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Zhu H, Tao Y, Wang S, Zhu X, Lin K, Zheng N, Chen LM, Xu F, Wu R. fMRI, LFP, and anatomical evidence for hierarchical nociceptive routing pathway between somatosensory and insular cortices. Neuroimage 2024; 289:120549. [PMID: 38382864 DOI: 10.1016/j.neuroimage.2024.120549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
The directional organization of multiple nociceptive regions, particularly within obscure operculoinsular areas, underlying multidimensional pain processing remains elusive. This study aims to establish the fundamental organization between somatosensory and insular cortices in routing nociceptive information. By employing an integrated multimodal approach of high-field fMRI, intracranial electrophysiology, and transsynaptic viral tracing in rats, we observed a hierarchically organized connection of S1/S2 → posterior insula → anterior insula in routing nociceptive information. The directional nociceptive pathway determined by early fMRI responses was consistent with that examined by early evoked LFP, intrinsic effective connectivity, and anatomical projection, suggesting fMRI could provide a valuable facility to discern directional neural circuits in animals and humans non-invasively. Moreover, our knowledge of the nociceptive hierarchical organization of somatosensory and insular cortices and the interface role of the posterior insula may have implications for the development of targeted pain therapies.
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Affiliation(s)
- Hongyan Zhu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Yan Tao
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Siqi Wang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Xutao Zhu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Kunzhang Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Ning Zheng
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science and Department of Psychology, Vanderbilt University, Nashville, TN 37232, USA.
| | - Fuqiang Xu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China.
| | - Ruiqi Wu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China; Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai 200031, China.
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Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review. Life (Basel) 2023; 13:life13020258. [PMID: 36836613 PMCID: PMC9962564 DOI: 10.3390/life13020258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Neuropathic pain, affecting 6.9-10% of the general population, has a negative impact on patients' quality of life and potentially leads to functional impairment and disability. Repetitive transcranial magnetic stimulation (rTMS)-a safe, indirect and non-invasive technique-has been increasingly applied for treating neuropathic pain. The mechanism underlying rTMS is not yet well understood, and the analgesic effects of rTMS have been inconsistent with respect to different settings/parameters, causing insufficient evidence to determine its efficacy in patients with neuropathic pain. This narrative review aimed to provide an up-to-date overview of rTMS for treating neuropathic pain as well as to summarize the treatment protocols and related adverse effects from existing clinical trials. Current evidence supports the use of 10 Hz HF-rTMS of the primary motor cortex to reduce neuropathic pain, especially in patients with spinal cord injury, diabetic neuropathy and post-herpetic neuralgia. However, the lack of standardized protocols impedes the universal use of rTMS for neuropathic pain. rTMS was hypothesized to achieve analgesic effects by upregulating the pain threshold, inhibiting pain impulse, modulating the brain cortex, altering imbalanced functional connectivity, regulating neurotrophin and increasing endogenous opioid and anti-inflammatory cytokines. Further studies are warranted to explore the differences in the parameters/settings of rTMS for treating neuropathic pain due to different disease types.
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Garcia-Larrea L, Quesada C. Cortical stimulation for chronic pain: from anecdote to evidence. Eur J Phys Rehabil Med 2022; 58:290-305. [PMID: 35343176 PMCID: PMC9980528 DOI: 10.23736/s1973-9087.22.07411-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidural stimulation of the motor cortex (eMCS) was devised in the 1990's, and has now largely supplanted thalamic stimulation for neuropathic pain relief. Its mechanisms of action involve activation of multiple cortico-subcortical areas initiated in the thalamus, with involvement of endogenous opioids and descending inhibition toward the spinal cord. Evidence for clinical efficacy is now supported by at least seven RCTs; benefits may persist up to 10 years, and can be reasonably predicted by preoperative use of non-invasive repetitive magnetic stimulation (rTMS). rTMS first developed as a means of predicting the efficacy of epidural procedures, then as an analgesic method on its own right. Reasonable evidence from at least six well-conducted RCTs favors a significant analgesic effect of high-frequency rTMS of the motor cortex in neuropathic pain (NP), and less consistently in widespread/fibromyalgic pain. Stimulation of the dorsolateral frontal cortex (DLPFC) has not proven efficacious for pain, so far. The posterior operculo-insular cortex is a new and attractive target but evidence remains inconsistent. Transcranial direct current stimulation (tDCS) is applied upon similar targets as rTMS and eMCS; it does not elicit action potentials but modulates the neuronal resting membrane state. tDCS presents practical advantages including low cost, few safety issues, and possibility of home-based protocols; however, the limited quality of most published reports entails a low level of evidence. Patients responsive to tDCS may differ from those improved by rTMS, and in both cases repeated sessions over a long time may be required to achieve clinically significant relief. Both invasive and non-invasive procedures exert their effects through multiple distributed brain networks influencing the sensory, affective and cognitive aspects of chronic pain. Their effects are mainly exerted upon abnormally sensitized pathways, rather than on acute physiological pain. Extending the duration of long-term benefits remains a challenge, for which different strategies are discussed in this review.
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Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France - .,University Hospital Pain Center (CETD), Neurological Hospital, Hospices Civils de Lyon, Lyon, France -
| | - Charles Quesada
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Physiotherapy, Sciences of Rehabilitation Institute (ISTR), University Claude Bernard Lyon 1, Villeurbanne, France
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Lubejko ST, Graham RD, Livrizzi G, Schaefer R, Banghart MR, Creed MC. The role of endogenous opioid neuropeptides in neurostimulation-driven analgesia. Front Syst Neurosci 2022; 16:1044686. [PMID: 36591324 PMCID: PMC9794630 DOI: 10.3389/fnsys.2022.1044686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Due to the prevalence of chronic pain worldwide, there is an urgent need to improve pain management strategies. While opioid drugs have long been used to treat chronic pain, their use is severely limited by adverse effects and abuse liability. Neurostimulation techniques have emerged as a promising option for chronic pain that is refractory to other treatments. While different neurostimulation strategies have been applied to many neural structures implicated in pain processing, there is variability in efficacy between patients, underscoring the need to optimize neurostimulation techniques for use in pain management. This optimization requires a deeper understanding of the mechanisms underlying neurostimulation-induced pain relief. Here, we discuss the most commonly used neurostimulation techniques for treating chronic pain. We present evidence that neurostimulation-induced analgesia is in part driven by the release of endogenous opioids and that this endogenous opioid release is a common endpoint between different methods of neurostimulation. Finally, we introduce technological and clinical innovations that are being explored to optimize neurostimulation techniques for the treatment of pain, including multidisciplinary efforts between neuroscience research and clinical treatment that may refine the efficacy of neurostimulation based on its underlying mechanisms.
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Affiliation(s)
- Susan T. Lubejko
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Robert D. Graham
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Giulia Livrizzi
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Robert Schaefer
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Matthew R. Banghart
- Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
- *Correspondence: Matthew R. Banghart,
| | - Meaghan C. Creed
- Department of Anesthesiology, Pain Center, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, United States
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Meaghan C. Creed,
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Negrini-Ferrari SE, Medeiros P, Malvestio RB, de Oliveira Silva M, Medeiros AC, Coimbra NC, Machado HR, de Freitas RL. The primary motor cortex electrical and chemical stimulation attenuates the chronic neuropathic pain by activation of the periaqueductal grey matter: The role of NMDA receptors. Behav Brain Res 2021; 415:113522. [PMID: 34391797 DOI: 10.1016/j.bbr.2021.113522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Motor cortex stimulation (MCS) is proper as a non-pharmacological therapy for patients with chronic and neuropathic pain (NP). AIMS This work aims to investigate if the MCS in the primary motor cortex (M1) produces analgesia and how the MCS could interfere in the MCS-induced analgesia. Also, to elucidate if the persistent activation of N-methyl-d-aspartic acid receptor (NMDAr) in the periaqueductal grey matter (PAG) can contribute to central sensitisation of the NP. METHODS Male Wistar rats were submitted to the von Frey test to evaluate the mechanical allodynia after 21 days of chronic constriction injury (CCI) of the sciatic nerve. The MCS was performed with low-frequency (20 μA, 100 Hz) currents during 15 s by a deep brain stimulation (DBS) device. Moreover, the effect of M1-treatment with an NMDAr agonist (at 2, 4, and 8 nmol) was investigated in CCI rats. The PAG dorsomedial column (dmPAG) was pretreated with the NMDAr antagonist LY 235959 (at 8 nmol), followed by MCS. RESULTS The MCS decreased the mechanical allodynia in rats with chronic NP. The M1-treatment with an NMDA agonist at 2 and 8 nmol reduced the mechanical allodynia in CCI rats. In addition, dmPAG-pretreatment with LY 235959 at 8 nmol attenuated the mechanical allodynia evoked by MCS. CONCLUSION The M1 cortex glutamatergic system is involved in the modulation of chronic NP. The analgesic effect of MCS may depend on glutamate signaling recruitting NMDAr located on PAG neurons in rodents with chronic NP.
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Affiliation(s)
- Sylmara Esther Negrini-Ferrari
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Priscila Medeiros
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Rafael Braghetto Malvestio
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Mariana de Oliveira Silva
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Ana Carolina Medeiros
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Norberto Cysne Coimbra
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, São Paulo, 14050-220, Brazil
| | - Helio Rubens Machado
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Brain Protection Laboratory in Childhood, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, 14049-900, São Paulo, Brazil
| | - Renato Leonardo de Freitas
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil; Biomedical Sciences Institute, Federal University of Alfenas (UNIFAL-MG), Str. Gabriel Monteiro da Silva, 700, Alfenas, 37130-000, Minas Gerais, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, São Paulo, 14050-220, Brazil.
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6
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Jiang M, Chen X, Zhang L, Liu W, Yu X, Wang Z, Zheng M. Electroacupuncture suppresses glucose metabolism and GLUT-3 expression in medial prefrontal cortical in rats with neuropathic pain. Biol Res 2021; 54:24. [PMID: 34362470 PMCID: PMC8344173 DOI: 10.1186/s40659-021-00348-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Accumulating evidence has demonstrated that the electroacupuncture (EA) stimulation could effectively alleviate neuropathic pain. The medial prefrontal cortex (mPFC) is a vital part of the cortical representation of pain in the brain, and its glucose metabolism is mostly affected in the progression of pain. However, the central mechanism of EA analgesia remains unclear. Methods Fifty-four male SD rats were equally randomized into sham surgery (Sham) group, chronic constriction injury (CCI) group and EA stimulation (EA) group. The CCI model, involving ligature of the right sciatic nerve, was established in all animals except the Sham group. EA stimulation was applied on the right side acupoints of Huantiao (GB30) and Yanglingquan (GB34) in the EA group. Paw withdrawal threshold (PWT) and paw thermal withdrawal latency (PWL) were measured. The 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) was used to evaluate glucose metabolism changes in the mPFC. The expression of glucose transporter 3 (GLUT-3) in the mPFC was determined by immune histochemistry and ELISA. Results Comparing with CCI groups, EA treatment was obviously reversed CCI-induced mechanical allodynia (P < 0.01), thermal hyperalgesia (P < 0.01) and the increase of glucose metabolism in the left mPFC (P < 0.05). Furthermore, EA treatment significantly decreased the protein expression of GLUT-3 in the left mPFC (P < 0.01). Conclusions Our results indicate that EA analgesia effect may be related to suppressing the glucose metabolism and GLUT-3 expression in the mPFC. This study could provide a potential insight into the central mechanisms involved in the analgesic effect of EA.
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Affiliation(s)
- Menghong Jiang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
| | - Xiaomei Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
| | - Liangping Zhang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
| | - Weiting Liu
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
| | - Xiangmei Yu
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
| | - Zhifu Wang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China. .,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Chinese Medicine Affiliated Rehabilitation Hospital, Fuzhou, 350122, Fujian, China.
| | - Meifeng Zheng
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.
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7
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Xin Z, Abe Y, Liu S, Tanaka KF, Hosomi K, Saitoh Y, Sekino M. Direct Impact of Motor Cortical Stimulation on the Blood Oxygen-level Dependent Response in Rats. Magn Reson Med Sci 2021; 20:83-90. [PMID: 32307360 PMCID: PMC7952200 DOI: 10.2463/mrms.mp.2019-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: Neuropathic pain is a complex and distressing chronic illness in modern medicine. Since 1990s, motor cortex stimulation (MCS) has emerged as a potential treatment for chronic neuropathic pain; however, the precise mechanisms underlying analgesia induced by MCS are not completely understood. The purpose of the present study was to investigate the blood oxygen-level dependent (BOLD) response in the brain during MCS. Methods: We inserted a bipolar tungsten electrode into the primary motor cortex (M1) of adult male Wistar rats. Functional magnetic resonance imaging (fMRI) scans were implemented simultaneously with the electrical stimulation of M1 and the BOLD signals taken from the fMRI were used as an index to reflect the response against MCS. Results: Our results demonstrated that the bilateral M1, ipsilateral caudate-putamen, and ipsilateral primary somatosensory cortex to the stimulation spot were activated after the onset of MCS. The BOLD signal time courses were analysed in these regions and similar temporal characteristics were found. Conclusion: By conducting direct cortical stimulation of the rodent brain to investigate its instant effect using fMRI, we identified encephalic regions directly involved in the instant motor cortical stimulation effects in healthy rat models. This result may be essential in establishing a foundation for further research on the underlying neuropathways associated with the MCS effects.
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Affiliation(s)
- Zonghao Xin
- School of Engineering, The University of Tokyo
| | - Yoshifumi Abe
- Department of Neuropsychiatry, Keio University School of Medicine
| | - Shuang Liu
- School of Engineering, The University of Tokyo
| | - Kenji F Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine
| | - Koichi Hosomi
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine
| | - Youichi Saitoh
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine
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Rahal L, Thibaut M, Rivals I, Claron J, Lenkei Z, Sitt JD, Tanter M, Pezet S. Ultrafast ultrasound imaging pattern analysis reveals distinctive dynamic brain states and potent sub-network alterations in arthritic animals. Sci Rep 2020; 10:10485. [PMID: 32591574 PMCID: PMC7320008 DOI: 10.1038/s41598-020-66967-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 05/29/2020] [Indexed: 01/20/2023] Open
Abstract
Chronic pain pathologies, which are due to maladaptive changes in the peripheral and/or central nervous systems, are debilitating diseases that affect 20% of the European adult population. A better understanding of the mechanisms underlying this pathogenesis would facilitate the identification of novel therapeutic targets. Functional connectivity (FC) extracted from coherent low-frequency hemodynamic fluctuations among cerebral networks has recently brought light on a powerful approach to study large scale brain networks and their disruptions in neurological/psychiatric disorders. Analysis of FC is classically performed on averaged signals over time, but recently, the analysis of the dynamics of FC has also provided new promising information. Keeping in mind the limitations of animal models of persistent pain but also the powerful tool they represent to improve our understanding of the neurobiological basis of chronic pain pathogenicity, this study aimed at defining the alterations in functional connectivity, in a clinically relevant animal model of sustained inflammatory pain (Adjuvant-induced Arthritis) in rats by using functional ultrasound imaging, a neuroimaging technique with a unique spatiotemporal resolution (100 μm and 2 ms) and sensitivity. Our results show profound alterations of FC in arthritic animals, such as a subpart of the somatomotor (SM) network, occurring several weeks after the beginning of the disease. Also, we demonstrate for the first time that dynamic functional connectivity assessed by ultrasound can provide quantitative and robust information on the dynamic pattern that we define as brain states. While the main state consists of an overall synchrony of hemodynamic fluctuations in the SM network, arthritic animal spend statistically more time in two other states, where the fluctuations of the primary sensory cortex of the inflamed hind paws show asynchrony with the rest of the SM network. Finally, correlating FC changes with pain behavior in individual animals suggest links between FC alterations and either the cognitive or the emotional aspects of pain. Our study introduces fUS as a new translational tool for the enhanced understanding of the dynamic pain connectome and brain plasticity in a major preclinical model of chronic pain.
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Affiliation(s)
- Line Rahal
- Laboratory of Brain Plasticity, ESPCI Paris, PSL Research University, CNRS UMR 8249, 10 rue Vauquelin, 75005, Paris, France
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France
| | - Miguel Thibaut
- Laboratory of Brain Plasticity, ESPCI Paris, PSL Research University, CNRS UMR 8249, 10 rue Vauquelin, 75005, Paris, France
| | - Isabelle Rivals
- Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, UMRS 1158, 10 rue Vauquelin, 75005, Paris, France
| | - Julien Claron
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France
| | - Zsolt Lenkei
- Laboratory of Brain Plasticity, ESPCI Paris, PSL Research University, CNRS UMR 8249, 10 rue Vauquelin, 75005, Paris, France
- Center of Psychiatry and Neurosciences, INSERM U894, 102 rue de la Santé, 75014, Paris, France
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR 7225, Sorbonne University, UPMC Univ Paris 06 UMR, S 1127, Paris, France
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France
| | - Sophie Pezet
- Laboratory of Brain Plasticity, ESPCI Paris, PSL Research University, CNRS UMR 8249, 10 rue Vauquelin, 75005, Paris, France.
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France.
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9
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Meeker TJ, Jupudi R, Lenz FA, Greenspan JD. New Developments in Non-invasive Brain Stimulation in Chronic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:280-292. [PMID: 33473332 DOI: 10.1007/s40141-020-00260-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of Review The goal of this review is to present a summary of the recent literature of a non-invasive brain stimulation (NIBS) to alleviate pain in people with chronic pain syndromes. This article reviews the current evidence for the use of transcranial direct current (tDCS) and repetitive transcranial magnetic stimulation (rTMS) to improve outcomes in chronic pain. Finally, we introduce the reader to novel stimulation methods that may improve therapeutic outcomes in chronic pain. Recent Findings While tDCS is approved for treatment of fibromyalgia in Canada and the European Union, no NIBS method is currently approved for chronic pain in the United States. Increasing sample sizes in randomized clinical trials (RCTs) seems the most efficient way to increase confidence in initial promising results. Trends at funding agencies reveal increased interest and support for NIBS such as recent Requests for Application from the National Institutes of Health. NIBS in conjunction with cognitive behavioral therapy and physical therapy may enhance outcomes in chronic pain. Novel stimulation methods, such as transcranial ultrasound stimulation, await rigorous study in chronic pain.
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Affiliation(s)
- Timothy J Meeker
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
| | - Rithvic Jupudi
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Frederik A Lenz
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Joel D Greenspan
- Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
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Volkers R, Giesen E, van der Heiden M, Kerperien M, Lange S, Kurt E, van Dongen R, Schutter D, Vissers KCP, Henssen D. Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data. Neuromodulation 2020; 23:436-443. [PMID: 32030854 PMCID: PMC7317964 DOI: 10.1111/ner.13119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
Objective Invasive motor cortex stimulation (iMCS) has been proposed as a treatment for intractable neuropathic pain syndromes. Although the mechanisms underlying the analgesic effect of iMCS remain largely elusive, several studies found iMCS‐related changes in regional cerebral blood flow (rCBF) in neuropathic pain patients. The aim of this study was to meta‐analyze the findings of neuroimaging studies on rCBF changes to iMCS. Methods PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were systematically searched for retrieval of relevant scientific papers. After initial assessment of relevancy by screening title and abstract by two investigators, independently, predefined inclusion and exclusion criteria were used for final inclusion of papers. Descriptive results were statistically assessed, whereas coordinates were pooled and meta‐analyzed in accordance with the activation likelihood estimation (ALE) methodology. Results Six studies were included in the systematic narrative analysis, suggesting rCBF increases in the cingulate gyrus, thalamus, insula, and putamen after switching the MCS device “ON” as compared to the “OFF” situation. Decreases in rCBF were found in for example the precentral gyrus and different occipital regions. Two studies did not report stereotactic coordinates and were excluded from further analysis. ALE meta‐analysis showed that, after switching the iMCS electrode “ON,” increased rCBF occurred in the (1) anterior cingulate gyrus; (2) putamen; (3) cerebral peduncle; (4) precentral gyrus; (5) superior frontal gyrus; (6) red nucleus; (7) internal part of the globus pallidus; (8) ventral lateral nucleus of the thalamus; (9) medial frontal gyrus; (10) inferior frontal gyrus; and (11) claustrum, as compared to the “OFF” situation. Reductions in rCBF were found in the posterior cingulate gyrus when the iMCS electrode was turned “OFF.” Conclusions These findings suggested that iMCS induces changes in principal components of the default mode‐, the salience‐, and sensorimotor network.
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Affiliation(s)
- Ruben Volkers
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmay Giesen
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maudy van der Heiden
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijke Kerperien
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sibylle Lange
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert van Dongen
- Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis Schutter
- Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Helmholtz Institute, Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan Henssen
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Henssen D, Giesen E, van der Heiden M, Kerperien M, Lange S, van Cappellen van Walsum AM, Kurt E, van Dongen R, Schutter D, Vissers K. A systematic review of the proposed mechanisms underpinning pain relief by primary motor cortex stimulation in animals. Neurosci Lett 2020; 719:134489. [DOI: 10.1016/j.neulet.2019.134489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/28/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023]
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12
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Sun X, Long H, Zhao C, Duan Q, Zhu H, Chen C, Sun W, Ju F, Sun X, Zhao Y, Xue B, Tian F, Mou X, Yuan H. Analgesia-enhancing effects of repetitive transcranial magnetic stimulation on neuropathic pain after spinal cord injury:An fNIRS study. Restor Neurol Neurosci 2019; 37:497-507. [PMID: 31381538 DOI: 10.3233/rnn-190934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xiaolong Sun
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Hua Long
- Department of Orthopaedics, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chenguang Zhao
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qiang Duan
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Department of Rehabilitation Medicine, The People’s Hospital of China Three Gorges University, Yichang, China
| | - Huilin Zhu
- Children Developmental & Behavioral Center, Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, China
| | - Chunyan Chen
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wei Sun
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fen Ju
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xinyan Sun
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yilin Zhao
- Department of Medical Affair, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Baijie Xue
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fei Tian
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xiang Mou
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Hua Yuan
- Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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13
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Meeker TJ, Keaser ML, Khan SA, Gullapalli RP, Seminowicz DA, Greenspan JD. Non-invasive Motor Cortex Neuromodulation Reduces Secondary Hyperalgesia and Enhances Activation of the Descending Pain Modulatory Network. Front Neurosci 2019; 13:467. [PMID: 31139047 PMCID: PMC6519323 DOI: 10.3389/fnins.2019.00467] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Central sensitization is a driving mechanism in many chronic pain patients, and manifests as hyperalgesia and allodynia beyond any apparent injury. Recent studies have demonstrated analgesic effects of motor cortex (M1) stimulation in several chronic pain disorders, yet its neural mechanisms remain uncertain. We evaluated whether anodal M1 transcranial direct current stimulation (tDCS) would mitigate central sensitization as measured by indices of secondary hyperalgesia. We used a capsaicin-heat pain model to elicit secondary mechanical hyperalgesia in 27 healthy subjects. In an assessor and subject-blind randomized, sham-controlled, crossover trial, anodal M1 tDCS decreased the intensity of pinprick hyperalgesia more than cathodal or sham tDCS. To elucidate the mechanism driving analgesia, subjects underwent fMRI of painful mechanical stimuli prior to and following induction of the pain model, after receiving M1 tDCS. We hypothesized that anodal M1 tDCS would enhance engagement of a descending pain modulatory (DPM) network in response to mechanical stimuli. Anodal tDCS normalized the effects of central sensitization on neurophysiological responses to mechanical pain in the medial prefrontal cortex, pregenual anterior cingulate cortex, and periaqueductal gray, important regions in the DPM network. Taken together, these results provide support for the hypothesis that anodal M1-tDCS reduces central sensitization-induced hyperalgesia through the DPM network in humans.
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Affiliation(s)
- Timothy J. Meeker
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Shariq A. Khan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Rao P. Gullapalli
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
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14
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Hussein AE, Esfahani DR, Moisak GI, Rzaev JA, Slavin KV. Motor Cortex Stimulation for Deafferentation Pain. Curr Pain Headache Rep 2018; 22:45. [PMID: 29796941 DOI: 10.1007/s11916-018-0697-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Since the early 1990s, motor cortex stimulation (MCS) has been a unique treatment modality for patients with drug-resistant deafferentation pain. While underpowered studies and case reports have limited definitive, data-driven analysis of MCS in the past, recent research has brought new clarity to the MCS literature and has helped identify appropriate indications for MCS and its long-term efficacy. RECENT FINDINGS In this review, new research in MCS, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are analyzed and compared with historical landmark papers. Currently, MCS is effective in providing relief to 40-64% of patients, with decreasing analgesic effect over time addressed by altering stimulation settings. rTMS and tDCS, two historic, non-invasive stimulation techniques, are providing new alternatives for the treatment of deafferentation pain, with rTMS finding utility in identifying MCS responders. Future advances in electrode arrays, neuro-navigation, and high-definition tDCS hold promise in providing pain relief to growing numbers of patients. Deafferentation pain is severe, disabling, and remains a challenge for patients and providers alike. Over the last several years, the MCS literature has been revitalized with studies and meta-analyses demonstrating MCS effectiveness and providing guidance in identifying responders. At the same time, rTMS and tDCS, two time-honored non-invasive stimulation techniques, are finding new utility in managing deafferentation pain and identifying good MCS candidates. As the number of potential therapies grow, the clinician's role is shifting to personalizing treatment to the unique pain of each patient. With new treatment modalities, this form of personalized medicine is more possible than ever before.
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Affiliation(s)
- Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA
| | - Darian R Esfahani
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA
| | - Galina I Moisak
- Federal Neurosurgical Center of Novosibirsk, Novosibirsk, Russian Federation
| | - Jamil A Rzaev
- Federal Neurosurgical Center of Novosibirsk, Novosibirsk, Russian Federation
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA.
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15
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Castro A, Raver C, Li Y, Uddin O, Rubin D, Ji Y, Masri R, Keller A. Cortical Regulation of Nociception of the Trigeminal Nucleus Caudalis. J Neurosci 2017; 37:11431-11440. [PMID: 29066554 PMCID: PMC5700425 DOI: 10.1523/jneurosci.3897-16.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 10/01/2017] [Accepted: 10/11/2017] [Indexed: 12/23/2022] Open
Abstract
Pain perception is strongly influenced by descending pathways from "higher" brain centers that regulate the activity of spinal circuits. In addition to the extensively studied descending system originating from the medulla, the neocortex provides dense anatomical projections that directly target neurons in the spinal cord and the spinal trigeminal nucleus caudalis (SpVc). Evidence exists that these corticotrigeminal pathways may modulate the processing of nociceptive inputs by SpVc, and regulate pain perception. We demonstrate here, with anatomical and optogenetic methods, and using both rats and mice (of both sexes), that corticotrigeminal axons densely innervate SpVc, where they target and directly activate inhibitory and excitatory neurons. Electrophysiological recordings reveal that stimulation of primary somatosensory cortex potently suppresses SpVc responses to noxious stimuli and produces behavioral hypoalgesia. These findings demonstrate that the corticotrigeminal pathway is a potent modulator of nociception and a potential target for interventions to alleviate chronic pain.SIGNIFICANCE STATEMENT Many chronic pain conditions are resistant to conventional therapy. Promising new approaches to pain management capitalize on the brain's own mechanisms for controlling pain perception. Here we demonstrate that cortical neurons directly innervate the brainstem to drive feedforward inhibition of nociceptive neurons. This corticotrigeminal pathway suppresses the activity of these neurons and produces analgesia. This corticotrigeminal pathway may constitute a therapeutic target for chronic pain.
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Affiliation(s)
- Alberto Castro
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
| | - Charles Raver
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
| | - Ying Li
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
| | - Olivia Uddin
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
| | - David Rubin
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
| | - Yadong Ji
- Department of Endodontics, Prosthodontics and Operative Surgery, Baltimore College of Dentistry, Program in Neuroscience, Baltimore, Maryland 21201
| | - Radi Masri
- Department of Endodontics, Prosthodontics and Operative Surgery, Baltimore College of Dentistry, Program in Neuroscience, Baltimore, Maryland 21201
| | - Asaf Keller
- Department of Anatomy & Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201, and
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16
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Groh A, Mease R, Krieger P. Wo der Schmerz in das Bewusstsein tritt: das thalamo-kortikale System bei der Schmerzverarbeitung. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/nf-2017-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Zusammenfassung
Die Übersetzung von schmerzhaften Reizen in Schmerzempfindungen wird durch mehrere periphere und zentrale Signalwege des Nervensystems verwirklicht. Man nimmt heute an, dass die Organisation dieser Signalwege die beiden Hauptfunktionen der Schmerzwahrnehmung wiederspiegeln: die Bewertung von schmerzhaften Reizen (wo, was, wie stark) und die Generierung negativer Emotionen. Experimentelle Befunde deuten darauf hin, dass aufsteigende Schmerzsignale über zwei Hauptwege im thalamokortikalen (TK) System verlaufen, die diese beiden Funktionen erfüllen. Wir diskutieren daher hier die strukturellen und funktionellen Befunde, die zu der Auffassung führten, dass diskriminierende Schmerzbewertung im lateralen TK-Weg ausgeführt wird, während der mediale TK-Weg schmerzassoziierte aversive Emotionen generiert. Obwohl der Schwerpunkt dieses Übersichtsartikels auf akuter Schmerzverarbeitung liegt, gehen wir zum Schluss darauf ein, wie Veränderungen in diesen Signalwegen zu pathologischen Schmerzempfindungen bei Menschen und Tiermodellen führen können.
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Affiliation(s)
- Alexander Groh
- Klinikum rechts der Isar der Technischen Universität München , Neurochirurgische Klinik und Poliklinik , Ismaninger Straße 22, 81675 München , Deutschland , Tel: 089 4140 7636
| | - Rebecca Mease
- Klinikum rechts der Isar der Technischen Universität München , Neurochirurgische Klinik und Poliklinik , Ismaninger Straße 22, 81675 München , Deutschland , Tel: 089 4140 7636
| | - Patrik Krieger
- Ruhr-Universität Bochum , Medizinische Fakultät, Systemische Neurowissenschaften , Universitätsstrasse 150, 44801 Bochum , Deutschland , Tel: 0234 3223898
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17
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Cha M, Um SW, Kwon M, Nam TS, Lee BH. Repetitive motor cortex stimulation reinforces the pain modulation circuits of peripheral neuropathic pain. Sci Rep 2017; 7:7986. [PMID: 28801619 PMCID: PMC5554204 DOI: 10.1038/s41598-017-08208-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/10/2017] [Indexed: 12/30/2022] Open
Abstract
Recent evidence indicates that motor cortex stimulation (MCS) is a potentially effective treatment for chronic neuropathic pain. However, the neural mechanisms underlying the attenuated hyperalgesia after MCS are not completely understood. In this study, we investigated the neural mechanism of the effects of MCS using an animal model of neuropathic pain. After 10 daily sessions of MCS, repetitive MCS reduced mechanical allodynia and contributed to neuronal changes in the anterior cingulate cortex (ACC). Interestingly, inhibition of protein kinase M zeta (PKMζ), a regulator of synaptic plasticity, in the ACC blocked the effects of repetitive MCS. Histological and molecular studies showed a significantly increased level of glial fibrillary acidic protein (GFAP) expression in the ACC after peripheral neuropathy, and neither MCS treatment nor ZIP administration affected this increase. These results suggest that repetitive MCS can attenuate the mechanical allodynia in neuropathic pain, and that the activation of PKMζ in the ACC may play a role in the modulation of neuropathic pain via MCS.
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Affiliation(s)
- Myeounghoon Cha
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Sun Woo Um
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Minjee Kwon
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Taick Sang Nam
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Bae Hwan Lee
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea. .,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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18
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Voulalas PJ, Ji Y, Jiang L, Asgar J, Ro JY, Masri R. Loss of dopamine D1 receptors and diminished D1/5 receptor-mediated ERK phosphorylation in the periaqueductal gray after spinal cord lesion. Neuroscience 2016; 343:94-105. [PMID: 27932310 DOI: 10.1016/j.neuroscience.2016.11.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/18/2016] [Accepted: 11/25/2016] [Indexed: 12/20/2022]
Abstract
Neuropathic pain resulting from spinal cord injury is often accompanied by maladaptive plasticity of the central nervous system, including the opioid receptor-rich periaqueductal gray (PAG). Evidence suggests that sensory signaling via the PAG is robustly modulated by dopamine D1- and D2-like receptors, but the effect of damage to the spinal cord on D1 and D2 receptor protein expression and function in the PAG has not been examined. Here we show that 21days after a T10 or C6 spinothalamic tract lesion, both mice and rats display a remarkable decline in the expression of D1 receptors in the PAG, revealed by western blot analysis. These changes were associated with a significant reduction in hindpaw withdrawal thresholds in lesioned animals compared to sham-operated controls. We investigated the consequences of diminished D1 receptor levels by quantifying D1-like receptor-mediated phosphorylation of ERK1,2 and CREB, events that have been observed in numerous brain structures. In naïve animals, western blot analysis revealed that ERK1,2, but not CREB phosphorylation was significantly increased in the PAG by the D1-like agonist SKF 81297. Using immunohistochemistry, we found that SKF 81297 increased ERK1,2 phosphorylation in the PAG of sham animals. However, in lesioned animals, basal pERK1,2 levels were elevated and did not significantly increase after exposure to SKF 81297. Our findings provide support for the hypothesis that molecular adaptations resulting in a decrease in D1 receptor expression and signaling in the PAG are a consequence of SCL.
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Affiliation(s)
- Pamela J Voulalas
- University of Maryland School of Dentistry, Department of Endodontics, Periodontics & Prosthodontics, 650 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Yadong Ji
- University of Maryland School of Dentistry, Department of Endodontics, Periodontics & Prosthodontics, 650 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Li Jiang
- University of Maryland School of Medicine, Department of Diagnostic Radiology, Baltimore, MD 21201, USA
| | - Jamila Asgar
- University of Maryland School of Dentistry, Department of Neural and Pain Sciences, 650 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Jin Y Ro
- University of Maryland School of Dentistry, Department of Neural and Pain Sciences, Baltimore, MD 21201, USA; Kyung Hee University, School of Dentistry, Department of Oral Medicine, Seoul, Republic of Korea
| | - Radi Masri
- University of Maryland School of Dentistry, Department of Endodontics, Periodontics & Prosthodontics, 650 W. Baltimore Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Anatomy and Neurobiology, 650 W. Baltimore Street, Baltimore, MD 21201, USA.
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19
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Cruccu G, Garcia-Larrea L, Hansson P, Keindl M, Lefaucheur JP, Paulus W, Taylor R, Tronnier V, Truini A, Attal N. EAN guidelines on central neurostimulation therapy in chronic pain conditions. Eur J Neurol 2016; 23:1489-99. [PMID: 27511815 DOI: 10.1111/ene.13103] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Our aim was to update previous European Federation of Neurological Societies guidelines on neurostimulation for neuropathic pain, expanding the search to new techniques and to chronic pain conditions other than neuropathic pain, and assessing the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. METHODS A systematic review and meta-analysis of trials published between 2006 and December 2014 was conducted. Pain conditions included neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS) type I and post-surgical chronic back and leg pain (CBLP). Spinal cord stimulation (SCS), deep brain stimulation (DBS), epidural motor cortex stimulation (MCS), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct electrical stimulation (tDCS) of the primary motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC) were assessed. The GRADE system was used to assess quality of evidence and propose recommendations. RESULTS The following recommendations were reached: 'weak' for SCS added to conventional medical management in diabetic painful neuropathy, CBLP and CRPS, for SCS versus reoperation in CBLP, for MCS in neuropathic pain, for rTMS of M1 in neuropathic pain and fibromyalgia and for tDCS of M1 in neuropathic pain; 'inconclusive' for DBS in neuropathic pain, rTMS and tDCS of the DLPFC, and for motor cortex tDCS in fibromyalgia and spinal cord injury pain. CONCLUSIONS Given the poor to moderate quality of evidence identified by this review, future large-scale multicentre studies of non-invasive and invasive neurostimulation are encouraged. The collection of higher quality evidence of the predictive factors for the efficacy of these techniques, such as the duration, quality and severity of pain, is also recommended.
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Affiliation(s)
- G Cruccu
- EAN Scientific Panel Pain, Vienna, Austria.,Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - L Garcia-Larrea
- NeuroPain Laboratory, INSERM U1028, Hôpital Neurologique and University Claude Bernard Lyon 1, Lyon, France
| | - P Hansson
- EAN Scientific Panel Pain, Vienna, Austria.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - M Keindl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
| | - J-P Lefaucheur
- EA4391, Department of Physiology, Henri Mondor Hospital, University Paris-Est, Créteil, France
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Sweden
| | - R Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - V Tronnier
- Department of Neurosurgery, University Hospital Lübeck, Lübeck, Germany.,IASP Special Interest Group on Neuromodulation, Washington, USA
| | - A Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - N Attal
- EAN Scientific Panel Pain, Vienna, Austria. .,INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré AP-HP, Boulogne-Billancourt and Université Versailles-Saint-Quentin, Versailles, France.
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20
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Nurmikko T, MacIver K, Bresnahan R, Hird E, Nelson A, Sacco P. Motor Cortex Reorganization and Repetitive Transcranial Magnetic Stimulation for Pain-A Methodological Study. Neuromodulation 2016; 19:669-678. [DOI: 10.1111/ner.12444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/16/2016] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Turo Nurmikko
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool; UK
- Neuroscience Research Unit, The Walton Centre NHS Foundation Trust; Liverpool UK
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
| | - Kathryn MacIver
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool; UK
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
| | - Rebecca Bresnahan
- Neuroscience Research Unit, The Walton Centre NHS Foundation Trust; Liverpool UK
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
| | - Emily Hird
- Neuroscience Research Unit, The Walton Centre NHS Foundation Trust; Liverpool UK
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
| | - Andrew Nelson
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
- School of Medicine, University of Liverpool, Liverpool; UK
| | - Paul Sacco
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool; UK
- Sensorymotor Laboratory, Pain Research Institute; Liverpool UK
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21
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Morishita T, Inoue T. Brain Stimulation Therapy for Central Post-Stroke Pain from a Perspective of Interhemispheric Neural Network Remodeling. Front Hum Neurosci 2016; 10:166. [PMID: 27148019 PMCID: PMC4838620 DOI: 10.3389/fnhum.2016.00166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/04/2016] [Indexed: 12/25/2022] Open
Abstract
Central post-stroke pain (CPSP) is a debilitating, severe disorder affecting patient quality of life. Since CPSP is refractory to medication, various treatment modalities have been tried with marginal results. Following the first report of epidural motor cortex (M1) stimulation (MCS) for CPSP, many researchers have investigated the mechanisms of electrical stimulation of the M1. CPSP is currently considered to be a maladapted network reorganization problem following stroke, and recent studies have revealed that the activities of the impaired hemisphere after stroke may be inhibited by the contralesional hemisphere. Even though this interhemispheric inhibition (IHI) theory was originally proposed to explain the motor recovery process in stroke patients, we considered that IHI may also contribute to the CPSP mechanism. Based on the IHI theory and the fact that electrical stimulation of the M1 suppresses CPSP, we hypothesized that the inhibitory signals from the contralesional hemisphere may suppress the activities of the M1 in the ipsilesional hemisphere, and therefore pain suppression mechanisms may be malfunctioning in CPSP patients. In this context, transcranial direct current stimulation (tDCS) was considered to be a reasonable procedure to address the interhemispheric imbalance, as the bilateral M1 can be simultaneously stimulated using an anode (excitatory) and cathode (inhibitory). In this article, we review the potential mechanisms and propose a new model of CPSP. We also report two cases where CPSP was addressed with tDCS, discuss the potential roles of tDCS in the treatment of CPSP, and make recommendations for future studies.
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Fukuoka, Japan
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22
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Jiang L, Voulalas P, Ji Y, Masri R. Post-translational modification of cortical GluA receptors in rodents following spinal cord lesion. Neuroscience 2016; 316:122-9. [PMID: 26724583 PMCID: PMC4724505 DOI: 10.1016/j.neuroscience.2015.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
Abstract
Previous studies investigating the pathophysiology of neuropathic pain caused by injury to the spinal cord suggest that pain may result, at least in part, from maladaptive plasticity in the somatosensory cortex and associated pain networks. However, little is known about the molecular and cellular mechanisms leading to maladaptive plasticity in the cortex and how they contribute to the development of neuropathic pain. AMPA-type glutamate receptors (GluARs) mediate fast excitatory synaptic transmission in the mammalian brain and play an important role in pain processing. Here we used an electrolytic lesion model of spinal cord injury in animals to study the expression and phosphorylation of GluA1 and 2 in the primary somatosensory cortex (S1). Experiments in rats and mice revealed that maladaptive plasticity and hypersensitivity after spinal cord lesion (SCL) are associated with a reduction in the fraction of GluA1 subunits that are phosphorylated at serine 831 (S831) in the hindlimb representation of S1 (S1HL). Manipulations that reduce the fraction of phosphorylated S831 in S1HL of non-lesioned animals, including low-frequency electrical stimulation and viral-mediated gene transfer of mutant S831, were associated with the development of hypersensitivity. Taken together, these findings suggest that phosphorylation of GluA1 at S831 plays an important role in the development of hypersensitivity after SCL.
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Affiliation(s)
- L Jiang
- Department of Endodontics, Periodontics, and Prosthodontics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - P Voulalas
- Department of Endodontics, Periodontics, and Prosthodontics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Y Ji
- Department of Endodontics, Periodontics, and Prosthodontics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - R Masri
- Department of Endodontics, Periodontics, and Prosthodontics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
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23
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Not an Aspirin: No Evidence for Acute Anti-Nociception to Laser-Evoked Pain After Motor Cortex rTMS in Healthy Humans. Brain Stimul 2016; 9:48-57. [DOI: 10.1016/j.brs.2015.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/18/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open
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24
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Lin HC, Huang YH, Chao THH, Lin WY, Sun WZ, Yen CT. Gabapentin reverses central hypersensitivity and suppresses medial prefrontal cortical glucose metabolism in rats with neuropathic pain. Mol Pain 2014; 10:63. [PMID: 25253440 PMCID: PMC4182821 DOI: 10.1186/1744-8069-10-63] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/10/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gabapentin (GBP) is known to suppress neuropathic hypersensitivity of primary afferents and the spinal cord dorsal horn. However, its supra-spinal action sites are unclear. We identify the brain regions where GBP changes the brain glucose metabolic rate at the effective dose that alleviates mechanical allodynia using 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning. RESULTS Comparing the PET imaging data before and after the GBP treatment, the spared nerve injury-induced increases of glucose metabolism in the thalamus and cerebellar vermis were reversed, and a significant decrease occurred in glucose metabolism in the medial prefrontal cortex (mPFC), including the anterior cingulate cortex. GBP treatment also reversed post-SNI connectivity increases between limbic cortices and thalamus. CONCLUSIONS Our results indicate that GBP analgesic effect may be mediated by reversing central hypersensitivity, and suppressing mPFC, a crucial part of the cortical representation of pain, in the brain.
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Affiliation(s)
- Hsiao-Chun Lin
- />Department of Life Science, National Taiwan University, No 1, Section 4, Roosevelt Road, Taipei, 10617 Taiwan
| | - Yu-Hsin Huang
- />Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002 Taiwan
| | - Tzu-Hao Harry Chao
- />Department of Life Science, National Taiwan University, No 1, Section 4, Roosevelt Road, Taipei, 10617 Taiwan
| | - Wen-Ying Lin
- />Department of Life Science, National Taiwan University, No 1, Section 4, Roosevelt Road, Taipei, 10617 Taiwan
- />Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002 Taiwan
| | - Wei-Zen Sun
- />Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002 Taiwan
| | - Chen-Tung Yen
- />Department of Life Science, National Taiwan University, No 1, Section 4, Roosevelt Road, Taipei, 10617 Taiwan
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25
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Moxon KA, Oliviero A, Aguilar J, Foffani G. Cortical reorganization after spinal cord injury: always for good? Neuroscience 2014; 283:78-94. [PMID: 24997269 DOI: 10.1016/j.neuroscience.2014.06.056] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/09/2014] [Accepted: 06/25/2014] [Indexed: 12/29/2022]
Abstract
Plasticity constitutes the basis of behavioral changes as a result of experience. It refers to neural network shaping and re-shaping at the global level and to synaptic contacts remodeling at the local level, either during learning or memory encoding, or as a result of acute or chronic pathological conditions. 'Plastic' brain reorganization after central nervous system lesions has a pivotal role in the recovery and rehabilitation of sensory and motor dysfunction, but can also be "maladaptive". Moreover, it is clear that brain reorganization is not a "static" phenomenon but rather a very dynamic process. Spinal cord injury immediately initiates a change in brain state and starts cortical reorganization. In the long term, the impact of injury - with or without accompanying therapy - on the brain is a complex balance between supraspinal reorganization and spinal recovery. The degree of cortical reorganization after spinal cord injury is highly variable, and can range from no reorganization (i.e. "silencing") to massive cortical remapping. This variability critically depends on the species, the age of the animal when the injury occurs, the time after the injury has occurred, and the behavioral activity and possible therapy regimes after the injury. We will briefly discuss these dependencies, trying to highlight their translational value. Overall, it is not only necessary to better understand how the brain can reorganize after injury with or without therapy, it is also necessary to clarify when and why brain reorganization can be either "good" or "bad" in terms of its clinical consequences. This information is critical in order to develop and optimize cost-effective therapies to maximize functional recovery while minimizing maladaptive states after spinal cord injury.
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Affiliation(s)
- K A Moxon
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA.
| | - A Oliviero
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain
| | - J Aguilar
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain
| | - G Foffani
- Hospital Nacional de Parapléjicos, SESCAM, Finca la Peraleda s/n, 45071 Toledo, Spain.
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