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Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Central neuropathic pain in multiple sclerosis is associated with impaired innocuous thermal pathways and neuronal hyperexcitability. PAIN MEDICINE 2021; 22:2311-2323. [PMID: 33734398 DOI: 10.1093/pm/pnab103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE About a third of patients with multiple sclerosis (MS) suffer from chronic and excruciating central neuropathic pain (CNP). The mechanism underlying CNP in MS is not clear, since previous studies are scarce and their results are inconsistent. Our aim was to determine whether CNP in MS is associated with impairment of the spinothalamic-thalamocortical pathways (STTCs) and/or increased excitability of the pain system. DESIGN Cross sectional study. SETTING General hospital. SUBJECTS 47 MS patients with CNP, 42 MS patients without CNP, and 32 healthy controls. METHODS Sensory testing included the measurement of temperature, pain, and touch thresholds and the thermal grill illusion (TGI) for evaluating STTCs function, and hyperpathia and allodynia as indicators of hyperexcitability. CNP was characterized using interviews and questionnaires. RESULTS The CNP group had higher cold and warm thresholds (p < 0.01), as well as higher TGI perception thresholds (p < 0.05), especially in painful body regions compared to controls, whereas touch and pain thresholds values were normal. The CNP group also had a significantly greater prevalence of hyperpathia and allodynia. Regression analysis revealed that whereas presence of CNP was associated with a higher cold threshold, CNP intensity, and the number of painful body regions were associated with allodynia and hyperpathia, respectively. CONCLUSIONS CNP in MS is characterized by a specific impairment of STTC function; the innocuous thermal pathways, and by pain hyperexcitability. Whereas CNP presence is associated with STTC impairment, its severity and extent are associated with pain hyperexcitability. Interventions that reduce excitability level may therefore mitigate CNP severity.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Gaby Zeilig
- Sackler Faculty of Medicine, Tel-Aviv University.,Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
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Nahman-Averbuch H, Thomas PL, Schneider VJ, Chamberlin LA, Peugh JL, Hershey AD, Powers SW, Coghill RC, King CD. Spatial aspects of pain modulation are not disrupted in adolescents with migraine. Headache 2020; 61:485-492. [PMID: 33231888 DOI: 10.1111/head.14017] [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: 07/20/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare spatial pain modulation capabilities between adolescents with and without migraine. BACKGROUND Conditioned pain modulation (CPM) responses at the leg are similar in adolescents with versus without migraine. However, the anatomical region of testing may affect spatial pain modulation capabilities as differences in nociceptive processing between patients with migraine and healthy controls are found in local areas that are near the site of clinical pain but not in nonlocal areas. This study aimed to examine spatial pain modulation capabilities tested by the CPM paradigm using test stimulus applied to a local body area. METHODS Nineteen adolescents with migraine (age 14.9 ± 2.3, mean ± SD; 16 female) and 20 healthy adolescents (age 13.8 ± 2.5, mean ± SD; 16 female) completed this case-control study at Cincinnati Children's Hospital Medical Center. Pressure pain thresholds (PPT) were assessed at the trapezius before and during immersion of the foot in a cold water bath (8°C). RESULTS In the migraine group (146.0 ± 79.1, mean ± SD), compared to healthy controls (248.0 ± 145.5, mean ± SD), significantly lower PPT (kilopascal) values were found (estimate = 124.28, 95% CI: 58.98, 189.59, p < 0.001; effect size: d = 1.40). No differences between the groups were found for pain intensity and unpleasantness ratings of cold-water immersion nor the CPM response. CONCLUSIONS This study found altered ascending nociceptive processing of mechanical stimuli at the neck in adolescents with migraine. However, endogenous pain modulatory mechanisms were functional and not altered. In light of other studies, impairments in inhibitory control may not be involved in migraine pathophysiology in pediatric patients regardless of stimulus location.
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Affiliation(s)
- Hadas Nahman-Averbuch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Priya L Thomas
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Victor J Schneider
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leigh Ann Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew D Hershey
- Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Pediatric NeuroImaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Huang YC, Pirri JK, Rayes D, Gao S, Mulcahy B, Grant J, Saheki Y, Francis MM, Zhen M, Alkema MJ. Gain-of-function mutations in the UNC-2/CaV2α channel lead to excitation-dominant synaptic transmission in Caenorhabditis elegans. eLife 2019; 8:e45905. [PMID: 31364988 PMCID: PMC6713474 DOI: 10.7554/elife.45905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/30/2019] [Indexed: 01/17/2023] Open
Abstract
Mutations in pre-synaptic voltage-gated calcium channels can lead to familial hemiplegic migraine type 1 (FHM1). While mammalian studies indicate that the migraine brain is hyperexcitable due to enhanced excitation or reduced inhibition, the molecular and cellular mechanisms underlying this excitatory/inhibitory (E/I) imbalance are poorly understood. We identified a gain-of-function (gf) mutation in the Caenorhabditis elegans CaV2 channel α1 subunit, UNC-2, which leads to increased calcium currents. unc-2(zf35gf) mutants exhibit hyperactivity and seizure-like motor behaviors. Expression of the unc-2 gene with FHM1 substitutions R192Q and S218L leads to hyperactivity similar to that of unc-2(zf35gf) mutants. unc-2(zf35gf) mutants display increased cholinergic and decreased GABAergic transmission. Moreover, increased cholinergic transmission in unc-2(zf35gf) mutants leads to an increase of cholinergic synapses and a TAX-6/calcineurin-dependent reduction of GABA synapses. Our studies reveal mechanisms through which CaV2 gain-of-function mutations disrupt excitation-inhibition balance in the nervous system.
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Affiliation(s)
- Yung-Chi Huang
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
| | - Jennifer K Pirri
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
| | - Diego Rayes
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
| | - Shangbang Gao
- Lunenfeld-Tanenbaum Research InstituteMount Sinai HospitalTorontoCanada
| | - Ben Mulcahy
- Lunenfeld-Tanenbaum Research InstituteMount Sinai HospitalTorontoCanada
| | - Jeff Grant
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
| | - Yasunori Saheki
- Lulu and Anthony Wang Laboratory of Neural Circuits and BehaviorThe Rockefeller UniversityNew YorkUnited States
| | - Michael M Francis
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
| | - Mei Zhen
- Lunenfeld-Tanenbaum Research InstituteMount Sinai HospitalTorontoCanada
- Department of Molecular GeneticsUniversity of TorontoTorontoCanada
- Department of PhysiologyUniversity of TorontoTorontoCanada
| | - Mark J Alkema
- Department of NeurobiologyUniversity of Massachusetts Medical SchoolWorcesterUnited States
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4
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Fernández-de-Las-Peñas C, Ambite-Quesada S, Florencio LL, Palacios-Ceña M, Ordás-Bandera C, Arendt-Nielsen L. Catechol-O-Methyltransferase Val158Met Polymorphism Is Associated with Anxiety, Depression, and Widespread Pressure Pain Sensitivity in Women with Chronic, but Not Episodic, Migraine. PAIN MEDICINE 2019; 20:1409-1417. [PMID: 30481348 DOI: 10.1093/pm/pny237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To analyze the association between the rs4680 catechol-O-methyltransferase Val158Met polymorphism and to determine the association of this polymorphism with clinical, psychological, and pain sensitivity variables in women with episodic or chronic migraine. METHODS Fifty women with episodic migraine, 50 with chronic migraine, and 50 matched healthy women participated. After amplifying the Val158Met polymorphism by polymerase chain reaction, we assessed genotype frequencies and allele distributions. Participants were classified according to the Val158Met polymorphism genotype into Val/Val, Val/Met, or Met/Met. A headache diary was used for collecting migraine pain features. Disability was assessed with the Migraine Disability Assessment Scale, trait/state anxiety levels with the State-Trait Anxiety Inventory, and depression/anxiety with the Hospital Anxiety and Depression Scale. Pressure pain thresholds (PPTs) were bilaterally assessed over the temporalis, the upper trapezius, the second metacarpal, and the tibialis anterior. RESULTS The distribution of the rs4680 Val158Met genotype was not significantly different between women with and without migraine (P = 0.157). No differences in migraine features were found to be dependent on the Val158Met genotype. Women with the Met/Met genotype showed higher migraine-related disability than those with the Val/Val or Val/Met genotype in both migraine groups (P < 0.01). Women with chronic, but not episodic, migraine with the Met/Met genotype exhibited higher depressive and anxiety levels and lower PPTs than those with the Val/Val or Val/Met genotype. CONCLUSIONS The Val158Met rs4680 polymorphism does not appear to be involved in predisposition to suffer from migraine; however, this genetic factor may be involved in the phenotypic expression of chronic migraine, as anxiety, depression, and widespread pressure pain sensitivity were greater in those women with chronic, but not episodic, migraine with the Met/Met genotype.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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Carvalho G, Almeida C, Florencio L, Pinheiro C, Dach F, Bigal M, Bevilaqua-Grossi D. Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study. Physiotherapy 2018; 104:424-429. [DOI: 10.1016/j.physio.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/12/2017] [Accepted: 10/17/2017] [Indexed: 01/03/2023]
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Solstrand Dahlberg L, Linnman CN, Lee D, Burstein R, Becerra L, Borsook D. Responsivity of Periaqueductal Gray Connectivity Is Related to Headache Frequency in Episodic Migraine. Front Neurol 2018; 9:61. [PMID: 29487563 PMCID: PMC5816750 DOI: 10.3389/fneur.2018.00061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 01/17/2023] Open
Abstract
Migraineurs show hypersensitivity to sensory stimuli at various stages throughout the migraine cycle. A number of putative processes have been implicated including a dysfunction in the descending pain modulatory system in which the periaqueductal gray (PAG) is considered to play a crucial role. Recurring migraine attacks could progressively perturb this system, lowering the threshold for future attacks, and contribute to disease chronification. Here, we investigated PAG connectivity with other brain regions during a noxious thermal stimulus to determine changes in migraineurs, and associations with migraine frequency. 21 episodic migraine patients and 22 matched controls were included in the study. During functional MRI, a thermode was placed on the subjects' temple delivering noxious and non-noxious heat stimuli. A psychophysiological interaction (PPI) analysis was carried out to examine pain-induced connectivity of the PAG with other brain regions. The PPI analysis showed increased PAG connectivity with the S1 face representation area and the supplementary motor area, an area involved with pain expectancy, in patients with higher frequency of migraine attacks. PAG connectivity with regions involved with the descending pain modulatory system (i.e., prefrontal cortex) was decreased in the migraineurs versus healthy individuals. Our results suggest that high frequency migraineurs may have diminished resistance to cephalic pain and a less efficient inhibitory pain modulatory response to external stressor (i.e., noxious heat). The findings support the notion that in migraine there is less effective pain modulation (viz., decreased pain inhibition or increased pain facilitation), potentially contributing to increased occurrence of attacks/chronification of migraine.
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Affiliation(s)
- Linda Solstrand Dahlberg
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Clas N Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Danielle Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
| | - Rami Burstein
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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7
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Torres-Reverón A, Palermo K, Hernández-López A, Hernández S, Cruz ML, Thompson KJ, Flores I, Appleyard CB. Endometriosis Is Associated With a Shift in MU Opioid and NMDA Receptor Expression in the Brain Periaqueductal Gray. Reprod Sci 2016; 23:1158-67. [PMID: 27089914 PMCID: PMC5933161 DOI: 10.1177/1933719116630410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Studies have examined how endometriosis interacts with the nervous system, but little attention has been paid to opioidergic systems, which are relevant to pain signaling. We used the autotransplantation rat model of endometriosis and allowed to progress for 60 days. The brain was collected and examined for changes in endogenous opioid peptides, mu opioid receptors (MORs), and the N-methyl-d-aspartate subunit receptor (NR1) in the periaqueductal gray (PAG), since both of these receptors can regulate PAG activity. No changes in endogenous opioid peptides in met- and leu-enkephalin or β-endorphin levels were observed within the PAG. However, MOR immunoreactivity was significantly decreased in the ventral PAG in the endometriosis group. Endometriosis reduced by 20% the number of neuronal profiles expressing MOR and reduced by 40% the NR1 profiles. Our results suggest that endometriosis is associated with subtle variations in opioidergic and glutamatergic activity within the PAG, which may have implications for pain processing.
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Affiliation(s)
- Annelyn Torres-Reverón
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA Department of Clinical Psychology, Ponce Health Sciences University/Ponce Research Institute, Ponce, PR, USA
| | - Karylane Palermo
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
| | - Anixa Hernández-López
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
| | - Siomara Hernández
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
| | - Myrella L Cruz
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
| | - Kenira J Thompson
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
| | - Idhaliz Flores
- Department of Microbiology, Ponce Health Sciences University, Ponce, PR, USA
| | - Caroline B Appleyard
- Department of Basic Sciences: Physiology and Pharmacology, Ponce Health Sciences University, Ponce, PR, USA
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Lovati C, Giani L, D'Amico D, Mariani C. Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 2016; 17:239-250. [PMID: 27547918 DOI: 10.1080/14737175.2016.1226133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The amount of cerebral functions is particularly elevated. This intense activity requires a great expenditure of energy: the restoration of energy is the fundamental function of sleep whilst the slowdown in energy consumption may be considered the physiological effect of primary headaches. The continuous interaction of sleep and primary headaches is possible as they share many anatomical and functional cerebral systems. Areas covered: This review describes how sleep and headaches are reciprocally involved in preservation and restoration of brain energy. Data were obtained from the most relevant and recent works available in PubMed about this topic. Expert commentary: The energetic view of sleep, primary headaches and their relationship may have relevant clinical consequences: the investigation and the modification of the multiple aspects, primarily environmental, that may influence sleep and headache, become mandatory to facilitate the cerebral energy preservation by reducing its consumption and by ensuring its recovery.
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Affiliation(s)
| | - Luca Giani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
| | - Domenico D'Amico
- c Headache Center , C. Besta Neurological Institute and Foundation , Milan , Italy
| | - Claudio Mariani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
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