disorders by integrating literature review, neuroimaging meta-analysis, and functional connectivity analysis on 90 chronic low back pain patients. Our results showed that the primary motor cortex (M1) (C3/C4, 10-20 EEG system) and prefrontal cortex (F3/F4/Fz) were the most used brain stimulation targets for chronic pain treatment according to the literature review. The bilateral precentral gyrus (M1), supplementary motor area, Rolandic operculum, and temporoparietal junction, were all identified as common potential NIBS targets through both a meta-analysis sourced from Neurosynth and functional connectivity analysis. This study presents a comprehensive summary of the current literature and refines the existing NIBS targets through a combination of imaging meta-analysis and functional connectivity analysis for chronic pain conditions. The derived coordinates (with integration of the international electroencephalography (EEG) 10/20 electrode placement system) within the above brain regions may further facilitate the localization of these targets for NIBS application. Our findings may have the potential to expand NIBS target selection beyond current clinical trials and improve chronic pain treatment.
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Affiliation(s)
- Qiao Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Tingting Li
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Sveta Reddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Sierra Hodges
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
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Cook KM, De Asis-Cruz J, Kim JH, Basu SK, Andescavage N, Murnick J, Spoehr E, Liggett M, du Plessis AJ, Limperopoulos C. Experience of early-life pain in premature infants is associated with atypical cerebellar development and later neurodevelopmental deficits. BMC Med 2023; 21:435. [PMID: 37957651 PMCID: PMC10644599 DOI: 10.1186/s12916-023-03141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits. METHODS Resting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment. RESULTS We observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months. CONCLUSIONS These results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.
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Affiliation(s)
- Kevin M Cook
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Sudeepta K Basu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jonathan Murnick
- Dept. of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, D.C, 20010, USA
| | - Emma Spoehr
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Melissa Liggett
- Division of Psychology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
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Zhou XC, Huang YB, Wu S, Hong SW, Tian Y, Hu HJ, Lv LJ, Lv ZZ. Lever positioning manipulation alters real-time brain activity in patients with lumbar disc herniation: An amplitude of low-frequency fluctuation and regional homogeneity study. Psychiatry Res Neuroimaging 2023; 334:111674. [PMID: 37413860 DOI: 10.1016/j.pscychresns.2023.111674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Lumbar disk herniation (LDH) is the preeminent disease of lever positioning manipulation (LPM), a complex disorder involving alterations in brain function. Resting-state functional magnetic resonance imaging (rs-fMRI) has the advantages of non-trauma, zero radiation, and high spatial resolution, which has become an effective means to study brain science in contemporary physical therapy. Furthermore, it can better elucidate the response characteristics of the brain region of LPM intervention in LDH. We utilized two data analysis methods, the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) of rs-fMRI, to assess the effects of LPM on real-time brain activity in patients with LDH. METHODS Patients with LDH (Group 1, n = 21) and age-, gender- and education-matched healthy controls without LDH (Group 2, n = 21) were prospectively enrolled. Brain fMRI was performed for Group 1 at two-time points (TPs): before LPM (TP1) and after one LPM session (TP2). The healthy controls (Group 2) did not receive LPM and underwent only one fMRI scan. Participants in Group 1 completed clinical questionnaires assessing pain and functional disorders using a Visual Analog Scale and the Japanese Orthopaedic Association (JOA), respectively. Furthermore, we employed MNL90 (Montreal Neurological Institute) as a brain-specific template. RESULTS Compared to the healthy controls (Group 2), the patients with LDH (Group 1) had significant variation in ALFF and ReHo values in brain activity. After the LPM session (TP2), Group 1 at TP1 also showed significant variation in ALFF and ReHo values in brain activity. In addition, the latter (TP2 vs TP1) showed more significant changes in brain regions than the former (Group 1 vs Group 2). The ALFF values were increased in the Frontal_Mid_R and decreased in the Precentral_L in Group 1 at TP2 compared with TP1. The Reho values were increased in the Frontal_Mid_R and decreased in the Precentral_L in Group 1 at TP2 compared with TP1. The ALFF values were increased in the Precuneus_R and decreased in the Frontal_Mid_Orb_L in Group 1 compared with Group 2. Only three brain areas with significant activity in Group 1 compared with Group 2: Frontal_Mid_Orb_L, Frontal_Sup_Orb_L, and Frontal_Mid_R. ALFF value in the Frontal_Mid_R at TP2 correlated positively with the change rates of JOA scores between TP1 and TP2 (P = 0.04, r = 0.319, R2 = 0.102). DISCUSSION Patients with LDH showed abnormal brain ALFF and ReHo values, which were altered after LPM. The default mode network, prefrontal cortex, and primary somatosensory cortex regions could predict real-time brain activity for sensory and emotional pain management in patients with LDH after LPM.
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Affiliation(s)
- Xing-Chen Zhou
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yu-Bo Huang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Shuang Wu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Shuang-Wei Hong
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yu Tian
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Hui-Jie Hu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Li-Jiang Lv
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China.
| | - Zhi-Zhen Lv
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Research Institute of Spinal manipulation, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China; Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, Zhejiang, China.
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Zhang C, Chen X, Yin Y, Xie D, Luo J, Ai Y, Zhan W, Kan H, Zhang S, Jiang G, Hu X. Functional Alterations of the Basal Ganglia Are Associated with Voluntary Activation of the Core Stabilizing Muscles in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Pain Res Manag 2023; 2023:2028379. [PMID: 37693681 PMCID: PMC10484657 DOI: 10.1155/2023/2028379] [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: 04/17/2023] [Revised: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
Purpose Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP. Methods We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients. Results Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level p < 0.005, Gaussian random field-corrected p < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all p < 0.050). Conclusions Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.
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Affiliation(s)
- Chanjuan Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Dongfeng Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Hongjun Kan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Shuxian Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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Li Y, Xu Z, Xie H, Fu R, Lo WLA, Cheng X, Yang J, Ge L, Yu Q, Wang C. Changes in cortical activation during upright stance in individuals with chronic low back pain: An fNIRS study. Front Hum Neurosci 2023; 17:1085831. [PMID: 36816497 PMCID: PMC9936824 DOI: 10.3389/fnhum.2023.1085831] [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: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Postural control deficits are a potential cause of persistent and recurrent pain in patients with chronic low back pain (CLBP). Although some studies have confirmed that the dorsolateral prefrontal cortex (DLPFC) contributes to pain regulation in CLBP, its role in the postural control of patients with CLBP remains unclear. Therefore, this study aimed to investigate the DLPFC activation of patients with CLBP and healthy controls under different upright stance task conditions. Methods Twenty patients with CLBP (26.50 ± 2.48 years) and 20 healthy controls (25.75 ± 3.57 years) performed upright stance tasks under three conditions: Task-1 was static balance with eyes open; Task-2 was static balance with eyes closed; Task-3 involved dynamic balance on an unstable surface with eyes open. A wireless functional near-infrared spectroscopy (fNIRS) system measured cortical activity, including the bilateral DLPFC, pre-motor cortex (PMC) and supplementary motor area (SMA), the primary motor cortex (M1), the primary somatosensory cortex (S1), and a force platform measured balance parameters during upright stance. Results The two-way repeated measures ANOVA results showed significant interaction in bilateral PMC/SMA activation. Moreover, patients with CLBP had significantly increased right DLPFC activation and higher sway 32 area and velocity than healthy controls during upright stance. Discussion Our results imply that PMC/SMA and DLPFC maintain standing balance. The patients with CLBP have higher cortical activity and upright stance control deficits, which may indicate that the patients with CLBP have low neural efficiency and need more motor resources to maintain balance.
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11
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Liu N, Li Y, Hong Y, Huo J, Chang T, Wang H, Huang Y, Li W, Zhang Y. Altered brain activities in mesocorticolimbic pathway in primary dysmenorrhea patients of long-term menstrual pain. Front Neurosci 2023; 17:1098573. [PMID: 36793538 PMCID: PMC9922713 DOI: 10.3389/fnins.2023.1098573] [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: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
Background Patients with primary dysmenorrhea (PDM) often present with abnormalities other than dysmenorrhea including co-occurrence with other chronic pain conditions and central sensitization. Changes in brain activity in PDM have been demonstrated; however, the results are not consistent. Herein, this study probed into altered intraregional and interregional brain activity in patients with PDM and expounded more findings. Methods A total of 33 patients with PDM and 36 healthy controls (HCs) were recruited and underwent a resting-state functional magnetic resonance imaging scan. Regional homogeneity (ReHo) and mean amplitude of low-frequency fluctuation (mALFF) analysis were applied to compare the difference in intraregional brain activity between the two groups, and the regions with ReHo and mALFF group differences were used as seeds for functional connectivity (FC) analysis to explore the difference of interregional activity. Pearson's correlation analysis was conducted between rs-fMRI data and clinical symptoms in patients with PDM. Results Compared with HCs, patients with PDM showed altered intraregional activity in a series of brain regions, including the hippocampus, the temporal pole superior temporal gyrus, the nucleus accumbens, the pregenual anterior cingulate cortex, the cerebellum_8, the middle temporal gyrus, the inferior temporal gyrus, the rolandic operculum, the postcentral gyrus and the middle frontal gyrus (MFG), and altered interregional FC mainly between regions of the mesocorticolimbic pathway and regions associated with sensation and movement. The anxiety symptoms are correlated with the intraregional activity of the right temporal pole superior temporal gyrus and FC between MFG and superior frontal gyrus. Conclusion Our study showed a more comprehensive method to explore changes in brain activity in PDM. We found that the mesocorticolimbic pathway might play a key role in the chronic transformation of pain in PDM. We, therefore, speculate that the modulation of the mesocorticolimbic pathway may be a potential novel therapeutic mechanism for PDM.
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Affiliation(s)
- Ni Liu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yingqiu Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yueying Hong
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jianwei Huo
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Tai Chang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Haoyuan Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yiran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wenxun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China,Wenxun Li ✉
| | - Yanan Zhang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China,*Correspondence: Yanan Zhang ✉
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12
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Adhia DB, Mani R, Mathew J, O'Leary F, Smith M, Vanneste S, De Ridder D. Exploring electroencephalographic infraslow neurofeedback treatment for chronic low back pain: a double-blinded safety and feasibility randomized placebo-controlled trial. Sci Rep 2023; 13:1177. [PMID: 36670176 PMCID: PMC9860016 DOI: 10.1038/s41598-023-28344-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Chronic low back pain (CLBP) is a disabling condition worldwide. In CLBP, neuroimaging studies demonstrate abnormal activities in cortical areas responsible for pain modulation, emotional, and sensory components of pain experience [i.e., pregenual and dorsal anterior cingulate cortex (pgACC, dACC), and somatosensory cortex (SSC), respectively]. This pilot study, conducted in a university setting, evaluated the feasibility, safety, and acceptability of a novel electroencephalography-based infraslow-neurofeedback (EEG ISF-NF) technique for retraining activities in pgACC, dACC and SSC and explored its effects on pain and disability. Participants with CLBP (n = 60), recruited between July'20 to March'21, received 12 sessions of either: ISF-NF targeting pgACC, dACC + SSC, a ratio of pgACC*2/dACC + SSC, or Placebo-NF. Descriptive statistics demonstrated that ISF-NF training is feasible [recruitment rate (7 participants/month), dropouts (25%; 20-27%), and adherence (80%; 73-88%)], safe (no adverse events reported), and was moderate to highly acceptable [Mean ± SD: 7.8 ± 2.0 (pgACC), 7.5 ± 2.7 (dACC + SCC), 8.2 ± 1.9 (Ratio), and 7.7 ± 1.5 (Placebo)]. ISF-NF targeting pgACC demonstrated the most favourable clinical outcomes, with a higher proportion of participants exhibiting a clinically meaningful reduction in pain severity [53%; MD (95% CI): - 1.9 (- 2.7, - 1.0)], interference [80%; MD (95% CI): - 2.3 (- 3.5, - 1.2)], and disability [73%; MD (95% CI): - 4.5 (- 6.1, - 2.9)] at 1-month follow-up. ISF-NF training is a feasible, safe, and an acceptable treatment approach for CLBP.
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Affiliation(s)
- Divya Bharatkumar Adhia
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand. .,Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand. .,Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Ramakrishnan Mani
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jerin Mathew
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Finella O'Leary
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand
| | - Mark Smith
- Neurofeedback Therapy Services of New York, New York, NY, USA
| | - Sven Vanneste
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand.,Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
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13
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Wei X, Wang L, Yu F, Lee C, Liu N, Ren M, Tu J, Zhou H, Shi G, Wang X, Liu CZ. Identifying the neural marker of chronic sciatica using multimodal neuroimaging and machine learning analyses. Front Neurosci 2022; 16:1036487. [PMID: 36532276 PMCID: PMC9748090 DOI: 10.3389/fnins.2022.1036487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/14/2022] [Indexed: 09/02/2023] Open
Abstract
Introduction Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots. Neuroimaging studies have identified functional abnormalities in patients with chronic sciatica (CS). However, few studies have investigated the neural marker of CS using brain structure and the classification value of multidimensional neuroimaging features in CS patients is unclear. Methods Here, structural and resting-state functional magnetic resonance imaging (fMRI) was acquired for 34 CS patients and 36 matched healthy controls (HCs). We analyzed cortical surface area, cortical thickness, amplitude of low-frequency fluctuation (ALFF), regional homogeneity (REHO), between-regions functional connectivity (FC), and assessed the correlation between neuroimaging measures and clinical scores. Finally, the multimodal neuroimaging features were used to differentiate the CS patients and HC individuals by support vector machine (SVM) algorithm. Results Compared to HC, CS patients had a larger cortical surface area in the right banks of the superior temporal sulcus and rostral anterior cingulate; higher ALFF value in the left inferior frontal gyrus; enhanced FCs between somatomotor and ventral attention network. Three FCs values were associated with clinical pain scores. Furthermore, the three multimodal neuroimaging features with significant differences between groups and the SVM algorithm could classify CS patients and HC with an accuracy of 90.00%. Discussion Together, our findings revealed extensive reorganization of local functional properties, surface area, and network metrics in CS patients. The success of patient identification highlights the potential of using artificial intelligence and multimodal neuroimaging markers in chronic pain research.
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Affiliation(s)
- Xiaoya Wei
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Liqiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fangting Yu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chihkai Lee
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ni Liu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Mengmeng Ren
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Jianfeng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hang Zhou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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14
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Zhang YN, Xing XX, Chen L, Dong X, Pan HT, Hua XY, Wang K. Modification of the resting-state network involved at different stages of neuropathic pain. Neurosci Lett 2022; 789:136866. [PMID: 36075318 DOI: 10.1016/j.neulet.2022.136866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
Neuropathic pain (NeuP) is shown to be associated with abnormal changes in several specific brain regions. However, the large-scale interactivity of neuronal networks underlying the sensory and emotional abnormalities during NeuP remains unexplored. The present study aimed to explore the alterations in the relevant functional resting-state networks (RSNs) and their intra-networks at the different stages of NeuP based on resting-state functional magnetic resonance imaging (rs-fMRI). A NeuP rat model was established by chronic constriction injury (CCI). Three RSNs were identified to be associated with the NeuP, including the default mode network (DMN), sensorimotor network (SMN), and interoceptive network (IN). The functional connectivity (FC) of the left caudate putamen (CPu) within the DMN and the right piriform cortex within the IN were significantly reduced at the early stage of NeuP, when the maximum allodynia was apparent early, which reflected the suppressed function of the DMN and IN. At 4 weeks post-CCI, when negative emotions were present, the FC of the right insular cortex in the SMN and left visual cortex in the IN were significantly elevated, representing the increased excitability of both SMN and IN. Our study revealed the characteristic functional organization at the network level induced by NeuP and emphasized the role of SMN, DMN, and IN in the pathological mechanisms of NeuP.
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Affiliation(s)
- Ya-Nan Zhang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China
| | - Liu Chen
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xin Dong
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hao-Tian Pan
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China.
| | - Ke Wang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
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15
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Medrano-Escalada Y, Plaza-Manzano G, Fernández-de-las-Peñas C, Valera-Calero JA. Structural, Functional and Neurochemical Cortical Brain Changes Associated with Chronic Low Back Pain. Tomography 2022; 8:2153-2163. [PMID: 36136876 PMCID: PMC9498382 DOI: 10.3390/tomography8050180] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/19/2022] Open
Abstract
Chronic low back pain (CLBP) is one of the most prevalent musculoskeletal disorders, being one of the leading contributors to disability worldwide and involving an important economic and social burden. Up to 90% of CLBP is non-specific (not associated with specific injuries), with a chronicity expectation estimated at 10%. Currently, motivational and emotional central circuits are being investigated due to their role in CLBP persistency and chronification. Therefore, this narrative review aimed to summarize the evidence regarding the cortical brain changes described for proposing novel multidisciplinary approaches. Novel advances in neuroimaging techniques demonstrated structural (e.g., decrease in the grey matter located at the dorsolateral prefrontal cortex), functional (e.g., connectivity impairments in those areas involved in pain processing), and neurochemical changes (e.g., decrease in cerebral metabolites). In addition, significant changes were found in the primary somatosensory and motor cortex, contributing to the alteration of low back muscles activation and function.
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Affiliation(s)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-913-941-545
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
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16
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Adhia DB, Mani R, Reynolds JNJ, Vanneste S, De Ridder D. High-definition transcranial infraslow pink noise stimulation for chronic low back pain: protocol for a pilot, safety and feasibility randomised placebo-controlled trial. BMJ Open 2022; 12:e056842. [PMID: 35705354 PMCID: PMC9204463 DOI: 10.1136/bmjopen-2021-056842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a common disabling health condition. Current treatments demonstrate modest effects, warranting newer therapies. Brain imaging demonstrates altered electrical activities in cortical areas responsible for pain modulation, emotional and sensory components of pain experience. Treatments targeting to change electrical activities of these key brain regions may produce clinical benefits. This pilot study aims to (1) evaluate feasibility, safety and acceptability of a novel neuromodulation technique, high-definition transcranial infraslow pink noise stimulation (HD-tIPNS), in people with CLBP, (2) explore the trend of effect of HD-tIPNS on pain and function, and (3) derive treatment estimates to support sample size calculation for a fully powered trial should trends of effectiveness be present. METHODS AND ANALYSIS A pilot, triple-blinded randomised two-arm placebo-controlled parallel trial. Participants (n=40) with CLBP will be randomised to either sham stimulation or HD-tIPNS (targeting somatosensory cortex and dorsal and pregenual anterior cingulate cortex). Primary outcomes include feasibility and safety measures, and clinical outcomes of pain (Brief Pain Inventory) and disability (Roland-Morris disability questionnaire). Secondary measures include clinical, psychological, quantitative sensory testing and electroencephalography collected at baseline, immediately postintervention, and at 1-week, 1-month and 3 months postintervention. All data will be analysed descriptively. A nested qualitative study will assess participants perceptions about acceptability of intervention and analysed thematically. ETHICS AND DISSEMINATION Ethical approval has been obtained from Health and Disability Ethics Committee (Ref:20/NTB/67). Findings will be reported to regulatory and funding bodies, presented at conferences, and published in a scientific journal. TRIAL REGISTRATION NUMBER ACTRN12620000505909p.
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Affiliation(s)
- Divya Bharatkumar Adhia
- Department of Surgical Sciences, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - John N J Reynolds
- Department of Anatomy and the Brain Health Research Centre, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Sven Vanneste
- School of Psychology, Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Department of Surgical Sciences, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
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Mao CP, Wilson G, Cao J, Meshberg N, Huang Y, Kong J. Abnormal Anatomical and Functional Connectivity of the Thalamo-sensorimotor Circuit in Chronic Low Back Pain: Resting-state Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Study. Neuroscience 2022; 487:143-154. [PMID: 35134490 PMCID: PMC8930700 DOI: 10.1016/j.neuroscience.2022.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
Thalamocortical dysfunction is thought to underlie the pathophysiology of chronic pain revealed by electroencephalographic studies. The thalamus serves as a primary relay center to transmit sensory information and motor impulses via dense connections with the somatosensory and motor cortex. In this study, diffusion tensor imaging (DTI) (probabilistic tractography) and resting-state functional magnetic resonance imaging (functional connectivity) were used to characterize the anatomical and functional integrity of the thalamo-sensorimotor pathway in chronic low back pain (cLBP). Fifty-four patients with cLBP and 54 healthy controls were included. The results suggested significantly increased anatomical connectivity of the left thalamo-motor pathway characterized by probabilistic tractography in patients with cLBP. Moreover, there was significantly altered resting-state functional connectivity (rsFC) of bilateral thalamo-motor/somatosensory pathways in patients with cLBP as compared to healthy controls. We also detected a significant correlation between pain intensity during the MRI scan and rsFC of the right thalamo-somatosensory pathway in cLBP. Our findings highlight the involvement of the thalamo-sensorimotor circuit in the pathophysiology of cLBP.
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Affiliation(s)
- Cui Ping Mao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Nathaniel Meshberg
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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18
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Wu X, Yu W, Tian X, Liang Z, Su Y, Wang Z, Li X, Yang L, Shen J. Altered Posterior Cerebellar Lobule Connectivity With Perigenual Anterior Cingulate Cortex in Women With Primary Dysmenorrhea. Front Neurol 2021; 12:645616. [PMID: 34239492 PMCID: PMC8258113 DOI: 10.3389/fneur.2021.645616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: This study aimed to investigate the potential connectivity mechanism between the cerebellum and anterior cingulate cortex (ACC) and the cerebellar structure in primary dysmenorrhea (PDM). Methods: We applied the spatially unbiased infratentorial template (SUIT) of the cerebellum to obtain anatomical details of cerebellar lobules, upon which the functional connectivity (FC) between the cerebellar lobules and ACC subregions was analyzed and the gray matter (GM) volume of cerebellar lobules was measured by using voxel-based morphometry (VBM) in 35 PDM females and 38 age-matched healthy females. The potential relationship between the altered FC or GM volume and clinical information was also evaluated in PDM females. Results: PDM females showed higher connectivity between the left perigenual ACC (pACC) and lobule vermis_VI, between the left pACC and left lobule IX, and between right pACC and right cerebellar lobule VIIb than did the healthy controls. Compared with healthy controls, no altered GM volume was found in PDM females. No significant correlation was found between altered cerebellum–ACC FC and the clinical variables in the PDM females. Conclusion: PDM females have abnormal posterior cerebellar connectivity with pACC but no abnormal structural changes. ACC–cerebellar circuit disturbances might be involved in the PDM females.
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Affiliation(s)
- Xiaoyan Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,School of Psychology, South China Normal University, Guangzhou, China
| | - Wenjun Yu
- Precise Genome Engineering Center, School of Life Sciences, Guangzhou University, Guangzhou, China.,School of Education, Jinggangshan University, Jiangxi, China
| | - Xuwei Tian
- Department of Radiology, First People's Hospital of Kashgar, Xinjiang, China
| | - Zhiying Liang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yun Su
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhihui Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiumei Li
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li Yang
- Precise Genome Engineering Center, School of Life Sciences, Guangzhou University, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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19
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Yin T, Sun G, Tian Z, Liu M, Gao Y, Dong M, Wu F, Li Z, Liang F, Zeng F, Lan L. The Spontaneous Activity Pattern of the Middle Occipital Gyrus Predicts the Clinical Efficacy of Acupuncture Treatment for Migraine Without Aura. Front Neurol 2020; 11:588207. [PMID: 33240209 PMCID: PMC7680874 DOI: 10.3389/fneur.2020.588207] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The purpose of the present study was to explore whether and to what extent the neuroimaging markers could predict the relief of the symptoms of patients with migraine without aura (MWoA) following a 4-week acupuncture treatment period. In study 1, the advanced multivariate pattern analysis was applied to perform a classification analysis between 40 patients with MWoA and 40 healthy subjects (HS) based on the z-transformed amplitude of low-frequency fluctuation (zALFF) maps. In study 2, the meaningful classifying features were selected as predicting features and the support vector regression models were constructed to predict the clinical efficacy of acupuncture in reducing the frequency of migraine attacks and headache intensity in 40 patients with MWoA. In study 3, a region of interest-based comparison between the pre- and post-treatment zALFF maps was conducted in 33 patients with MwoA to assess the changes in predicting features after acupuncture intervention. The zALFF value of the foci in the bilateral middle occipital gyrus, right fusiform gyrus, left insula, and left superior cerebellum could discriminate patients with MWoA from HS with higher than 70% accuracy. The zALFF value of the clusters in the right and left middle occipital gyrus could effectively predict the relief of headache intensity (R 2 = 0.38 ± 0.059, mean squared error = 2.626 ± 0.325) and frequency of migraine attacks (R 2 = 0.284 ± 0.072, mean squared error = 20.535 ± 2.701) after the 4-week acupuncture treatment period. Moreover, the zALFF values of these two clusters were both significantly reduced after treatment. The present study demonstrated the feasibility and validity of applying machine learning technologies and individual cerebral spontaneous activity patterns to predict acupuncture treatment outcomes in patients with MWoA. The data provided a quantitative benchmark for selecting acupuncture for MWoA.
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Affiliation(s)
- Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guojuan Sun
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zilei Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mailan Liu
- College of Acupuncture and Moxibustion and Tui-na, Hunan University of Chinese Medicine, Changsha, China
| | - Yujie Gao
- Traditional Chinese Medicine School, Ningxia Medical University, Yinchuan, China
| | - Mingkai Dong
- Department of Acupuncture and Moxibustion, Xinjin Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Feng Wu
- Department of Acupuncture and Moxibustion, Changsha Hospital of Traditional Chinese Medicine, Changsha, China
| | - Zhengjie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Lei Lan
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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