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Weizman L, Sharon H, Dayan L, Espaniol J, Brill S, Nahman-Averbuch H, Hendler T, Jacob G. Oral Delta-9-Tetrahydrocannabinol (THC) Increases Parasympathetic Activity and Supraspinal Conditioned Pain Modulation in Chronic Neuropathic Pain Male Patients: A Crossover, Double-Blind, Placebo-Controlled Trial. CNS Drugs 2024; 38:375-385. [PMID: 38597988 PMCID: PMC11026292 DOI: 10.1007/s40263-024-01085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Disordered autonomic nervous system regulation and supraspinal pain inhibition have been repeatedly described in chronic pain. We aimed to explore the effects of δ-9-tetrahydrocannabinol (THC), an emerging treatment option, on autonomic nervous system and central pain modulation measures in patients with chronic pain. METHODS Twelve male patients with chronic radicular neuropathic pain participated in a randomized, double-blind, crossover, placebo-controlled, single-administration trial. Low/high frequency (LF/HF) heart rate variability (HRV) ratio and conditioned pain modulation (CPM) response were measured and resting-state functional magnetic resonance imaging (MRI) was performed at baseline and after sublingual administration of either 0.2 mg/kg oral THC or placebo. RESULTS THC significantly reduced the LF/HF ratio compared with placebo (interaction effect F(1,11) = 20.5; p < 0.005) and significantly improved CPM responses (interaction effect F(1,9) = 5.2; p = 0.048). The THC-induced reduction in LF/HF ratio correlated with increased functional connectivity between the rostral ventrolateral medulla and the dorsolateral prefrontal cortex [T(10) = 6.4, cluster p-FDR < 0.005]. CONCLUSIONS THC shifts the autonomic balance towards increased parasympathetic tone and improves inhibitory pain mechanisms in chronic pain. The increase in vagal tone correlates with connectivity changes in higher-order regulatory brain regions, suggesting THC exerts top-down effects. These changes may reflect a normalizing effect of THC on multiple domains of supraspinal pain dysregulation. CLINICAL TRIAL REGISTRY NUMBER NCT02560545.
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Affiliation(s)
- Libat Weizman
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Haggai Sharon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lior Dayan
- Department of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Joumana Espaniol
- Department of Internal Medicine F, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Recanati Autonomic Dysfunction Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Silviu Brill
- Department of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hadas Nahman-Averbuch
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University Pain Center, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Giris Jacob
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Internal Medicine F, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Recanati Autonomic Dysfunction Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Reyes N, Huang JJ, Choudhury A, Pondelis N, Locatelli EVT, Hollinger R, Felix ER, Pattany PM, Galor A, Moulton EA. FL-41 Tint Reduces Activation of Neural Pathways of Photophobia in Patients with Chronic Ocular Pain. Am J Ophthalmol 2024; 259:172-184. [PMID: 38101593 PMCID: PMC10939838 DOI: 10.1016/j.ajo.2023.12.004] [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: 06/28/2023] [Revised: 10/17/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE To assess the therapeutic effect of tinted lenses (FL-41) on photophobia and light-evoked brain activity using functional magnetic resonance imaging (fMRI) in individuals with chronic ocular surface pain. DESIGN Prospective case series. METHODS 25 subjects from the Miami veterans affairs (VA) eye clinic were recruited based on the presence of chronic ocular pain, dry eye symptoms, and photophobia. Using a 3T MRI scanner, subjects underwent 2 fMRI scans using an event-related design based on light stimuli: one scan while wearing FL-41 lenses and one without. Unpleasantness ratings evoked by the light stimuli were collected after each scan. RESULTS With FL-41 lenses, subjects reported decreased (n = 19), maintained (n = 2), or increased (n = 4) light-evoked unpleasantness ratings. Group analysis at baseline (no lens) revealed significant light evoked responses in bilateral primary somatosensory (S1), bilateral secondary somatosensory (S2), bilateral insula, bilateral frontal pole, visual, precuneus, paracingulate, and anterior cingulate cortices (ACC) as well as cerebellar vermis, bilateral cerebellar hemispheric lobule VI, and bilateral cerebellar crus I and II. With FL-41 lenses, light-evoked responses were significantly decreased in bilateral S1, bilateral S2, bilateral insular, right temporal pole, precuneus, ACC, and paracingulate cortices as well as bilateral cerebellar hemispheric lobule VI. CONCLUSION FL-41 lenses modulated photophobia symptoms in some individuals with chronic ocular pain. In conjunction, FL-41 lenses decreased activation in cortical areas involved in processing affective and sensory-discriminative dimensions of pain. Further research into these relationships will advance the ability to provide precision therapy for individuals with ocular pain.
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Affiliation(s)
- Nicholas Reyes
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami (N.R., J.J.H., A.C., E.V.T.L., A.G.), Miami, Florida, USA
| | - Jaxon J Huang
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami (N.R., J.J.H., A.C., E.V.T.L., A.G.), Miami, Florida, USA
| | - Anjalee Choudhury
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami (N.R., J.J.H., A.C., E.V.T.L., A.G.), Miami, Florida, USA
| | - Nicholas Pondelis
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesia (N.P., E.A.M.), Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, USA
| | - Elyana V T Locatelli
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami (N.R., J.J.H., A.C., E.V.T.L., A.G.), Miami, Florida, USA
| | - Ruby Hollinger
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA
| | - Elizabeth R Felix
- Research Service, Miami Veterans Administration Medical Center (E.R.F.), Miami, Florida, USA; Physical Medicine and Rehabilitation (E.R.F.), University of Miami, Miami, Florida, USA
| | - Pradip M Pattany
- Department of Radiology (P.M.P.), University of Miami, Miami, Florida, USA
| | - Anat Galor
- Surgical Services, Miami Veterans Administration Medical Center (N.R., J.J.H., A.C., E.V.T.L., R.H., A.G.), Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami (N.R., J.J.H., A.C., E.V.T.L., A.G.), Miami, Florida, USA
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesia (N.P., E.A.M.), Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, USA; Department of Ophthalmology (E.A.M.), Boston Children's Hospital, Harvard Medical School, Massachusetts, USA.
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Gulati M, Dursun E, Vincent K, Watt FE. The influence of sex hormones on musculoskeletal pain and osteoarthritis. THE LANCET. RHEUMATOLOGY 2023; 5:e225-e238. [PMID: 38251525 DOI: 10.1016/s2665-9913(23)00060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 03/22/2023]
Abstract
The association of female sex with certain rheumatic symptoms and diseases is now indisputable. Some of the most striking examples of this association occur in individuals with musculoskeletal pain and osteoarthritis, in whom sex-dependent changes in incidence and prevalence of disease are seen throughout the lifecourse. Joint and muscle pain are some of the most common symptoms of menopause, and there is increasingly compelling evidence that changes in or loss of sex hormones (be it natural, autoimmune, pharmacological, or surgical) influence musculoskeletal pain propensity and perhaps disease. However, the effects of modulation or replacement of sex hormones in this context are far less established, particularly whether these approaches could represent a preventative or therapeutic opportunity once symptoms have developed. In this Review, we present evidence for the association of changes in sex hormones with musculoskeletal pain and painful osteoarthritis, discussing data from diverse natural, therapeutic, and experimental settings in humans and relevant animal models relating to hormone loss or replacement and the consequent effects on health, pain, and disease. We also postulate mechanisms by which sex hormones could mediate these effects. Further research is needed; however, increased scientific understanding of this complex area could lead to real benefits in musculoskeletal and women's health.
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Affiliation(s)
- Malvika Gulati
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Eren Dursun
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Rheumatology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Choudhury A, Reyes N, Galor A, Mehra D, Felix E, Moulton EA. Clinical Neuroimaging of Photophobia in Individuals With Chronic Ocular Surface Pain. Am J Ophthalmol 2023; 246:20-30. [PMID: 36223850 PMCID: PMC10964268 DOI: 10.1016/j.ajo.2022.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To examine neural mechanisms underlying photophobia in individuals with chronic ocular surface pain by using functional magnetic resonance imaging (fMRI). DESIGN Cross-sectional case/control analysis. METHODS A total of 16 individuals from the Miami Veterans Affairs eye clinic underwent comprehensive ocular surface evaluations and were surveyed for ocular surface symptoms. Case patients included patients who reported chronic ocular surface pain symptoms and light sensitivity at least most of the time over 1 week. Controls included persons without chronic ocular surface pain who reported no or minimal light sensitivity. All patients viewed light stimuli during 2 fMRI scans, one before and one after topical anesthetic instillation, and rated their level of pain intensity to the stimulus at the end of each scan. Areas of brain activation in response to light stimuli presentation were correlated with pain responses and examined post- vs pre-anesthesia. RESULTS Case patients (n = 8) reported higher pain intensity ratings than controls (n = 8) in response to light stimuli during fMRI. Case patient ratings correlated more with light-evoked activation in pain-related areas within the trigeminal brainstem, primary somatosensory cortex (S1), anterior mid-cingulate cortex (aMCC), and insula than in controls. Topical anesthesia led to varying responses in pain ratings among case patients as well as decreased light-evoked activation in S1 and aMCC. CONCLUSIONS The trigeminal nociceptive system may contribute to photophobia in individuals with chronic ocular surface pain. We demonstrate modulation of cortical structures in this pathway with topically applied anesthetic to the eyes. Further understanding of modulatory interactions that govern ocular surface pain and photophobia is critical for developing effective, precision-based therapies.
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Affiliation(s)
- Anjalee Choudhury
- Surgical Services (A.C., N.R., A.G., D.M.), Miami Veterans Administration Medical Center, Miami, Florida, USA; Bascom Palmer Eye Institute (A.C., N.R., A.G., D.M.), University of Miami, Miami, Florida, USA
| | - Nicholas Reyes
- Surgical Services (A.C., N.R., A.G., D.M.), Miami Veterans Administration Medical Center, Miami, Florida, USA; Bascom Palmer Eye Institute (A.C., N.R., A.G., D.M.), University of Miami, Miami, Florida, USA
| | - Anat Galor
- Surgical Services (A.C., N.R., A.G., D.M.), Miami Veterans Administration Medical Center, Miami, Florida, USA; Bascom Palmer Eye Institute (A.C., N.R., A.G., D.M.), University of Miami, Miami, Florida, USA
| | - Divy Mehra
- Surgical Services (A.C., N.R., A.G., D.M.), Miami Veterans Administration Medical Center, Miami, Florida, USA; Bascom Palmer Eye Institute (A.C., N.R., A.G., D.M.), University of Miami, Miami, Florida, USA
| | - Elizabeth Felix
- Research Service (E.F.), Miami Veterans Administration Medical Center, Miami, Florida, USA; Physical Medicine and Rehabilitation (E.F.), University of Miami, Miami, Florida, USA
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab (E.A.M.), Pain and Affective Neuroscience Center, Department of Anesthesia (E.A.M.), Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (E.A.M.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Shen Z, Li W, Chang W, Yue N, Yu J. Sex differences in chronic pain-induced mental disorders: Mechanisms of cerebral circuitry. Front Mol Neurosci 2023; 16:1102808. [PMID: 36891517 PMCID: PMC9986270 DOI: 10.3389/fnmol.2023.1102808] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
Mental disorders such as anxiety and depression induced by chronic pain are common in clinical practice, and there are significant sex differences in their epidemiology. However, the circuit mechanism of this difference has not been fully studied, as preclinical studies have traditionally excluded female rodents. Recently, this oversight has begun to be resolved and studies including male and female rodents are revealing sex differences in the neurobiological processes behind mental disorder features. This paper reviews the structural functions involved in the injury perception circuit and advanced emotional cortex circuit. In addition, we also summarize the latest breakthroughs and insights into sex differences in neuromodulation through endogenous dopamine, 5-hydroxytryptamine, GABAergic inhibition, norepinephrine, and peptide pathways like oxytocin, as well as their receptors. By comparing sex differences, we hope to identify new therapeutic targets to offer safer and more effective treatments.
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Affiliation(s)
- Zuqi Shen
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Li
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiqi Chang
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Na Yue
- Weifang Maternal and Child Health Hospital, Weifang, China
| | - Jin Yu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
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6
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Impaired Inter-Hemispheric Functional Connectivity during Resting State in Female Patients with Migraine. Brain Sci 2022; 12:brainsci12111505. [PMID: 36358431 PMCID: PMC9688662 DOI: 10.3390/brainsci12111505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The application of voxel-mirrored homotopic connectivity (VMHC) analysis to study the central mechanism of migraine has been limited. Furthermore, little is known about inter-hemispheric functional connectivity (FC) alterations during resting state in female patients with migraine. This study aimed to investigate potential interictal VMHC impairments in migraine without aura (MwoA) patients and the relationship between connectivity alterations and clinical parameters. Resting-state functional magnetic resonance imaging data and clinical information were acquired from 43 female MwoA patients and 43 matched healthy controls. VMHC analysis was used to compare differences between these two groups, and brain regions showing significant differences were chosen as a mask to perform a seed-based FC group comparison. Subsequent correlation analysis was conducted to explore the relationship between abnormal inter-hemispheric FC and clinical data. Compared with healthy controls, female MwoA patients revealed significantly decreased VMHC in the bilateral cerebellum; cuneus; and lingual, middle occipital, precentral and postcentral gyri. Seed-based FC analysis indicated disrupted intrinsic connectivity in the cerebellum, and default mode, visual and sensorimotor network. These VMHC and FC abnormalities were negatively correlated with clinical indexes including duration of disease, migraine days and visual analogue scale. These inter-hemispheric FC impairments and correlations between abnormal VMHC and FC and clinical scores may improve our understanding of the central mechanism of female-specific migraine.
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Ding X, Liao FF, Su L, Yang X, Yang W, Ren QH, Zhang JZ, Wang HM. Sciatic nerve block downregulates the BDNF pathway to alleviate the neonatal incision-induced exaggeration of incisional pain via decreasing microglial activation. Brain Behav Immun 2022; 105:204-224. [PMID: 35853558 DOI: 10.1016/j.bbi.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022] Open
Abstract
Sciatic nerve block is under investigation as a possible therapeutic strategy for neonatal injury-induced exaggeration of pain responses to reinjury. Spinal microglial priming, brain-derived neurotrophic factor (BDNF) and Src homology-2 domain-containing protein tyrosine phosphatase-2 (SHP2) participate in exaggerated incisional pain induced by neonatal incision. However, effects of sciatic nerve block on exacerbated incisional pain and underlying mechanisms remain unclear. Here, we demonstrated that sciatic nerve block alleviates pain hypersensitivity and microglial activation in rats subjected to neonatal incision and adult incision (nIN-IN). Chemogenetic activation or inhibition of spinal microglia attenuates or mimics effects of sciatic nerve block on pain hypersensitivity, respectively. Moreover, α-amino-3-hydroxy- 5-methy- 4-isoxazole propionate (AMPA) receptor subunit GluA1 contributes to the exaggeration of incisional pain. The inhibition of BDNF or SHP2 blocks upregulations of downstream molecules in nIN-IN rats. Knockdown of SHP2 attenuates the increase of GluA1 induced by injection of BDNF in adult rats with only neonatal incision. The inhibition of microglia or ablation of microglial BDNF attenuates upregulations of SHP2 and GluA1. Additionally, sciatic nerve block downregulates the expression of these three molecules. Upregulation of BDNF, SHP2 or AMPA receptor attenuates sciatic nerve block-induced reductions of downstream molecules and pain hypersensitivity. Microglial activation abrogates reductions of these three molecules induced by sciatic nerve block. These results suggest that decreased activation of spinal microglia contributes to beneficial effects of sciatic nerve block on the neonatal incision-induced exaggeration of incisional pain via downregulating BDNF/SHP2/GluA1-containing AMPA receptor signaling. Thus, sciatic nerve block may be a promising therapy.
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Affiliation(s)
- Xu Ding
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Fei-Fei Liao
- Neuroscience Research Institute, Peking University, Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Key Laboratory for Neuroscience, Ministry of Education of China & National Health Commission of China, Beijing 100191, China
| | - Li Su
- Neuroscience Research Institute, Peking University, Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Key Laboratory for Neuroscience, Ministry of Education of China & National Health Commission of China, Beijing 100191, China
| | - Xi Yang
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Qing-Hua Ren
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jin-Zhe Zhang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Huan-Min Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Makovac E, Venezia A, Hohenschurz-Schmidt D, Dipasquale O, Jackson JB, Medina S, O'Daly O, Williams SCR, McMahon SB, Howard MA. The association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey. J Physiol 2021; 599:5243-5260. [PMID: 34647321 DOI: 10.1113/jp282013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored. Here, we sought to determine brain regions mediating ANS and descending pain control associations. Thirty participants underwent conditioned pain modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between 'pressure-only' and 'pressure + cold' stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain were acquired. Heart rate variability (HRV) was simultaneously recorded. Normalised low-frequency HRV (LF-HRVnu) and the CPM score were negatively correlated; individuals with higher LF-HRVnu during pain reported reductions in pain during CPM. PAG-ventro-medial prefrontal cortex (vmPFC) and PAG-rostral ventromedial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-vmPFC functional connectivity mediated the strength of the LF-HRVnu-CPM association. CPM response magnitude was also negatively correlated with vmPFC GM volume. Our multi-modal approach, using behavioural, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments. KEY POINTS: Heart rate variability (HRV) is associated with descending pain modulation as measured by the conditioned pain modulation protocol (CPM). There is an association between CPM scores and the functional connectivity between the periaqueductal grey (PAG) and ventro-medial prefrontal cortex (vmPFC). CPM scores are also associated with vmPFC grey matter volume. The strength of functional connectivity between the PAG and vmPFC mediates the association between HRV and CPM. Our data provide new evidence of interactions between the autonomic nervous system and descending pain mechanisms.
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Affiliation(s)
- Elena Makovac
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | | - David Hohenschurz-Schmidt
- Department of Neuroimaging, King's College London, London, UK.,Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | | | - Jade B Jackson
- Department of Neuroimaging, King's College London, London, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sonia Medina
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, UK
| | | | - Stephen B McMahon
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
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Shuaibi S, AlAshqar A, Ahmed SF, Alroughani R, AlThufairi H, Owayed S, AlHamdan F, Al-Hashel J. Primary Headache Disorder Among School Students in Kuwait. Front Neurol 2021; 12:621017. [PMID: 33603711 PMCID: PMC7884619 DOI: 10.3389/fneur.2021.621017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Primary headaches are remarkably prevalent worldwide and are increasingly reported among children. However, the exact trend in this age group, particularly in the Gulf region, remains largely unknown. Aims and Objectives: To examine the prevalence of primary headache disorders among primary and middle school students in Kuwait. Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle school children and adolescents of both genders in randomly selected schools located in two governorates in Kuwait in the 2018/2019 academic year. Prevalence and attributable burden of headaches, definite and probable migraines, definite and probable tension-type headaches, chronic headaches (≥15 days/month), and probable medication-overuse headaches were assessed using the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Results: Of 1,485 questionnaires that were distributed, 1,089 students completed the questionnaire with a respondent rate of 73.4%. The study population consisted of 420 boys (38.56%) and 669 girls (61.43%) students with a mean age of 11.5 ± 2.11 years. The 1-year prevalence of primary headache disorders was 42.78%, with more middle schoolers reporting headaches than primary schoolers (50.37 vs. 30.48%; p < 0.02). The mean age of students with primary headaches was 11.98 ± 2.03 years in both genders. When stratified according to diagnostic criteria, migraine headaches were the most frequently reported (20.75%), followed by tension type headaches (18.8%), chronic headaches (2.75%), and probable medication-overuse headaches (0.46%). Primary headaches were significantly higher in girls compared to boys among middle schoolers (66.46 vs. 38.49%; p < 0.001); however, no significant difference between genders was noted among primary school students (33.12 vs. 22.33%; p < 0.118). Conclusion: Primary headaches are remarkably common in Kuwaiti school students, with migraine headaches being the most frequently reported type. Age and female gender may play a role in the development of primary headaches. These findings necessitate the direction of health services and research efforts toward this age group and warrant the need for further epidemiological studies.
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Affiliation(s)
- Sameera Shuaibi
- Internal Medicine Department, Ministry of Health, Kuwait, Kuwait
| | | | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait
- Neuropsychiatry Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | - Shaikhah Owayed
- Internal Medicine Department, Ministry of Health, Kuwait, Kuwait
| | | | - Jasem Al-Hashel
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait
- Faculty of Medicine, Kuwait University, Safat, Kuwait
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Jackson JB, O'Daly O, Makovac E, Medina S, Rubio ADL, McMahon SB, Williams SCR, Howard MA. Noxious pressure stimulation demonstrates robust, reliable estimates of brain activity and self-reported pain. Neuroimage 2020; 221:117178. [PMID: 32707236 PMCID: PMC7762811 DOI: 10.1016/j.neuroimage.2020.117178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Functional neuroimaging techniques have provided great insight in the field of pain. Utilising these techniques, we have characterised pain-induced responses in the brain and improved our understanding of key pain-related phenomena. Despite the utility of these methods, there remains a need to assess the test retest reliability of pain modulated blood-oxygen-level-dependant (BOLD) MR signal across repeated sessions. This is especially the case for more novel yet increasingly implemented stimulation modalities, such as noxious pressure, and it is acutely important for multi-session studies considering treatment efficacy. In the present investigation, BOLD signal responses were estimated for noxious-pressure stimulation in a group of healthy participants, across two separate sessions. Test retest reliability of functional magnetic resonance imaging (fMRI) data and self-reported visual analogue scale measures were determined by the intra-class correlation coefficient. High levels of reliability were observed in several key brain regions known to underpin the pain experience, including in the thalamus, insula, somatosensory cortices, and inferior frontal regions, alongside "excellent" reliability of self-reported pain measures. These data demonstrate that BOLD-fMRI derived signals are a valuable tool for quantifying noxious responses pertaining to pressure stimulation. We further recommend the implementation of pressure as a stimulation modality in experimental applications.
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Affiliation(s)
- Jade B Jackson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Owen O'Daly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Elena Makovac
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sonia Medina
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Stephen B McMahon
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Matthew A Howard
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
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Makovac E, Dipasquale O, Jackson JB, Medina S, O'Daly O, O'Muircheartaigh J, de Lara Rubio A, Williams SCR, McMahon SB, Howard MA. Sustained perturbation in functional connectivity induced by cold pain. Eur J Pain 2020; 24:1850-1861. [PMID: 32648623 DOI: 10.1002/ejp.1633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Functional connectivity (FC) perturbations have been reported in multiple chronic pain phenotypes, but the nature of reported changes varies between cohorts and may relate to the consequences of living with chronic-pain related comorbidities, such as anxiety and depression. Healthy volunteer studies provide opportunities to study the effects of tonic noxious stimulation independently of these sequelae. Connectivity changes in task negative and positive networks, for example, the default mode and salience networks (DMN/SN), respectively, have been described, but how these and other connectivity networks, for example, those governing descending pain control are affected by the presence of tonic, noxious stimulation in healthy, pain-free individuals, remains unknown. METHOD In 20 healthy volunteers, we assessed FC prior to, during, and following tonic cold painful stimulation in the ventromedial prefrontal cortex (vmPFC), rostral anterior insula (rAI), subgenual anterior cingulate cortex (ACC) and periaqueductal grey (PAG). We also recorded subjectively reported pain using a computerised visual analogue scale. RESULTS We saw DMN FC changes during painful stimulation and that inter-network connectivity between the rAI with the vmPFC increased during pain, whereas PAG-precuneus FC decreased. Pain-induced FC alterations persisted following noxious stimulation. FC changes related to the magnitude of individuals' subjectively reported pain. CONCLUSIONS We demonstrate FC changes during and following tonic cold-pain in healthy participants. Similarities between our findings and reports of patients with chronic pain suggest that some FC changes observed in these patients may relate to the presence of an ongoing afferent nociceptive drive. SIGNIFICANCE How pain-related resting state networks are affected by tonic cold-pain remains unknown. We investigated functional connectivity alterations during and following tonic cold pain in healthy volunteers. Cold pain perturbed the functional connectivity of the ventro-medial prefrontal cortex, anterior insula, and the periacquaductal grey area. These connectivity changes were associated with the magnitude of individuals' reported pain. We suggest that some connectivity changes described in chronic pain patients may be due to an ongoing afferent peripheral drive.
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Affiliation(s)
- Elena Makovac
- Department of Neuroimaging, King's College London, London, UK
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | | - Jade B Jackson
- Department of Neuroimaging, King's College London, London, UK
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Sonia Medina
- Department of Neuroimaging, King's College London, London, UK
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, UK
| | - Jonathan O'Muircheartaigh
- Department of Neuroimaging, King's College London, London, UK
- Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | | | | | - Stephen B McMahon
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
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Mayer EA, Labus J, Aziz Q, Tracey I, Kilpatrick L, Elsenbruch S, Schweinhardt P, Van Oudenhove L, Borsook D. Role of brain imaging in disorders of brain-gut interaction: a Rome Working Team Report. Gut 2019; 68:1701-1715. [PMID: 31175206 PMCID: PMC6999847 DOI: 10.1136/gutjnl-2019-318308] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 12/12/2022]
Abstract
Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in particular IBS. While altered signals from the viscera contribute to clinical symptoms, the brain integrates these interoceptive signals with emotional, cognitive and memory related inputs in a non-linear fashion to produce symptoms. Tremendous progress has occurred in the development of new imaging techniques that look at structural, functional and metabolic properties of brain regions and networks. Standardisation in image acquisition and advances in computational approaches has made it possible to study large data sets of imaging studies, identify network properties and integrate them with non-imaging data. These approaches are beginning to generate brain signatures in IBS that share some features with those obtained in other often overlapping chronic pain disorders such as urological pelvic pain syndromes and vulvodynia, suggesting shared mechanisms. Despite this progress, the identification of preclinical vulnerability factors and outcome predictors has been slow. To overcome current obstacles, the creation of consortia and the generation of standardised multisite repositories for brain imaging and metadata from multisite studies are required.
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Affiliation(s)
- Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Qasim Aziz
- Neurogastroenterology Group, Queen Mary University of London, London, UK
| | - Irene Tracey
- Departments of Anaesthetics and Clinical Neurology, Pembroke College, Oxford, UK
| | - Lisa Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg, Duisburg, Germany
| | | | - Lukas Van Oudenhove
- Translational Research in GastroIntestinal Disorders, KU Leuven Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - David Borsook
- Center for Pain and the Brain, Boston Children's, Massachusetts General and McLean Hospitals, Harvard Medical School, Boston, Massachusetts, USA
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13
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Neuroimaging of pain in animal models: a review of recent literature. Pain Rep 2019; 4:e732. [PMID: 31579844 PMCID: PMC6728006 DOI: 10.1097/pr9.0000000000000732] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 01/19/2023] Open
Abstract
Neuroimaging of pain in animals allows us to better understand mechanisms of pain processing and modulation. In this review, we discuss recently published brain imaging studies in rats, mice, and monkeys, including functional magnetic resonance imaging (MRI), manganese-enhanced MRI, positron emission tomography, and electroencephalography. We provide an overview of innovations and limitations in neuroimaging techniques, as well as results of functional brain imaging studies of pain from January 1, 2016, to October 10, 2018. We then discuss how future investigations can address some bias and gaps in the field. Despite the limitations of neuroimaging techniques, the 28 studies reinforced that transition from acute to chronic pain entails considerable changes in brain function. Brain activations in acute pain were in areas more related to the sensory aspect of noxious stimulation, including primary somatosensory cortex, insula, cingulate cortex, thalamus, retrosplenial cortex, and periaqueductal gray. Pharmacological and nonpharmacological treatments modulated these brain regions in several pain models. On the other hand, in chronic pain models, brain activity was observed in regions commonly associated with emotion and motivation, including prefrontal cortex, anterior cingulate cortex, hippocampus, amygdala, basal ganglia, and nucleus accumbens. Neuroimaging of pain in animals holds great promise for advancing our knowledge of brain function and allowing us to expand human subject research. Additional research is needed to address effects of anesthesia, analysis approaches, sex bias and omission, and potential effects of development and aging.
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Delaruelle Z, Ivanova TA, Khan S, Negro A, Ornello R, Raffaelli B, Terrin A, Mitsikostas DD, Reuter U. Male and female sex hormones in primary headaches. J Headache Pain 2018; 19:117. [PMID: 30497379 PMCID: PMC6755575 DOI: 10.1186/s10194-018-0922-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The three primary headaches, tension-type headache, migraine and cluster headache, occur in both genders, but all seem to have a sex-specific prevalence. These gender differences suggest that both male and female sex hormones could have an influence on the course of primary headaches. This review aims to summarise the most relevant and recent literature on this topic. METHODS Two independent reviewers searched PUBMED in a systematic manner. Search strings were composed using the terms LH, FSH, progesteron*, estrogen*, DHEA*, prolactin, testosterone, androgen*, headach*, migrain*, "tension type" or cluster. A timeframe was set limiting the search to articles published in the last 20 years, after January 1st 1997. RESULTS Migraine tends to follow a classic temporal pattern throughout a woman's life corresponding to the fluctuation of estrogen in the different reproductive stages. The estrogen withdrawal hypothesis forms the basis for most of the assumptions made on this behalf. The role of other hormones as well as the importance of sex hormones in other primary headaches is far less studied. CONCLUSION The available literature mainly covers the role of sex hormones in migraine in women. Detailed studies especially in the elderly of both sexes and in cluster headache and tension-type headache are warranted to fully elucidate the role of these hormones in all primary headaches.
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Affiliation(s)
- Zoë Delaruelle
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | | | - Sabrina Khan
- Danish Headache Center, Glostrup Hospital, Copenhagen, Denmark
| | - Andrea Negro
- Dipartimento di Medicina Clinica e Molecolare, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Raffaele Ornello
- Department of Neurology, University of La’Aquila, L’Aquila, Italy
| | - Bianca Raffaelli
- Departmentt of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Terrin
- Department of Neurosciences, Headache Center, University of Padua, Padua, Italy
| | - Dimos D. Mitsikostas
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Uwe Reuter
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - on behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- First Moscow State Medical University, Moscow, Russia
- Danish Headache Center, Glostrup Hospital, Copenhagen, Denmark
- Dipartimento di Medicina Clinica e Molecolare, Universita degli Studi di Roma La Sapienza, Rome, Italy
- Department of Neurology, University of La’Aquila, L’Aquila, Italy
- Departmentt of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurosciences, Headache Center, University of Padua, Padua, Italy
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Charite Universitatsmedizin Berlin, Berlin, Germany
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15
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Weizman L, Dayan L, Brill S, Nahman-Averbuch H, Hendler T, Jacob G, Sharon H. Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology 2018; 91:e1285-e1294. [PMID: 30185448 DOI: 10.1212/wnl.0000000000006293] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize the functional brain changes involved in δ-9-tetrahydrocannabinol (THC) modulation of chronic neuropathic pain. METHODS Fifteen patients with chronic radicular neuropathic pain participated in a randomized, double-blind, placebo-controlled trial employing a counterbalanced, within-subjects design. Pain assessments and functional resting state brain scans were performed at baseline and after sublingual THC administration. We examined functional connectivity of the anterior cingulate cortex (ACC) and pain-related network dynamics using graph theory measures. RESULTS THC significantly reduced patients' pain compared to placebo. THC-induced analgesia was correlated with a reduction in functional connectivity between the anterior cingulate cortex (ACC) and the sensorimotor cortex. Moreover, the degree of reduction was predictive of the response to THC. Graph theory analyses of local measures demonstrated reduction in network connectivity in areas involved in pain processing, and specifically in the dorsolateral prefrontal cortex (DLPFC), which were correlated with individual pain reduction. CONCLUSION These results suggest that the ACC and DLPFC, 2 major cognitive-emotional modulation areas, and their connections to somatosensory areas, are functionally involved in the analgesic effect of THC in chronic pain. This effect may therefore be mediated through induction of functional disconnection between regulatory high-order affective regions and the sensorimotor cortex. Moreover, baseline functional connectivity between these brain areas may serve as a predictor for the extent of pain relief induced by THC.
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Affiliation(s)
- Libat Weizman
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Lior Dayan
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Silviu Brill
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Hadas Nahman-Averbuch
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Talma Hendler
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Giris Jacob
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Haggai Sharon
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK.
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16
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Yu W, Guan F, Fu L, Long C, Yang L. Disrupted physical pain sensation by social exclusion in women with dysmenorrhea. J Pain Res 2018; 11:1469-1477. [PMID: 30122977 PMCID: PMC6080663 DOI: 10.2147/jpr.s168516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Dysmenorrhea (DM), which involves both acute and chronic pain, is associated with abnormalities in pain modulation. Previous studies have shown that social pain relies on some of the same neural regions that process physical pain, highlighting a possible physical–social pain overlap. However, evidence suggesting that social pain modulates the sensitivity to physical pain remains controversial. The present study aimed to assess the effects of social pain manipulation on sensitivity to physical pain in DM sufferers and healthy female controls (HC). Materials and methods Fifty-nine otherwise healthy patients with DM and 55 HC matched for age, education, calendar age, and gynecological age were randomly assigned to inclusion or exclusion conditions of Cyberball, a virtual ball tossing game used to induce social pain (social exclusion). Pain threshold and pain tolerance in response to nociceptive pressure and cold stimuli were assessed before and after the study condition. Results In response to cold stimulation, pain threshold and tolerance significantly reduced in DM compared to HC participants in the inclusion condition, indicating increased pain sensitivity in DM group. However, exclusion increased the pain threshold and tolerance compared to inclusion in DM but decreased pain threshold and tolerance in HC. Neither inclusion nor exclusion altered pressure pain sensitivity in DM, but, after social exclusion, DM participants were more fearful of being evaluated unfavorably. No significant differences were observed in self-esteem scores between DM and HC after both inclusion and exclusion. Conclusion We observed altered pain sensation in DM participants in response to social pain manipulation, suggesting that DM not only impacts menstruation but also modulates the perception of pain more generally, especially its affective processes. The present study suggests that the effect of social pain on pain sensation and certain psychometric properties depends on previous pain experience, implicating a reciprocal influence of social and physical pain processes.
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Affiliation(s)
- WenJun Yu
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, People's Republic of China, .,College of Education, JingGangShan University, Ji'an, People's Republic of China
| | - Fang Guan
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, People's Republic of China,
| | - Li Fu
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, People's Republic of China,
| | - Cheng Long
- School of Life Sciences, South China Normal University, Guangzhou, People's Republic of China
| | - Li Yang
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, People's Republic of China,
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17
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Da Silva JT, Zhang Y, Asgar J, Ro JY, Seminowicz DA. Diffuse noxious inhibitory controls and brain networks are modulated in a testosterone-dependent manner in Sprague Dawley rats. Behav Brain Res 2018; 349:91-97. [PMID: 29733874 PMCID: PMC7184319 DOI: 10.1016/j.bbr.2018.04.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Abstract
Diffuse noxious inhibitory control (DNIC), which involves endogenous pain modulation, has been investigated as a potential mechanism for the differences in pain modulation observed between men and women, though the literature shows contradictory findings. We used a capsaicin-induced DNIC behavioral assay and resting state functional magnetic resonance imaging (rsfMRI) to assess the effect of testosterone on pain modulation and related brain circuitry in rats. We hypothesized that testosterone is required for DNIC that leads to efficient pain inhibition by increasing descending pain modulation. Male, female, and orchidectomized (GDX) male rats had a capsaicin injection into the forepaw to induce DNIC and mechanical thresholds were observed on the hindpaw. rsfMRI scans were acquired before and after capsaicin injection to analyze the effects of DNIC on periaqueductal gray (PAG), anterior cingulate cortex (ACC) and nucleus accumbens (NAc) connectivity to the whole brain. The strength of DNIC was higher in males compared to females and GDX males. PAG connectivity with prelimbic cortex (PrL), ACC and insula was stronger in males compared to females and GDX males, whereas females and GDX males had increased connectivity between the right ACC, hippocampus and thalamus. GDX males also showed a stronger connectivity between right ACC and NAc, and right NAc with PrL, ACC, insula and thalamus. Our findings suggest that testosterone plays a key role in reinforcing the endogenous pain inhibitory system, while circuitries related to reward and emotion are more strongly recruited in the absence of testosterone.
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Affiliation(s)
- Joyce T Da Silva
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States.
| | - Youping Zhang
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - Jamila Asgar
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - Jin Y Ro
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
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18
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Gupta A, Mayer EA, Fling C, Labus JS, Naliboff BD, Hong JY, Kilpatrick LA. Sex-based differences in brain alterations across chronic pain conditions. J Neurosci Res 2017; 95:604-616. [PMID: 27870423 PMCID: PMC5120652 DOI: 10.1002/jnr.23856] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/18/2016] [Accepted: 07/06/2016] [Indexed: 12/17/2022]
Abstract
Common brain mechanisms are thought to play a significant role across a multitude of chronic pain syndromes. In addition, there is strong evidence for the existence of sex differences in the prevalence of chronic pain and in the neurobiology of pain. Thus, it is important to consider sex when developing general principals of pain neurobiology. The goal of the current Mini-Review is to evaluate what is known about sex-specific brain alterations across multiple chronic pain populations. A total of 15 sex difference and 143 single-sex articles were identified from among 412 chronic pain neuroimaging articles. Results from sex difference studies indicate more prominent primary sensorimotor structural and functional alterations in female chronic pain patients compared with male chronic pain patients: differences in the nature and degree of insula alterations, with greater insula reactivity in male patients; differences in the degree of anterior cingulate structural alterations; and differences in emotional-arousal reactivity. Qualitative comparisons of male-specific and female-specific studies appear to be consistent with the results from sex difference studies. Given these differences, mixed-sex studies of chronic pain risk creating biased data or missing important information and single-sex studies have limited generalizability. The advent of large-scale neuroimaging databases will likely aid in building a more comprehensive understanding of sex differences and commonalities in brain mechanisms underlying chronic pain. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Emeran A Mayer
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Department of Psychiatry, UCLA, Los Angeles, CA, USA
- Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, USA
| | - Connor Fling
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
| | - Jennifer S Labus
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Department of Psychiatry, UCLA, Los Angeles, CA, USA
- Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, USA
| | - Bruce D Naliboff
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jui-Yang Hong
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Lisa A Kilpatrick
- Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, USA
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, USA
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19
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Abstract
Nonopioid agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are the most commonly used class of analgesics. Increasing evidence suggests that cyclooxygenase (COX) inhibition at both peripheral and central sites can contribute to the antihyperalgesic effects of NSAIDs, with the predominant clinical effect being mediated centrally. In this study, we examined the cerebral response to ibuprofen in presurgical and postsurgical states and looked at the analgesic interaction between surgical state and treatment. We used an established clinical pain model involving third molar extraction, and quantitative arterial spin labelling (ASL) imaging to measure changes in tonic/ongoing neural activity. Concurrent to the ASL scans, we presented visual analogue scales inside the scanner to evaluate the subjective experience of pain. This novel methodology was incorporated into a randomized double-blind placebo-controlled design, with an open method of drug administration. We found that independent of its antinociceptive action, ibuprofen has no effect on regional cerebral blood flow under pain-free conditions (presurgery). However, in the postsurgical state, we observed increased activation of top-down modulatory circuits, which was accompanied by decreases in the areas engaged because of ongoing pain. Our findings demonstrate that ibuprofen has a measurable analgesic response in the human brain, with the subjective effects of pain relief reflected in two distinct brain networks. The observed activation of descending modulatory circuits warrants further investigation, as this may provide new insights into the inhibitory mechanisms of analgesia that might be exploited to improve safety and efficacy in pain management.
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Abstract
OBJECTIVE Sex differences in pain are well established, with women reporting greater incidence of clinical pain and heightened responsivity to experimental pain stimuli relative to men. Sex hormones (ie, estrogens, progestins, androgens) could contribute to extant differences in pain sensitivity between men and women. Despite this, there has been limited experimental research assessing the relationship between pain and sex hormones. The purpose of this study was to extend previous research and examine the association between sex hormones and nociceptive processing in healthy women. MATERIALS AND METHODS A total of 40 healthy women were tested during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (testing order counterbalanced). Salivary estradiol, progesterone, and testosterone were collected at each testing session and pain was examined from electrocutaneous threshold/tolerance, ischemia threshold/tolerance, and McGill Pain Questionnaire-Short Form ratings of noxious stimuli. Nociceptive flexion reflex threshold was assessed as a measure of spinal nociception. RESULTS Overall, there were no significant menstrual phase-related differences in pain outcomes. Nonetheless, variability in testosterone (and to a lesser degree estradiol) was associated with pain; testosterone was antinociceptive, whereas estradiol was pronociceptive. No hormone was associated with nociceptive flexion reflex threshold. DISCUSSION Although future research is needed to replicate and extend these findings to clinical populations (ie, chronic pain, premenstrual dysphoric disorder), results from the present study indicate that menstrual phase-related changes in sex hormones have minimal influence on experimental pain. However, individual differences in testosterone may play a protective role against pain in healthy women.
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21
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Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 21:762-78. [DOI: 10.1093/humupd/dmv039] [Citation(s) in RCA: 359] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/10/2015] [Indexed: 12/30/2022] Open
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22
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Iacovides S, Avidon I, Baker F. Does pain vary across the menstrual cycle? A review. Eur J Pain 2015; 19:1389-405. [DOI: 10.1002/ejp.714] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 02/06/2023]
Affiliation(s)
- S. Iacovides
- Wits Dial-a-bed Sleep Laboratory; Brain Function Research Group; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - I. Avidon
- Exercise Physiology Laboratory; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - F.C. Baker
- Wits Dial-a-bed Sleep Laboratory; Brain Function Research Group; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
- Human Sleep Research Program; SRI International; San Francisco USA
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23
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Kirtley OJ, O’Carroll RE, O’Connor RC. The role of endogenous opioids in non-suicidal self-injurious behavior: Methodological challenges. Neurosci Biobehav Rev 2015; 48:186-9. [DOI: 10.1016/j.neubiorev.2014.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/21/2014] [Accepted: 11/07/2014] [Indexed: 01/10/2023]
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24
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Kirveskari E, Vartiainen NV, Kallio-Laine K, Kalso E, Forss N. Normal laser-evoked cortical responses in patients with chronic hemibody pain. Eur J Pain 2014; 19:1168-76. [PMID: 25523148 DOI: 10.1002/ejp.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with widespread unilateral chronic pain associated with recurrent herpes simplex virus (HSV) infections show functional and/or structural changes in the insula, anterior cingulate cortex, frontal and prefrontal cortices, as well as the thalamus, suggesting central dysfunction of the pain system in these patients. Central pain has been associated with attenuated laser-evoked cortical responses. We aimed to clarify whether the observed deficient activation of these areas to acute nociceptive stimuli is due to a lesion at a lower level of pain processing pathways. METHODS We explored the functional integrity of the ascending nociceptive pathways by recording the cortical-evoked responses to noxious laser stimulation using magnetoencephalography and electroencephalography in eight patients (age 41-51 years, mean 46) with recurrent HSV infections and a history of chronic, spontaneous, widespread unilateral pain, and in nine age-matched healthy control subjects. RESULTS The cortical-evoked fields of the HSV patients originating from the secondary somatosensory and posterior parietal cortices, as well as the evoked potentials recorded from the midline, did not differ from those of the control subjects, indicating functionally intact ascending nociceptive pathways. CONCLUSIONS The present results show that our patients with chronic hemibody pain do not show signs of spinothalamic tract lesion. This indicates normal processing of sensory aspects of painful stimuli, while higher pain processing areas show altered activation. We conclude that normal laser-evoked magnetic fields (LEF) or laser-evoked potentials (LEP) may not exclude central pain condition.
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Affiliation(s)
- E Kirveskari
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland.,Department of Neurological Sciences, University of Helsinki, Finland
| | - N V Vartiainen
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland
| | - K Kallio-Laine
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland
| | - E Kalso
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland.,Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Finland
| | - N Forss
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Neurological Sciences, University of Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Finland
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Lacourt T, Houtveen J, Doornen L, Benson S, Grigoleit JS, Cesko E, Elsenbruch S. Biological and psychological predictors of visceral pain sensitivity in healthy premenopausal women. Eur J Pain 2014; 18:567-574. [DOI: 10.1002/j.1532-2149.2013.00397.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- T.E. Lacourt
- Department of Clinical and Health Psychology; Social and Behavioral Sciences; Utrecht University; The Netherlands
| | - J.H. Houtveen
- Department of Clinical and Health Psychology; Social and Behavioral Sciences; Utrecht University; The Netherlands
| | - L.J.P. Doornen
- Department of Clinical and Health Psychology; Social and Behavioral Sciences; Utrecht University; The Netherlands
| | - S. Benson
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital Essen; University of Duisburg-Essen; Germany
| | - J.-S. Grigoleit
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital Essen; University of Duisburg-Essen; Germany
| | - E. Cesko
- Clinic of Dermatology; Venerology and Allergology; University Hospital Essen; University of Duisburg-Essen; Germany
| | - S. Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital Essen; University of Duisburg-Essen; Germany
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Rhudy JL, Bartley EJ, Palit S, Kerr KL, Kuhn BL, Martin SL, DelVentura JL, Terry EL. Do sex hormones influence emotional modulation of pain and nociception in healthy women? Biol Psychol 2013; 94:534-44. [DOI: 10.1016/j.biopsycho.2013.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/19/2013] [Accepted: 10/05/2013] [Indexed: 11/30/2022]
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Hayen A, Herigstad M, Pattinson KTS. Understanding dyspnea as a complex individual experience. Maturitas 2013; 76:45-50. [PMID: 23849705 DOI: 10.1016/j.maturitas.2013.06.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
Dyspnea is the highly threatening experience of breathlessness experienced by patients with diverse pathologies, including respiratory, cardiovascular, and neuromuscular diseases, cancer and panic disorder. This debilitating symptom is especially prominent in the elderly and the obese, two growing populations in the Western world. It has further been found that women suffer more strongly from dyspnea than men. Despite optimization of disease-specific treatments, dyspnea is often inadequately treated. The immense burden faced by patients, families and the healthcare system makes improving management of chronic dyspnea a priority. Dyspnea is a multidimensional sensation that encompasses an array of unpleasant respiratory sensations that vary according to underlying cause and patient characteristics. Biopsychological factors beyond disease pathology exacerbate the perception of dyspnea, increase symptom severity and reduce quality of life. Psychological state (especially comorbid anxiety and depression), hormone status, gender, body weight (obesity) and general fitness level are particularly important. Neuroimaging has started to uncover the neural mechanisms involved in the processing of sensory and affective components of dyspnea. Awareness of biopsychological factors beyond pathology is essential for diagnosis and treatment of dyspnea. Increasing understanding the interactions between biopsychological factors and dyspnea perception will enhance the development of symptomatic treatments that specifically address each patient's most pressing needs at a specific stage in life. Future neuroimaging research can provide objective markers to fully understand the role of biopsychological factors in the perception of dyspnea in the hope of uncovering target areas for pharmacologic and non-pharmacologic therapy.
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Affiliation(s)
- Anja Hayen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, United Kingdom.
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Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain 2013; 154:124-134. [PMID: 23273106 PMCID: PMC3549497 DOI: 10.1016/j.pain.2012.09.017] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 09/15/2012] [Accepted: 09/29/2012] [Indexed: 01/20/2023]
Abstract
Cannabis is reported to be remarkably effective for the relief of otherwise intractable pain. However, the bases for pain relief afforded by this psychotropic agent are debatable. Nonetheless, the frontal-limbic distribution of cannabinoid receptors in the brain suggests that cannabis may target preferentially the affective qualities of pain. This central mechanism of action may be relevant to cannabinoid analgesia in humans, but has yet to be demonstrated. Here, we employed functional magnetic resonance imaging to investigate the effects of delta-9-tetrahydrocannabinol (THC), a naturally occurring cannabinoid, on brain activity related to cutaneous ongoing pain and hyperalgesia that were temporarily induced by capsaicin in healthy volunteers. On average, THC reduced the reported unpleasantness, but not the intensity of ongoing pain and hyperalgesia: the specific analgesic effect on hyperalgesia was substantiated by diminished activity in the anterior mid cingulate cortex. In individuals, the drug-induced reduction in the unpleasantness of hyperalgesia was positively correlated with right amygdala activity. THC also reduced functional connectivity between the amygdala and primary sensorimotor areas during the ongoing-pain state. Critically, the reduction in sensory-limbic functional connectivity was positively correlated with the difference in drug effects on the unpleasantness and the intensity of ongoing pain. Peripheral mechanisms alone cannot account for the dissociative effects of THC on the pain that was observed. Instead, the data reveal that amygdala activity contributes to interindividual response to cannabinoid analgesia, and suggest that dissociative effects of THC in the brain are relevant to pain relief in humans.
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Derntl B, Hack RL, Kryspin-Exner I, Habel U. Association of menstrual cycle phase with the core components of empathy. Horm Behav 2013; 63:97-104. [PMID: 23098806 PMCID: PMC3549494 DOI: 10.1016/j.yhbeh.2012.10.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 12/30/2022]
Abstract
Evidence has accumulated that emotion recognition performance varies with menstrual cycle phase. However, according to some empathy models, facial affect recognition constitutes only one component of empathic behavior, besides emotional perspective taking and affective responsiveness. It remains unclear whether menstrual cycle phase and thus estradiol and progesterone levels are also associated with the two other empathy constructs. Therefore, we investigated 40 healthy right-handed females, 20 during their follicular phase and 20 during their midluteal phase and compared their performance in three tasks tapping the empathic components as well as self-report data. Salivary hormone levels were obtained and correlated with performance parameters. Subjects were matched for age and education and did not differ in neuropsychological function. Analysis of empathy performance revealed a significant effect of phase in emotion recognition, showing higher accuracy in the follicular group. Regarding affective responsiveness, we observed a significant difference in reaction times, with faster responses for sad and angry stimuli in the midluteal group. No significant group difference emerged for emotional perspective taking. Furthermore, significant correlations between progesterone levels and emotion recognition accuracy and affective responsiveness emerged only in the luteal group. However, groups did not differ in self-reported empathy. Our results indicate that menstrual cycle phase and thus ovarian hormone concentration are differentially related to empathic behavior, particularly emotion recognition and responsiveness to negative situations, with progesterone covarying with both in the luteal phase.
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Affiliation(s)
- Birgit Derntl
- Institute for Clinical, Biological and Differential Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.
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