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Liu A, Wang J, Jin T, Jiang Z, Huang S, Li S, Ying Z, Jiang H. Identifying the genetic association between the cerebral cortex and fibromyalgia. Cereb Cortex 2024; 34:bhae318. [PMID: 39106177 DOI: 10.1093/cercor/bhae318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/08/2024] [Indexed: 08/09/2024] Open
Abstract
Fibromyalgia (FM) is a central sensitization syndrome that is strongly associated with the cerebral cortex. This study used bidirectional two-sample Mendelian randomization (MR) analysis to investigate the bidirectional causality between FM and the cortical surface area and cortical thickness of 34 brain regions. Inverse variance weighted (IVW) was used as the primary method for this study, and sensitivity analyses further supported the results. The forward MR analysis revealed that genetically determined thinner cortical thickness in the parstriangularis (OR = 0.0567 mm, PIVW = 0.0463), caudal middle frontal (OR = 0.0346 mm, PIVW = 0.0433), and rostral middle frontal (OR = 0.0285 mm, PIVW = 0.0463) was associated with FM. Additionally, a reduced genetically determined cortical surface area in the pericalcarine (OR = 0.9988 mm2, PIVW = 0.0085) was associated with an increased risk of FM. Conversely, reverse MR indicated that FM was associated with cortical thickness in the caudal middle frontal region (β = -0.0035 mm, PIVW = 0.0265), fusiform region (β = 0.0024 mm, SE = 0.0012, PIVW = 0.0440), the cortical surface area in the supramarginal (β = -9.3938 mm2, PIVW = 0.0132), and postcentral regions (β = -6.3137 mm2, PIVW = 0.0360). Reduced cortical thickness in the caudal middle frontal gyrus is shown to have a significant relationship with FM prevalence in a bidirectional causal analysis.
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Affiliation(s)
- Aihui Liu
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Jing Wang
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Tianyu Jin
- China Rehabilitation Research center, No. 10, Jiaomen North Road, Fengtai District, Beijing 100068, China
| | - Zhaoyu Jiang
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Shan Huang
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Shinan Li
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Zhenhua Ying
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
| | - Hongyang Jiang
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 31000, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang Province 310000, China
- Department of Radiology, Center for Rehabilitation Medicine, Hangzhou Medical College, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang 310000, China
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Canlı K, Van Oijen J, Van Oosterwijck J, Meeus M, Van Oosterwijck S, De Meulemeester K. Influence of sensory retraining on cortical reorganization in peripheral neuropathy: A systematic review. PM R 2024; 16:888-907. [PMID: 38155585 DOI: 10.1002/pmrj.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/19/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study systematically reviewed the literature about sensory retraining effect in comparison to other rehabilitative techniques on cortical reorganization in patients with peripheral neuropathic pain. TYPE: Systematic review. LITERATURE SURVEY After an electronic search of PubMed, Web of Science, and Embase, risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the ROBINS-1 (Risk of bias in non-randomized studies-of interventions) for non-randomized studies of intervention. METHODOLOGY The strength of conclusion was determined using the evidence-based guideline development approach. SYNTHESIS Limited evidence indicates a higher increase in cortical inhibition and a higher reduction in cortical activation during a motor task of the affected hemisphere after graded motor imagery compared to wait-list. Higher reductions in map volume (total excitability of the cortical representation) of the affected hemisphere after peripheral electrical stimulation (PES) were observed when compared to transcranial direct current stimulation (tDCS) or to sham treatment with limited evidence. No other differences in cortical excitability and representation of the affected and non-affected hemisphere were observed when comparing mirror therapy with sham therapy or tDCS, PES with sham therapy or tDCS, and graded motor imagery with wait-list. CONCLUSIONS Graded motor imagery and PES result in higher cortical excitability reductions of the affected hemisphere compared to wait-list, tDCS and sham treatment, respectively.
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Affiliation(s)
- Kübra Canlı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Joris Van Oijen
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerpen, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Kayleigh De Meulemeester
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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Marsili F, Potgieter P, Birkill CF. Adaptive Autonomic and Neuroplastic Control in Diabetic Neuropathy: A Narrative Review. Curr Diabetes Rev 2024; 20:38-54. [PMID: 38018186 DOI: 10.2174/0115733998253213231031050044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a worldwide socioeconomic burden, and is accompanied by a variety of metabolic disorders, as well as nerve dysfunction referred to as diabetic neuropathy (DN). Despite a tremendous body of research, the pathogenesis of DN remains largely elusive. Currently, two schools of thought exist regarding the pathogenesis of diabetic neuropathy: a) mitochondrial-induced toxicity, and b) microvascular damage. Both mechanisms signify DN as an intractable disease and, as a consequence, therapeutic approaches treat symptoms with limited efficacy and risk of side effects. OBJECTIVE Here, we propose that the human body exclusively employs mechanisms of adaptation to protect itself during an adverse event. For this purpose, two control systems are defined, namely the autonomic and the neural control systems. The autonomic control system responds via inflammatory and immune responses, while the neural control system regulates neural signaling, via plastic adaptation. Both systems are proposed to regulate a network of temporal and causative connections which unravel the complex nature of diabetic complications. RESULTS A significant result of this approach infers that both systems make DN reversible, thus opening the door to novel therapeutic applications.
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Affiliation(s)
| | - Paul Potgieter
- Research Department, Algiamed Technologies, Burnaby, Canada
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Guerra-Armas J, Flores-Cortes M, Pineda-Galan C, Luque-Suarez A, La Touche R. Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients. Brain Sci 2023; 13:brainsci13040617. [PMID: 37190582 DOI: 10.3390/brainsci13040617] [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: 03/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.
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Affiliation(s)
- Javier Guerra-Armas
- Faculty of Health Sciences, Universidad Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas, Spain
| | - Mar Flores-Cortes
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
| | | | - Alejandro Luque-Suarez
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
- Instituto de la Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
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Tang DL, Niziolek CA, Parrell B. Modulation of somatosensation by transcranial magnetic stimulation over somatosensory cortex: a systematic review. Exp Brain Res 2023; 241:951-977. [PMID: 36949150 PMCID: PMC10851347 DOI: 10.1007/s00221-023-06579-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
Over the last three decades, transcranial magnetic stimulation (TMS) has gained popularity as a tool to modulate human somatosensation. However, the effects of different stimulation types on the multiple distinct subdomains of somatosensation (e.g., tactile perception, proprioception and pain) have not been systematically compared. This is especially notable in the case of newer theta-burst stimulation protocols now in widespread use. Here, we aimed to systematically and critically review the existing TMS literature and provide a complete picture of current knowledge regarding the role of TMS in modulating human somatosensation across stimulation protocols and somatosensory domains. Following the PRISMA guidelines, fifty-four studies were included in the current review and were compared based on their methodologies and results. Overall, findings from these studies provide evidence that different types of somatosensation can be both disrupted and enhanced by targeted stimulation of specific somatosensory areas. Some mixed results, however, were reported in the literature. We discussed possible reasons for these mixed results, methodological limitations of existing investigations, and potential avenues for future research.
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Affiliation(s)
- Ding-Lan Tang
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Caroline A Niziolek
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
| | - Benjamin Parrell
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
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Li Y, Xu Z, Xie H, Fu R, Lo WLA, Cheng X, Yang J, Ge L, Yu Q, Wang C. Changes in cortical activation during upright stance in individuals with chronic low back pain: An fNIRS study. Front Hum Neurosci 2023; 17:1085831. [PMID: 36816497 PMCID: PMC9936824 DOI: 10.3389/fnhum.2023.1085831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Postural control deficits are a potential cause of persistent and recurrent pain in patients with chronic low back pain (CLBP). Although some studies have confirmed that the dorsolateral prefrontal cortex (DLPFC) contributes to pain regulation in CLBP, its role in the postural control of patients with CLBP remains unclear. Therefore, this study aimed to investigate the DLPFC activation of patients with CLBP and healthy controls under different upright stance task conditions. Methods Twenty patients with CLBP (26.50 ± 2.48 years) and 20 healthy controls (25.75 ± 3.57 years) performed upright stance tasks under three conditions: Task-1 was static balance with eyes open; Task-2 was static balance with eyes closed; Task-3 involved dynamic balance on an unstable surface with eyes open. A wireless functional near-infrared spectroscopy (fNIRS) system measured cortical activity, including the bilateral DLPFC, pre-motor cortex (PMC) and supplementary motor area (SMA), the primary motor cortex (M1), the primary somatosensory cortex (S1), and a force platform measured balance parameters during upright stance. Results The two-way repeated measures ANOVA results showed significant interaction in bilateral PMC/SMA activation. Moreover, patients with CLBP had significantly increased right DLPFC activation and higher sway 32 area and velocity than healthy controls during upright stance. Discussion Our results imply that PMC/SMA and DLPFC maintain standing balance. The patients with CLBP have higher cortical activity and upright stance control deficits, which may indicate that the patients with CLBP have low neural efficiency and need more motor resources to maintain balance.
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Kalia H, Pritzlaff S, Li AH, Ottestad E, Gulati A, Makous J, Chakravarthy K. Application of the novel Nalu™ Neurostimulation System for peripheral nerve stimulation. Pain Manag 2022; 12:795-804. [PMID: 35946308 DOI: 10.2217/pmt-2021-0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Peripheral nerve stimulation is an established treatment modality for chronic neuropathic pain. Over the last decade, with the advent of innovative devices and delivery platforms, peripheral nerve stimulation has evolved from invasive open surgeries to image-guided, minimally invasive percutaneous procedures. The authors hereby present a novel device, the Nalu™ Neurostimulation System (Nalu Medical, CA, USA), which has established its advantages in providing predictable and reliable peripheral nerve stimulation therapy for chronic neuropathic pain management. This novel device is effective in treating chronic pain conditions such as post-herniorrhaphy pain syndrome, intercostal neuralgia, post-laminectomy syndrome, and complex regional pain syndrome and holds great promise for the treatment of peripheral neuropathic pain.
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Affiliation(s)
- Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA
| | - Scott Pritzlaff
- Division of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, CA, USA
| | - Alice H Li
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Einar Ottestad
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Amitabh Gulati
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,VA Department of Anesthesia, San Diego Health Care, San Diego, CA, USA
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Pondelis NJ, Moulton EA. Supraspinal Mechanisms Underlying Ocular Pain. Front Med (Lausanne) 2022; 8:768649. [PMID: 35211480 PMCID: PMC8862711 DOI: 10.3389/fmed.2021.768649] [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] [Received: 09/01/2021] [Accepted: 12/27/2021] [Indexed: 12/04/2022] Open
Abstract
Supraspinal mechanisms of pain are increasingly understood to underlie neuropathic ocular conditions previously thought to be exclusively peripheral in nature. Isolating individual causes of centralized chronic conditions and differentiating them is critical to understanding the mechanisms underlying neuropathic eye pain and ultimately its treatment. Though few functional imaging studies have focused on the eye as an end-organ for the transduction of noxious stimuli, the brain networks related to pain processing have been extensively studied with functional neuroimaging over the past 20 years. This article will review the supraspinal mechanisms that underlie pain as they relate to the eye.
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Affiliation(s)
- Nicholas J Pondelis
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Strauss S, Barby S, Härtner J, Pfannmöller JP, Neumann N, Moseley GL, Lotze M. Graded motor imagery modifies movement pain, cortical excitability and sensorimotor function in complex regional pain syndrome. Brain Commun 2021; 3:fcab216. [PMID: 34661105 PMCID: PMC8514858 DOI: 10.1093/braincomms/fcab216] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/17/2021] [Accepted: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
Patients with complex regional pain syndrome suffer from chronic neuropathic pain and also show a decrease in sensorimotor performance associated with characteristic central and peripheral neural system parameters. In the brain imaging domain, these comprise altered functional sensorimotor representation for the affected hand side. With regard to neurophysiology, a decrease in intracortical inhibition for the sensorimotor cortex contralateral to the affected hand has been repetitively verified, which might be related to increased primary somatosensory cortex functional activation for the affected limb. Rare longitudinal intervention studies in randomized controlled trials have demonstrated that a decrease in primary somatosensory cortex functional MRI activation coincided with pain relief and recovery in sensorimotor performance. By applying a randomized wait-list control crossover study design, we tested possible associations of clinical, imaging and neurophysiology parameters in 21 patients with complex regional pain syndrome in the chronic stage (>6 months). In more detail, we applied graded motor imagery over 6 weeks to relieve movement pain of the affected upper limb. First, baseline parameters were tested between the affected and the non-affected upper limb side and age-matched healthy controls. Second, longitudinal changes in clinical and testing parameters were associated with neurophysiological and imaging parameters. During baseline short intracortical inhibition, as assessed with transcranial magnetic stimulation, was decreased only for hand muscles of the affected hand side. During movement of the affected limb, primary somatosensory cortex functional MRI activation was increased. Hand representation area size for somatosensory stimulation in functional MRI was smaller on the affected side with longer disease duration. Graded motor imagery intervention but not waiting, resulted in a decrease of movement pain. An increase of somatosensory hand representation size over graded motor imagery intervention was related to movement pain relief. Over graded motor imagery intervention, pathological parameters like the increased primary somatosensory cortex activation during fist movement or decreased short intracortical inhibition were modified in the same way as movement pain and hand performance improved. No such changes were observed during the waiting period. Overall, we demonstrated characteristic changes in clinical, behaviour and neuropathology parameters applying graded motor imagery in patients with upper limb complex regional pain syndrome, which casts light on the effects of graded motor imagery intervention on biomarkers for chronic neuropathic pain.
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Affiliation(s)
- Sebastian Strauss
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Silke Barby
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Jonas Härtner
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Jörg Peter Pfannmöller
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Nicola Neumann
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide 5000, Australia
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
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Chadwick A, Frazier A, Khan TW, Young E. Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review. J Pain Res 2021; 14:3145-3161. [PMID: 34675643 PMCID: PMC8517910 DOI: 10.2147/jpr.s320863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine. METHODS Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological. RESULTS Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors. CONCLUSION Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.
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Affiliation(s)
- Andrea Chadwick
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Frazier
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Young
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Tompra N, van Dieën JH, Plinsinga ML, Coppieters MW. Left/right discrimination is not impaired in people with unilateral chronic Achilles tendinopathy. Musculoskelet Sci Pract 2021; 54:102388. [PMID: 33965774 DOI: 10.1016/j.msksp.2021.102388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Impaired left/right discrimination of an affected body part has been observed in various chronic pain states. This study aimed to examine whether people with unilateral chronic Achilles tendinopathy also present with impaired left/right discrimination. DESIGN Cross-sectional study. METHODS Nineteen runners with persistent unilateral Achilles tendinopathy and 19 matched healthy volunteers performed a left/right discrimination task in a laboratory setting. Participants were shown pictures of feet, hands and Shepard-Metzler figures and were asked to decide as accurately and as fast as possible whether the body part belonged to the left or right side of the body, or whether the Shepard-Metzler figures were rotated or mirrored. Performance was evaluated in terms of accuracy and response time. Data were analysed with mixed-design ANOVAs. RESULTS The decline in left/right discrimination ability at group level, if present, between affected and unaffected side, or compared to healthy participants, was negligible for both accuracy (<1.5%) and response time (<50 ms). There was no significant effect of side (affected versus unaffected side) or group (people with Achilles tendinopathy versus healthy) for accuracy (p > 0.36) or response time (p > 0.69). CONCLUSIONS People with Achilles tendinopathy recognised the affected side as accurately and as fast as the non-affected side and their performance was comparable to healthy participants. The absence of impaired left/right discrimination despite the chronicity of the condition may be attributable to the typical intermittent nature of Achilles tendinopathy pain and/or maintained sports activity.
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Affiliation(s)
- Nefeli Tompra
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands. https://twitter.com/NefeliTompra
| | - Jaap H van Dieën
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands. https://twitter.com/DieenJaap
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia. https://twitter.com/Melaniielp
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.
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Freigang S, Lehner C, Fresnoza SM, Mahdy Ali K, Hlavka E, Eitler A, Szilagyi I, Bornemann-Cimenti H, Deutschmann H, Reishofer G, Berlec A, Kurschel-Lackner S, Valentin A, Sutter B, Zaar K, Mokry M. Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients. Brain Sci 2021; 11:brainsci11080961. [PMID: 34439580 PMCID: PMC8391537 DOI: 10.3390/brainsci11080961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/30/2022] Open
Abstract
Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.
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Affiliation(s)
- Sascha Freigang
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
- Correspondence: ; Tel.: +43-316-385-81935
| | - Christian Lehner
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Shane M. Fresnoza
- Institute of Psychology, University of Graz, 8010 Graz, Austria;
- BioTechMed, 8010 Graz, Austria
| | - Kariem Mahdy Ali
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Elisabeth Hlavka
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Annika Eitler
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Istvan Szilagyi
- Department of Paediatric Surgery, Medical University Graz, 8036 Graz, Austria;
| | - Helmar Bornemann-Cimenti
- Department of Anaesthesiology, Critical Care and Pain Medicine, Medical University Graz, 8036 Graz, Austria;
| | - Hannes Deutschmann
- Department of Radiology, Clinical Division of Neuroradiology, Vascular and Interventionial Radiology, Medical University of Graz, 8036 Graz, Austria; (H.D.); (G.R.)
| | - Gernot Reishofer
- Department of Radiology, Clinical Division of Neuroradiology, Vascular and Interventionial Radiology, Medical University of Graz, 8036 Graz, Austria; (H.D.); (G.R.)
| | - Anže Berlec
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Senta Kurschel-Lackner
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Antonio Valentin
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9RT, UK;
| | - Bernhard Sutter
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Karla Zaar
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
| | - Michael Mokry
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria; (C.L.); (K.M.A.); (E.H.); (A.E.); (A.B.); (S.K.-L.); (B.S.); (K.Z.); (M.M.)
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Jergova S, Martinez H, Hernandez M, Schachner B, Gross S, Sagen J. Development of a Phantom Limb Pain Model in Rats: Behavioral and Histochemical Evaluation. FRONTIERS IN PAIN RESEARCH 2021; 2:675232. [PMID: 35295448 PMCID: PMC8915728 DOI: 10.3389/fpain.2021.675232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Therapeutic strategies targeting phantom limb pain (PLP) provide inadequate pain relief; therefore, a robust and clinically relevant animal model is necessary. Animal models of PLP are based on a deafferentation injury followed by autotomy behavior. Clinical studies have shown that the presence of pre-amputation pain increases the risk of developing PLP. In the current study, we used Sprague-Dawley male rats with formalin injections or constriction nerve injury at different sites or time points prior to axotomy to mimic clinical scenarios of pre-amputation inflammatory and neuropathic pain. Animals were scored daily for PLP autotomy behaviors, and several pain-related biomarkers were evaluated to discover possible underlying pathological changes. Majority displayed some degree of autotomy behavior following axotomy. Injury prior to axotomy led to more severe PLP behavior compared to animals without preceding injury. Autotomy behaviors were more directed toward the pretreatment insult origin, suggestive of pain memory. Increased levels of IL-1β in cerebrospinal fluid and enhanced microglial responses and the expression of NaV1.7 were observed in animals displaying more severe PLP outcomes. Decreased expression of GAD65/67 was consistent with greater PLP behavior. This study provides a preclinical basis for future understanding and treatment development in the management of PLP.
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Deer TR, Eldabe S, Falowski SM, Huntoon MA, Staats PS, Cassar IR, Crosby ND, Boggs JW. Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation. J Pain Res 2021; 14:721-736. [PMID: 33737830 PMCID: PMC7966353 DOI: 10.2147/jpr.s297091] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Steven M Falowski
- Department of Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Marc A Huntoon
- Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Härtner J, Strauss S, Pfannmöller J, Lotze M. Tactile acuity of fingertips and hand representation size in human Area 3b and Area 1 of the primary somatosensory cortex. Neuroimage 2021; 232:117912. [PMID: 33652142 DOI: 10.1016/j.neuroimage.2021.117912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
Intracortical mapping in monkeys revealed a full body map in all four cytoarchitectonic subdivisions of the contralateral primary somatosensory cortex (S1), as well as positive associations between spatio-tactile acuity performance of the fingers and their representation field size especially within cytoarchitectonic Area 3b and Area 1. Previous non-invasive investigations on these associations in humans assumed a monotonous decrease of representation field size from index finger to little finger although the field sizes are known to change in response to training or in disease. Recent developments improved noninvasive functional mapping of S1 by a) adding a cognitive task during repetitive stimulation to decrease habituation to the stimuli, b) smaller voxel size of fMRI-sequences, c) surface-based analysis accounting for cortical curvature, and d) increase of spatial specificity for fMRI data analysis by avoidance of smoothing, partial volume effects, and pial vein signals. We here applied repetitive pneumatic stimulation of digit 1 (D1; thumb) and digit 5 (D5; little finger) on both hands to investigate finger/hand representation maps in the complete S1, but also in cytoarchitectonic Areas 1, 2, 3a, and 3b separately, in 21 healthy volunteers using 3T fMRI. The distances between activation maxima of D1 and D5 were evaluated by two independent raters, blinded for performance parameters. The fingertip representations showed a somatotopy and were localized in the transition region between the crown and the anterior wall of the post central gyrus agreeing with Area 1 and 3b. Participants were comprehensively tested for tactile performance using von Freyhair filaments to determine cutaneous sensory thresholds (CST) as well as grating orientation thresholds (GOT) and two-point resolution (TPD) for spatio-tactile acuity testing. Motor performance was evaluated with pinch grip performance (Roeder test). We found bilateral associations of D1-D5 distance for GOT thresholds and partially also for TPD in Area 3b and in Area 1, but not if using the complete S1 mask. In conclusion, we here demonstrate that 3T fMRI is capable to map associations between spatio-tactile acuity and the fingertip representation in Area 3b and Area 1 in healthy participants.
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Affiliation(s)
- J Härtner
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine of Greifswald, Walther-Rathenau-Str.46, D-17475 Greifswald, Germany
| | - S Strauss
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine of Greifswald, Walther-Rathenau-Str.46, D-17475 Greifswald, Germany; Neurology, University Medicine of Greifswald, Germany
| | - J Pfannmöller
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine of Greifswald, Walther-Rathenau-Str.46, D-17475 Greifswald, Germany; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, USA
| | - M Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine of Greifswald, Walther-Rathenau-Str.46, D-17475 Greifswald, Germany.
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16
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Yamashita Y, Nishigami T, Mibu A, Tanaka K, Wand BM, Catley MJ, Higashi T. Development and Psychometric Testing of the Japanese Version of the Fremantle Neck Awareness Questionnaire: A Cross-Sectional Study. J Pain Res 2021; 14:311-324. [PMID: 33568938 PMCID: PMC7870290 DOI: 10.2147/jpr.s267930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Contemporary theories of pain suggest that how the body is perceived is central to the emergence of pain. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. However, there is no comprehensive measure to quantify self-perception of the painful area in Japanese people with neck pain. This study aimed to develop a Japanese version of a self-perception questionnaire specific to the neck and evaluate the validity and reliability of the scale using Rasch analysis. Materials and Methods The Fremantle Neck Awareness Questionnaire (FreNAQ-J) was developed by modifying the FreBAQ-J. One hundred people with chronic neck pain and fifty-six matched healthy controls completed the questionnaire. Rasch analysis was used to evaluate targeting, category order, unidimensionality, person fit, internal consistency, differential item functioning, and differential test functioning in the neck pain population. Validity was investigated by examining the relationship between the FreNAQ-J and clinical status. Results People with chronic neck pain endorsed FreNAQ-J items with greater frequency than healthy controls. FreNAQ-J did not reject the null hypothesis of fitting the Rasch model, had acceptable internal consistency and good test–retest reliability. Summed FreNAQ-J scores were significantly correlated with pain intensity, disability, pain-related catastrophizing and fear of movement. Conclusion The individual items of the FreNAQ-J can be validly summed to provide a score of self-perception. The FreNAQ-J is the first scale developed for comprehensively evaluating disturbed body perception in Japanese patients with chronic neck pain.
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Affiliation(s)
- Yuh Yamashita
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, 852-8520, Japan.,Department of Rehabilitation, Morinaga Orthopedic Clinic, Saga, 849-0934, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Prefectural University of Hiroshima, Mihara, Hiroshima, 723-0053, Japan
| | - Akira Mibu
- Department of Nursing and Physical Therapy, Konan Women's University, Kobe, Hyogo, 658-0001, Japan
| | | | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, 6959, Australia
| | - Mark J Catley
- School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Toshio Higashi
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, 852-8520, Japan
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Kersch A, Perera P, Mercado M, Gorrie A, Sainsbury D, McGrath T, Aouad P, Sarraf S, Jaaniste T, Champion D. Somatosensory Testing in Pediatric Patients with Chronic Pain: An Exploration of Clinical Utility. CHILDREN-BASEL 2020; 7:children7120275. [PMID: 33291481 PMCID: PMC7762158 DOI: 10.3390/children7120275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022]
Abstract
We aimed to evaluate the utility of clinical somatosensory testing (SST), an office adaptation of laboratory quantitative sensory testing, in a biopsychosocial assessment of a pediatric chronic somatic pain sample (N = 98, 65 females, 7–18 years). Stimulus–response tests were applied at pain regions and intra-subject control sites to cutaneous stimuli (simple and dynamic touch, punctate pressure and cool) and deep pressure stimuli (using a handheld pressure algometer, and, in a subset, manually inflated cuff). Validated psychological, pain-related and functional measures were administered. Cutaneous allodynia, usually regional, was elicited by at least one stimulus in 81% of cases, most frequently by punctate pressure. Central sensitization, using a composite measure of deep pressure pain threshold and temporal summation of pain, was implied in the majority (59.2%) and associated with worse sleep impairment and psychological functioning. In regression analyses, depressive symptoms were the only significant predictor of pain intensity. Functional interference was statistically predicted by deep pressure pain threshold and depressive symptoms. Manually inflated cuff algometry had comparable sensitivity to handheld pressure algometry for deep pressure pain threshold but not temporal summation of pain. SST complemented standard biopsychosocial assessment of pediatric chronic pain; use of SST may facilitate the understanding of disordered neurobiology.
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Affiliation(s)
- Anna Kersch
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Panchalee Perera
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Melanie Mercado
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew Gorrie
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - David Sainsbury
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
| | - Tara McGrath
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Phillip Aouad
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sara Sarraf
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
| | - Tiina Jaaniste
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - David Champion
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Huang J, Li Y, Xie H, Yang S, Jiang C, Sun W, Li D, Liao Y, Ba X, Xiao L. Abnormal Intrinsic Brain Activity and Neuroimaging-Based fMRI Classification in Patients With Herpes Zoster and Postherpetic Neuralgia. Front Neurol 2020; 11:532110. [PMID: 33192967 PMCID: PMC7642867 DOI: 10.3389/fneur.2020.532110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/01/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Neuroimaging studies on neuropathic pain have discovered abnormalities in brain structure and function. However, the brain pattern changes from herpes zoster (HZ) to postherpetic neuralgia (PHN) remain unclear. The present study aimed to compare the brain activity between HZ and PHN patients and explore the potential neural mechanisms underlying cognitive impairment in neuropathic pain patients. Methods: Resting-state functional magnetic resonance imaging (MRI) was carried out among 28 right-handed HZ patients, 24 right-handed PHN patients, and 20 healthy controls (HC), using a 3T MRI system. The amplitude of low-frequency fluctuation (ALFF) was analyzed to detect the brain activity of the patients. Correlations between ALFF and clinical pain scales were assessed in two groups of patients. Differences in brain activity between groups were examined and used in a support vector machine (SVM) algorithm for the subjects' classification. Results: Spontaneous brain activity was reduced in both patient groups. Compared with HC, patients from both groups had decreased ALFF in the precuneus, posterior cingulate cortex, and middle temporal gyrus. Meanwhile, the neural activities of angular gyrus and middle frontal gyrus were lowered in HZ and PHN patients, respectively. Reduced ALFF in these regions was associated with clinical pain scales in PHN patients only. Using SVM algorithm, the decreased brain activity in these regions allowed for the classification of neuropathic pain patients (HZ and PHN) and HC. Moreover, HZ and PHN patients are also roughly classified by the same model. Conclusion: Our study indicated that mean ALFF values in these pain-related regions can be used as a functional MRI-based biomarker for the classification of subjects with different pain conditions. Altered brain activity might contribute to PHN-induced pain.
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Affiliation(s)
- Jiabin Huang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Huijun Xie
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Shaomin Yang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Changyu Jiang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Wuping Sun
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Disen Li
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yuliang Liao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xiyuan Ba
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Lizu Xiao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Granata G, Valle G, Di Iorio R, Iodice F, Petrini FM, Strauss I, D'anna E, Iberite F, Lauretti L, Fernandez E, Romanello R, Stieglitz T, Raspopovic S, Calabresi P, Micera S, Rossini PM. Cortical plasticity after hand prostheses use: Is the hypothesis of deafferented cortex "invasion" always true? Clin Neurophysiol 2020; 131:2341-2348. [PMID: 32828036 DOI: 10.1016/j.clinph.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study motor cortex plasticity after a period of training with a new prototype of bidirectional hand prosthesis in three left trans-radial amputees, correlating these changes with the modification of Phantom Limb Pain (PLP) in the same period. METHODS Each subject underwent a brain motor mapping with Transcranial Magnetic Stimulation (TMS) and PLP evaluation with questionnaires during a six-month training with a prototype of bidirectional hand prosthesis. RESULTS The baseline motor maps showed in all three amputees a smaller area of muscles representation of the amputated side compared to the intact limb. After training, there was a partial reversal of the baseline asymmetry. The two subjects affected by PLP experienced a statistically significant reduction of pain. CONCLUSIONS Two apparently opposite findings, the invasion of the "deafferented" cortex by neighbouring areas and the "persistence" of neural structures after amputation, could vary according to different target used for measurement. Our results do not support a correlation between PLP and motor cortical changes. SIGNIFICANCE The selection of the target and of the task is essential for studies investigating motor brain plasticity. This study boosts against a direct and unique role of motor cortical changes on PLP genesis.
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Affiliation(s)
- G Granata
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - G Valle
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - R Di Iorio
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Iodice
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
| | - F M Petrini
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - I Strauss
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - E D'anna
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - F Iberite
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - L Lauretti
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - E Fernandez
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - R Romanello
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - S Raspopovic
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P Calabresi
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Micera
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P M Rossini
- Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
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Deer TR, Naidu R, Strand N, Sparks D, Abd-Elsayed A, Kalia H, Hah JM, Mehta P, Sayed D, Gulati A. A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions. Bioelectron Med 2020; 6:9. [PMID: 32346553 PMCID: PMC7181529 DOI: 10.1186/s42234-020-00045-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing. Main body While clinical data is forthcoming, understanding factors that influence successful outcomes in the use of PNS still needs to be delineated. This article reviews the evolution and bioelectronic principles of peripheral nerve stimulation including patient selection, nerve targets, techniques and guidance of target delivery. We collate the current evidence for outcomes and provide recommendations for salient topics in PNS. Conclusion Peripheral nerve stimulation has evolved from a surgically invasive procedure to a minimally invasive technique that can be used early in the treatment of peripheral nerve pain. This review identifies and addresses many of the variables which influence the success of PNS in the clinical setting.
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Affiliation(s)
- Timothy R Deer
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Ramana Naidu
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Natalie Strand
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Dawn Sparks
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Alaa Abd-Elsayed
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Hemant Kalia
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Jennifer M Hah
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Pankaj Mehta
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Dawood Sayed
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Amitabh Gulati
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
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21
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Role of Potassium Ions Quantum Tunneling in the Pathophysiology of Phantom Limb Pain. Brain Sci 2020; 10:brainsci10040241. [PMID: 32325702 PMCID: PMC7226264 DOI: 10.3390/brainsci10040241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Abstract
(1) Background: multiple theories were proposed to explain the phenomenon of phantom limb pain (PLP). Nevertheless, the phenomenon is still shrouded in mystery. The aim of this study is to explore the phenomenon from a new perspective, where quantum tunneling of ions, a promising field in medical practice, might play a major role. (2) Methods: investigators designed a quantum mathematical model based on the Schrödinger equation to examine the probability of potassium ions quantum tunneling through closed membrane potassium channels to the inside of phantom axons, leading to the generation of action potential. (3) Results: the model suggests that the probability of action potential induction at a certain region of the membrane of phantom neurons, when a neuron of the stump area is stimulated over 1 mm2 surface area of the membrane available for tunneling is 1.04 × 10−2. Furthermore, upon considering two probabilities of potassium channelopathies, one that decreased the energy of the barrier by 25% and another one by 50%, the tunneling probability became 1.22 × 10−8 and 3.86 × 10−4, respectively. (4) Conclusion: quantum models of potassium ions can provide a reliable theoretical hypothesis to unveil part of the ambiguity behind PLP.
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22
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Huo BB, Shen J, Hua XY, Zheng MX, Lu YC, Wu JJ, Shan CL, Xu JG. Alteration of metabolic connectivity in a rat model of deafferentation pain: a 18F-FDG PET/CT study. J Neurosurg 2020; 132:1295-1303. [PMID: 30835695 DOI: 10.3171/2018.11.jns181815] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Refractory deafferentation pain has been evidenced to be related to central nervous system neuroplasticity. In this study, the authors sought to explore the underlying glucose metabolic changes in the brain after brachial plexus avulsion, particularly metabolic connectivity. METHODS Rats with unilateral deafferentation following brachial plexus avulsion, a pain model of deafferentation pain, were scanned by small-animal 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) PET/CT to explore the changes of metabolic connectivity among different brain regions. Thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT) of the intact forepaw were also measured for evaluating pain sensitization. Brain metabolic connectivity and TWL were compared from baseline to 1 week after brachial plexus avulsion. RESULTS Alterations of metabolic connectivity occurred not only within the unilateral hemisphere contralateral to the injured forelimb, but also in the other hemisphere and even in the connections between bilateral hemispheres. Metabolic connectivity significantly decreased between sensorimotor-related areas within the left hemisphere (contralateral to the injured forelimb) (p < 0.05), as well as between areas across bilateral hemispheres (p < 0.05). Connectivity between areas within the right hemisphere (ipsilateral to the injured forelimb) significantly increased (p = 0.034). TWL and MWT of the left (intact) forepaw after surgery were significantly lower than those at baseline (p < 0.001). CONCLUSIONS This study revealed that unilateral brachial plexus avulsion facilitates pain sensitization in the opposite limb. A specific pattern of brain metabolic changes occurred in this procedure. Metabolic connectivity reorganized not only in the sensorimotor area corresponding to the affected forelimb, but also in extensive areas involving the bilateral hemispheres. These findings may broaden our understanding of central nervous system changes, as well as provide new information and a potential intervention target for nosogenesis of deafferentation pain.
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Affiliation(s)
- Bei-Bei Huo
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Jun Shen
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Xu-Yun Hua
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
- 3Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
- 3Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye-Chen Lu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Jia-Jia Wu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
- Departments of2Rehabilitation Medicine and
| | - Chun-Lei Shan
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
- Departments of2Rehabilitation Medicine and
| | - Jian-Guang Xu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
- Departments of2Rehabilitation Medicine and
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23
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Altered intrinsic brain activity and regional cerebral blood flow in patients with chronic neck and shoulder pain. Pol J Radiol 2020; 85:e155-e162. [PMID: 32322322 PMCID: PMC7172875 DOI: 10.5114/pjr.2020.94063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To identify the changes of intrinsic brain activity and regional cerebral blood flow in patients with chronic neck and shoulder pain (CNSP) by using amplitude of low-frequency fluctuation (ALFF) analysis and arterial spin labelling study. Material and methods In total, 28 CNSP patients and 25 age-matched and sex-matched healthy controls (HCs) participated in the study. Resting-state functional magnetic resonance imaging (rs-fMRI) and arterial spin labelling (ASL) MRI were acquired. Correlations between ALFF and cerebral blood flow (CBF) were analysed. Subsequently, the differences in ALFF and CBF were compared in the two groups. Finally, the visual analogue scale (VAS) was also assessed in the CNSP group. Results Compared with HCs, CNSP patients showed significantly abnormal ALFF and CBF in several brain regions, including the cerebellum posterior lobe, middle orbitofrontal gyrus, medial superior frontal gyrus, middle temporal gyrus, precuneus, cingulate gyrus, middle occipital gyrus, middle frontal gyrus, postcentral gyrus, precentral gyrus, and superior parietal gyrus. Correlation analysis showed that the ALFF value of the medial superior frontal gyrus positively correlated with the VAS score. However, no correlation was found between the CBF values and the VAS score. Conclusions The altered ALFF and CBF values in CNSP patients were observed in different pain-related brain regions that were involved in pain modulation and perception. The combination of rs-fMRI and ASL MRI might provide complementary information for increasing our understanding of the neuropathology in CNSP.
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24
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CRPS Is Not Associated with Altered Sensorimotor Cortex GABA or Glutamate. eNeuro 2020; 7:ENEURO.0389-19.2020. [PMID: 31980452 PMCID: PMC7029188 DOI: 10.1523/eneuro.0389-19.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating chronic pain disorder typically in the upper or lower limbs. While CRPS usually develops from a peripheral event, it is likely maintained by CNS changes. Indeed, CRPS is reported to be associated with sensorimotor cortex changes, or functional “reorganization,” as well as deficits such as poor tactile acuity. While the mechanisms underpinning cortical reorganization in CRPS are unknown, some have hypothesized that it involves disinhibition (i.e., a reduction in GABA activity). In this study, we addressed this hypothesis by using edited magnetic resonance spectroscopy to determine sensorimotor GABA and glutamate concentrations in 16 humans with CRPS and 30 matched control subjects and the relationship of these concentrations with tactile acuity. We found that individuals with upper limb CRPS displayed reduced tactile acuity in the painful hand, compared with the nonpainful hand and pain-free control subjects. Despite this acuity deficit, CRPS was not associated with altered GABA or glutamate concentrations within the sensorimotor cortex on either the side that represents the affected or unaffected hand. Furthermore, there was no significant relationship between sensorimotor GABA or glutamate concentrations and tactile acuity in CRPS subjects or control subjects. Although our sample was small, these data suggest that CRPS is not associated with altered total sensorimotor GABA or glutamate concentrations. While these results are at odds with the sensorimotor cortex disinhibition hypothesis, it is possible that GABAergic mechanisms other than total GABA concentration may contribute to such disinhibition.
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25
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Mancini F, Wang AP, Schira MM, Isherwood ZJ, McAuley JH, Iannetti GD, Sereno MI, Moseley GL, Rae CD. Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome. J Neurosci 2019; 39:9185-9196. [PMID: 31570533 PMCID: PMC6855684 DOI: 10.1523/jneurosci.2005-18.2019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/21/2023] Open
Abstract
It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to "restore" somatotopic representations to treat pain.SIGNIFICANCE STATEMENT This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.
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Affiliation(s)
- Flavia Mancini
- Computational and Biological Learning, Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, United Kingdom,
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
| | - Audrey P Wang
- Neuroscience Research Australia, Sydney, New South Wales 2031, Australia
- Faculty of Medicine and Health and Faculty of Health Sciences, University of Sydney, Sydney, New South Wales 2145, Australia
| | - Mark M Schira
- Neuroscience Research Australia, Sydney, New South Wales 2031, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - Zoey J Isherwood
- School of Psychology, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - James H McAuley
- Neuroscience Research Australia, Sydney, New South Wales 2031, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Giandomenico D Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
- Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome 00161, Italy
| | - Martin I Sereno
- Department of Psychology, University College London, London WC1E 6BT, United Kingdom
- Department of Psychology, San Diego State University, San Diego, California 92182, and
| | - G Lorimer Moseley
- Neuroscience Research Australia, Sydney, New South Wales 2031, Australia
- IMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, Sydney, New South Wales 2031, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia
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26
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Wang Y, Cao P, Mei L, Yin W, Mao Y, Niu C, Zhang Z, Tao W. Microglia in the Primary Somatosensory Barrel Cortex Mediate Trigeminal Neuropathic Pain. Neuroscience 2019; 414:299-310. [PMID: 31181369 DOI: 10.1016/j.neuroscience.2019.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
Trigeminal neuropathic pain (TGN) is an attacking, abrupt, electric-shock headache involving abnormal cortical activity. The neural mechanism underlying TGN remains elusive. In this study, we explored the role of microglia in the primary somatosensory barrel cortex (S1BF), which is a critical region for TGN, of a mouse model of TGN that displayed significant pain-related behaviors. Using electrophysiological recordings, we found robust neuronal hyperactivity in glutamatergic neurons of S1BF (GluS1BF). Chemogenetic inhibition of GluS1BF neurons significantly relieved mechanical allodynia in TGN mice. In naïve mice, chemogenetic activation of GluS1BF neurons induced pain sensitization. In addition, we found that microglia in the S1BF (microgliaS1BF) were significantly activated, with density and morphology changes. Intraperitoneal administration of minocycline, a microglia inhibitor, attenuated pain sensitization, and decreased GluS1BF neuronal activity. Together, these findings demonstrate the putative importance of microglia as a key regulator in TGN through actions on GluS1BF neuronal adaptation.
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Affiliation(s)
- Yuping Wang
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China
| | - Peng Cao
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China
| | - Lisheng Mei
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China
| | - Weiwei Yin
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China
| | - Yu Mao
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China; Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei 230022, PR China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, PR China
| | - Zhi Zhang
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China.
| | - Wenjuan Tao
- Hefei National Laboratory for Physical Sciences at the Microscale, Key Laboratory of Brain Function and Disease, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei 230027, PR China; Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei 230022, PR China.
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27
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Salo KST, Vaalto SMI, Koponen LM, Nieminen JO, Ilmoniemi RJ. The effect of experimental pain on short-interval intracortical inhibition with multi-locus transcranial magnetic stimulation. Exp Brain Res 2019; 237:1503-1510. [PMID: 30919012 PMCID: PMC6525662 DOI: 10.1007/s00221-019-05502-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Chronic neuropathic pain is known to alter the primary motor cortex (M1) function. Less is known about the normal, physiological effects of experimental neurogenic pain on M1. The objective of this study is to determine how short-interval intracortical inhibition (SICI) is altered in the M1 representation area of a muscle exposed to experimental pain compared to SICI of another muscle not exposed to pain. The cortical representation areas of the right abductor pollicis brevis (APB) and biceps brachii (BB) muscles of 11 subjects were stimulated with a multi-locus transcranial magnetic stimulation device while the resulting motor-evoked potentials (MEPs) were recorded with electromyography. Single- and paired-pulse TMS was administered in seven conditions, including one with the right hand placed in cold water. The stimulation intensity for the conditioning pulses in the paired-pulse examination was 80% of the resting motor threshold (RMT) of the stimulated site and 120% of RMT for both the test and single pulses. The paired-pulse MEP amplitudes were normalized with the mean amplitude of the single-pulse MEPs of the same condition and muscle. SICI was compared between conditions. After the cold pain, the normalized paired-pulse MEP amplitudes decreased in APB, but not in BB, indicating that SICI was potentially increased only in the cortical area of the muscle subjected to pain. These data suggest that SICI is increased in the M1 representation area of a hand muscle shortly after exposure to pain has ended, which implies that short-lasting pain can alter the inhibitory balance in M1.
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Affiliation(s)
- Karita S-T Salo
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, AALTO, P.O. Box 12200, 00076, Espoo, Finland. .,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Selja M I Vaalto
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, AALTO, P.O. Box 12200, 00076, Espoo, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lari M Koponen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, AALTO, P.O. Box 12200, 00076, Espoo, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jaakko O Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, AALTO, P.O. Box 12200, 00076, Espoo, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, AALTO, P.O. Box 12200, 00076, Espoo, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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28
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Liu J, Zhang F, Liu X, Zhuo Z, Wei J, Du M, Chan Q, Wang X, Wang D. Altered small-world, functional brain networks in patients with lower back pain. SCIENCE CHINA-LIFE SCIENCES 2018; 61:1420-1424. [PMID: 30417246 DOI: 10.1007/s11427-017-9108-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023]
Abstract
In this study, we aimed to investigate the functional network changes that occur in patients with lower back pain (LBP). We also investigated the link between LBP and the small-world properties of functional networks within the brain. Functional MRI (fMRI) was performed on 20 individuals with LBP and 17 age and gender-matched normal controls during the resting state. The severity of the pain in the individuals with LBP ranged from 5 to 8 on a 0-10 scale, with 0 indicating no pain. Network-based statistics were performed to investigate the differences between the brain networks of individuals with LBP and those of normal controls. Several small-world parameters of brain networks were calculated, including the clustering coefficient, characteristic path length, local efficiency, and global efficiency. These criteria reflect the overall network efficiency. The brain networks in the individuals with LBP due to herniation of a lumbar disc demonstrated a significantly longer characteristic path length as well as a lower clustering coefficient, global efficiency, and local efficiency compared to those in control subjects. We found that LBP patients tended to have unstable and inefficient brain networks when compared with healthy controls. In addition, LBP individuals showed significantly decreased functional connectivity in the anterior cingulate cortex, middle cingulate cortex, post cingulate cortex, inferior frontal gyrus, middle temporal gyrus, occipital gyrus, postcentral gyrus, precentral gyrus, supplementary motor area, thalamus, fusiform, caudate, and cerebellum. We believe that these regions may be involved in the pathophysiology of lower back pain.
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Affiliation(s)
- Jing Liu
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Feng Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China
| | - Xiufen Liu
- Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China
| | | | - Juan Wei
- Philips Research China, Shanghai, 200040, China
| | - Minyi Du
- Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China
| | | | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China.
| | - Dongxin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China.
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29
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Andoh J, Milde C, Tsao J, Flor H. Cortical plasticity as a basis of phantom limb pain: Fact or fiction? Neuroscience 2018; 387:85-91. [DOI: 10.1016/j.neuroscience.2017.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/04/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022]
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30
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Vuckovic A, Gallardo VJF, Jarjees M, Fraser M, Purcell M. Prediction of central neuropathic pain in spinal cord injury based on EEG classifier. Clin Neurophysiol 2018; 129:1605-1617. [PMID: 29886266 DOI: 10.1016/j.clinph.2018.04.750] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/08/2018] [Accepted: 04/26/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To create a classifier based on electroencephalography (EEG) to identify spinal cord injured (SCI) participants at risk of developing central neuropathic pain (CNP) by comparing them with patients who had already developed pain and with able bodied controls. METHODS Multichannel EEG was recorded in the relaxed eyes opened and eyes closed states in 10 able bodied participants and 31 subacute SCI participants (11 with CNP, 10 without NP and 10 who later developed pain within 6 months of the EEG recording). Up to nine EEG band power features were classified using linear and non-linear classifiers. RESULTS Three classifiers (artificial neural networks ANN, support vector machine SVM and linear discriminant analysis LDA) achieved similar average performances, higher than 85% on a full set of features identifying patients at risk of developing pain and achieved comparably high performance classifying between other groups. With only 10 channels, LDA and ANN achieved 86% and 83% accuracy respectively, identifying patients at risk of developing CNP. CONCLUSION Transferable learning classifier can detect patients at risk of developing CNP. EEG markers of pain appear before its physical symptoms. Simple and complex classifiers have comparable performance. SIGNIFICANCE Identify patients to receive prophylaxic treatment of CNP.
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Affiliation(s)
| | - Vicente Jose Ferrer Gallardo
- Biomedical Engineering Division, University of Glasgow, Glasgow, UK; Basque Center on Cognition, Brain and Language, Spain
| | - Mohammed Jarjees
- Biomedical Engineering Division, University of Glasgow, Glasgow, UK; Engineering Technical College of Mosul, The Northern Technical University, Mosul, Iraq
| | - Mathew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
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31
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Abstract
Pain modulates rhythmic neuronal activity recorded by Electroencephalography (EEG) in humans. Our laboratory previously showed that rat models of acute and neuropathic pain manifest increased power in primary somatosensory cortex (S1) recorded by electrocorticography (ECoG). In this study, we hypothesized that pain increases EEG power and corticocortical coherence in different rat models of pain, whereas treatments with clinically effective analgesics reverse these changes. Our results show increased cortical power over S1 and prefrontal cortex (PFC) in awake, freely behaving rat models of acute, inflammatory and neuropathic pain. Coherence between PFC and S1 is increased at a late, but not early, time point during the development of neuropathic pain. Electroencephalography power is not affected by ibuprofen in the acute pain model. However, pregabalin and mexiletine reverse the changes in power and S1-PFC coherence in the inflammatory and neuropathic pain models. These data suggest that quantitative EEG might be a valuable predictor of pain and analgesia in rodents.
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32
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Cheng YF, Chang YT, Chen WH, Shih HC, Chen YH, Shyu BC, Chen CC. Cardioprotection induced in a mouse model of neuropathic pain via anterior nucleus of paraventricular thalamus. Nat Commun 2017; 8:826. [PMID: 29018188 PMCID: PMC5635036 DOI: 10.1038/s41467-017-00891-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/03/2017] [Indexed: 12/13/2022] Open
Abstract
Myocardial infarction is the leading cause of death worldwide. Restoration of blood flow rescues myocardium but also causes ischemia-reperfusion injury. Here, we show that in a mouse model of chronic neuropathic pain, ischemia-reperfusion injury following myocardial infarction is reduced, and this cardioprotection is induced via an anterior nucleus of paraventricular thalamus (PVA)-dependent parasympathetic pathway. Pharmacological inhibition of extracellular signal-regulated kinase activation in the PVA abolishes neuropathic pain-induced cardioprotection, whereas activation of PVA neurons pharmacologically, or optogenetic stimulation, is sufficient to induce cardioprotection. Furthermore, neuropathic injury and optogenetic stimulation of PVA neurons reduce the heart rate. These results suggest that the parasympathetic nerve is responsible for this unexpected cardioprotective effect of chronic neuropathic pain in mice. Various forms of preconditioning can prevent ischemic-reperfusion injury after myocardial infarction. Here, the authors show that in mice, the presence of chronic neuropathic pain can have a cardioprotective effect, and that this is dependent on neural activation in the paraventricular thalamus.
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Affiliation(s)
- Yi-Fen Cheng
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 114, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
| | - Ya-Ting Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan.,International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, 115, Taiwan
| | - Wei-Hsin Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
| | - Hsi-Chien Shih
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
| | - Yen-Hui Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
| | - Bai-Chuang Shyu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
| | - Chien-Chang Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 114, Taiwan. .,Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan. .,International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, 115, Taiwan.
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Kim W, Kim SK, Nabekura J. Functional and structural plasticity in the primary somatosensory cortex associated with chronic pain. J Neurochem 2017; 141:499-506. [PMID: 28278355 DOI: 10.1111/jnc.14012] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 02/03/2023]
Abstract
Tissue or nerve injury induces widespread plastic changes from the periphery and spinal cord up to the cortex, resulting in chronic pain. Although many clinicians and researchers have extensively studied altered nociceptive signaling and neural circuit plasticity at the spinal cord level, effective treatments to ameliorate chronic pain are still insufficient. For about the last two decades, the rapid development in macroscopic brain imaging studies on humans and animal models have revealed maladaptive plastic changes in the 'pain matrix' brain regions, which may subsequently contribute to chronic pain. Among these brain regions, our group has concentrated for many years on the primary somatosensory (S1) cortex with a help of advanced imaging techniques and has found the functional and structural changes in neurons/glia as well as individual synapses in the S1 cortex during chronic pain. Taken together, it is now believed that such S1 plasticity is one of the causes for chronic pain, not a simple and passive epiphenomenon following tissue/nerve injury as previously thought. In this small review, we discuss the relation of plasticity in the S1 cortex with chronic pain, based on clinical trials and experimental studies conducted on this field. This article is part of the special article series "Pain".
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Affiliation(s)
- Woojin Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Sun Kwang Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Junichi Nabekura
- Division of Homeostatic Development, National Institute for Physiological Sciences, Okazaki, Aichi, Japan.,Department of Physiological Sciences, The Graduate School for Advanced Study, Hayama, Kanagawa, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Tokyo, Japan
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Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study. Scand J Pain 2017; 15:30-37. [DOI: 10.1016/j.sjpain.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 11/21/2022]
Abstract
Abstract
Background and aims
Patients suffering from Complex Regional Pain Syndrome (CRPS) of the upper limb show a changed cortical representation of the affected hand. The lip area invades the former hand area contralateral to the affected hand. This change in cortical representation is correlated to the intensity of ongoing pain in patients with CRPS. Further studies revealed that restoration of the original representation coincides with a decrease of pain. Sensory-motor training protocols can increase and/or relocate cortical somatosensory and motor representation areas of the fingers, as shown, for example, in Braille reading individuals and professional violin players. Further, there is evidence that sensory-motor discrimination training has a beneficial effect on both the intensity of pain and the mislocalization of sensory-motor cortical areas in CRPS patients. Based on these propositions, we developed a novel sensory-motor self-training paradigm for CRPS patients to use in a home-based manner.
Methods
Ten CRPS patients performed the sensory-motor training for 2 weeks. The training consists of a braille-like haptic task with different training modes (bi-manual, speed and memory training). During the training, as well as 1 week before and after, patients were asked to fill out pain diaries. Furthermore, measures of impairment were acquired at baseline and post training.
Results
Patients showed significant pain reduction after the 2 week training period. The overall disability as well as the depression scores showed a trend to improve after the 2 week training. The reduction in pain was correlated with the total amount of training performed.
Conclusions
This is a first proof of principle study of a novel sensory-motor self-training protocol to reduce pain in CRPS patients. The more consistent the patients trained the larger the pain reduction. Sensory-motor training, which can be performed on a regular basis at home might provide a novel interventional strategy to improve symptoms of CRPS.
Implications
Although a larger study needs to be conducted to confirm our findings, including long-term follow-up, the results show, that a sensory-motor home-based training is a strategy worth exploring further for the reduction of pain as well as high frequency training for patients with CRPS.
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Abstract
The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI.
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Affiliation(s)
- Katherine T Martucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab (SNAPL), 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304-1345, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab (SNAPL), 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304-1345, USA.
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Meng FX, Hou JM, Sun TS. Effect of oxidative stress induced by intracranial iron overload on central pain after spinal cord injury. J Orthop Surg Res 2017; 12:24. [PMID: 28178997 PMCID: PMC5299723 DOI: 10.1186/s13018-017-0526-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Central pain (CP) is a common clinical problem in patients with spinal cord injury (SCI). Recent studies found the pathogenesis of CP was related to the remodeling of the brain. We investigate the roles of iron overload and subsequent oxidative stress in the remodeling of the brain after SCI. METHODS We established a rat model of central pain after SCI. Rats were divided randomly into four groups: SCI, sham operation, SCI plus deferoxamine (DFX) intervention, and SCI plus nitric oxide synthase (NOS) inhibitor treatment. Pain behavior was observed and thermal pain threshold was measured regularly, and brain levels of iron, transferrin receptor 1 (TfR1), ferritin (Fn), and lactoferrin (Lf), were detected in the different groups 12 weeks after establishment of the model. RESULTS Rats demonstrated self-biting behavior after SCI. Furthermore, the latent period of thermal pain was reduced and iron levels in the hind limb sensory area, hippocampus, and thalamus increased after SCI. Iron-regulatory protein (IRP) 1 levels increased in the hind limb sensory area, while Fn levels decreased. TfR1 mRNA levels were also increased and oxidative stress was activated. Oxidative stress could be inhibited by ferric iron chelators and NOS inhibitors. CONCLUSIONS SCI may cause intracranial iron overload through the NOS-iron-responsive element/IRP pathway, resulting in central pain mediated by the oxidative stress response. Iron chelators and oxidative stress inhibitors can effectively relieve SCI-associated central pain.
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Affiliation(s)
- Fan Xing Meng
- Third Military Medical University, No. 30 Gaotanyan Street, 400038 Chongqing, China
- Department of Orthopedics, Chinese PLA Army General Hospital, Dongcheng District, Nanmencang No. 5, 100700 Beijing, China
| | - Jing Ming Hou
- Department of Orthopedics, Chinese PLA Army General Hospital, Dongcheng District, Nanmencang No. 5, 100700 Beijing, China
- Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, 400038 Chongqing, China
| | - Tian Sheng Sun
- Third Military Medical University, No. 30 Gaotanyan Street, 400038 Chongqing, China
- Department of Orthopedics, Chinese PLA Army General Hospital, Dongcheng District, Nanmencang No. 5, 100700 Beijing, China
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Horst R, Maicki T, Trąbka R, Albrecht S, Schmidt K, Mętel S, von Piekartz H. Activity- vs. structural-oriented treatment approach for frozen shoulder: a randomized controlled trial. Clin Rehabil 2017; 31:686-695. [DOI: 10.1177/0269215516687613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder. Design: Double-blinded, randomized, experimental study. Setting: Outpatient clinic. Subjects: We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint. Interventions: The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day. Main measures: Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy. Results: A total of 66 patients were randomized into two groups: The activity-oriented group ( n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group ( n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up ( p < 0.05). Conclusions: Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.
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Affiliation(s)
- Renata Horst
- Private Practice and Institute for Further Education for Medical Professions, Ingelheim, Germany
| | - Tomasz Maicki
- Clinic of Rehabilitation, Jagiellonian University, Cracow, Poland
- Cracow Rehabilitation Center, Cracow, Poland
| | - Rafał Trąbka
- Clinic of Rehabilitation, Jagiellonian University, Cracow, Poland
- Cracow Rehabilitation Center, Cracow, Poland
| | | | - Katharina Schmidt
- Department of Sports Medicine, Goethe-University, Frankfurt am Main, Germany
| | - Sylwia Mętel
- Department of Physical Medicine and Biomedical Renewal, University of Physical Education in Krakow, Cracow, Poland
| | - Harry von Piekartz
- University of Applied Science, Hochschule Osnabruck Fakultat Wirtschafts- und Sozialwissenschaften, Osnabrueck, Germany
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Alomar S, Bakhaidar M. Neuroimaging of neuropathic pain: review of current status and future directions. Neurosurg Rev 2016; 41:771-777. [DOI: 10.1007/s10143-016-0807-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/24/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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Hotta J, Saari J, Koskinen M, Hlushchuk Y, Forss N, Hari R. Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome. THE JOURNAL OF PAIN 2016; 18:255-265. [PMID: 27847313 DOI: 10.1016/j.jpain.2016.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/30/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022]
Abstract
Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q < .05, false discovery rate-corrected) included the hand representation area in the sensorimotor cortex, inferior frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control. PERSPECTIVE This article shows that in CRPS, the observation of others' motor actions induces abnormal neural activity in brain areas essential for sensorimotor functions and pain. These results build the cerebral basis for action-observation impairments in CRPS.
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Affiliation(s)
- Jaakko Hotta
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Finland.
| | - Jukka Saari
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Miika Koskinen
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yevhen Hlushchuk
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Finland
| | - Riitta Hari
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Art, Aalto University School of Arts, Design and Architecture, Helsinki, Finland
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Thibault K, Rivière S, Lenkei Z, Férézou I, Pezet S. Orofacial Neuropathic Pain Leads to a Hyporesponsive Barrel Cortex with Enhanced Structural Synaptic Plasticity. PLoS One 2016; 11:e0160786. [PMID: 27548330 PMCID: PMC4993517 DOI: 10.1371/journal.pone.0160786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/25/2016] [Indexed: 12/30/2022] Open
Abstract
Chronic pain is a long-lasting debilitating condition that is particularly difficult to treat due to the lack of identified underlying mechanisms. Although several key contributing processes have been described at the level of the spinal cord, very few studies have investigated the supraspinal mechanisms underlying chronic pain. Using a combination of approaches (cortical intrinsic imaging, immunohistochemical and behavioural analysis), our study aimed to decipher the nature of functional and structural changes in a mouse model of orofacial neuropathic pain, focusing on cortical areas involved in various pain components. Our results show that chronic neuropathic orofacial pain is associated with decreased haemodynamic responsiveness to whisker stimulation in the barrel field cortex. This reduced functional activation is likely due to the increased basal neuronal activity (measured indirectly using cFos and phospho-ERK immunoreactivity) observed in several cortical areas, including the contralateral barrel field, motor and cingulate cortices. In the same animals, immunohistochemical analysis of markers for active pre- or postsynaptic elements (Piccolo and phospho-Cofilin, respectively) revealed an increased immunofluorescence in deep cortical layers of the contralateral barrel field, motor and cingulate cortices. These results suggest that long-lasting orofacial neuropathic pain is associated with exacerbated neuronal activity and synaptic plasticity at the cortical level.
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Affiliation(s)
- Karine Thibault
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Sébastien Rivière
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Zsolt Lenkei
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Isabelle Férézou
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Sophie Pezet
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
- * E-mail:
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Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2016; 98:120-136.e2. [PMID: 27317866 DOI: 10.1016/j.apmr.2016.05.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/08/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To systematically review the relationship between lumbar proprioception and low back pain (LBP). DATA SOURCES Four electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus) and reference lists of relevant articles were searched from inception to March-April 2014. STUDY SELECTION Studies compared lumbar proprioception in patients with LBP with controls or prospectively evaluated the relationship between proprioception and LBP. Two reviewers independently screened articles and determined inclusion through consensus. DATA EXTRACTION Data extraction and methodologic quality assessment were independently performed using standardized checklists. DATA SYNTHESIS Twenty-two studies (1203 participants) were included. Studies measured lumbar proprioception via active or passive joint repositioning sense (JRS) or threshold to detection of passive motion (TTDPM). Data from 17 studies were pooled for meta-analyses to compare patients with controls. Otherwise, descriptive syntheses were performed. Data were analyzed according to measurement method and LBP subgroup. Active JRS was worse in patients compared with controls when measured in sitting (standard mean difference, .97; 95% confidence interval [CI], .31-1.64). There were no differences between groups measured via active JRS in standing (standard mean difference, .41; 95% CI, -.07 to .89) or passive JRS in sitting (standard mean difference, .38; 95% CI, -.83 to 1.58). Patients in the O'Sullivan flexion impairment subgroup had worse proprioception than the total LBP cohort. The TTDPM was significantly worse in patients than controls. One prospective study found no link between lumbar proprioception and LBP. CONCLUSIONS Patients with LBP have impaired lumbar proprioception compared with controls when measured actively in sitting positions (particularly those in the O'Sullivan flexion impairment subgroup) or via TTDPM. Clinicians should consider the relationship between sitting and proprioception in LBP and subgroup patients to guide management. Further studies focusing on subgroups, longitudinal assessment, and improving proprioception measurement are needed.
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Tsay A, Allen T, Proske U, Giummarra M. Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation. Neurosci Biobehav Rev 2015; 52:221-32. [DOI: 10.1016/j.neubiorev.2015.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/11/2014] [Accepted: 03/06/2015] [Indexed: 01/29/2023]
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Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord 2015; 16:25. [PMID: 25887644 PMCID: PMC4331171 DOI: 10.1186/s12891-015-0480-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/27/2015] [Indexed: 12/22/2022] Open
Abstract
Background Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders (MSD). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions. Discussion Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population. Summary Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.
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Affiliation(s)
- René Pelletier
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada.
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
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Canavero S, Bonicalzi V. Pain Myths and the Genesis of Central Pain. PAIN MEDICINE 2015; 16:240-8. [DOI: 10.1111/pme.12509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Barrett JE. The pain of pain: challenges of animal behavior models. Eur J Pharmacol 2015; 753:183-90. [PMID: 25583180 DOI: 10.1016/j.ejphar.2014.11.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/07/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022]
Abstract
Berend Olivier has had a long-standing interest in the utility of animal models for a wide variety of therapeutic indications. His work has spanned multiple types of models, blending ethological, or species typical and naturalistic behaviors, along with methodologies based on learned behavior. He has consistently done so, from an analytical as well as predictive perspective, and has made multiple contributions while working in both the pharmaceutical industry and within an academic institution. Although focused primarily on psychiatric disorders, Berend has conducted research in the area of pain in humans and in animals, demonstrating an expansive appreciation for the breadth, scope and significance of the science and applications of the discipline of pharmacology to these diverse areas. This review focuses on the use of animal models in pain research from the perspective of the long-standing deficiencies in the development of therapeutics in this area and from a preclinical perspective where the translational weaknesses have been quite problematic. The challenges confronting animal models of pain, however, are not unique to this area of research, as they cut across several therapeutic areas. Despite the deficiencies, failures and concerns, existing animal models of pain continue to be of widespread use and are essential to progress in pain research as well as in other areas. Although not focusing on specific animal models of pain, this paper seeks to examine general issues facing the use of these models. It does so by exploring alternative approaches which capture recent developments, which build upon principles and concepts we have learned from Berend's contributions, and which provide the prospect of helping to address the absence of novel therapeutics in this area.
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Affiliation(s)
- James E Barrett
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19103, United States.
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Burianová H, Rich AN, Williams M, Morgan M, Marstaller L, Maruff P, Baker CI, Savage G. Long-term plasticity in adult somatosensory cortex: functional reorganization after surgical removal of an arteriovenous malformation. Neurocase 2015; 21:618-27. [PMID: 25265167 DOI: 10.1080/13554794.2014.960429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The temporal scale of neuroplasticity following acute alterations in brain structure due to neurosurgical intervention is still under debate. We conducted a longitudinal study with the objective of investigating the postoperative changes in a patient who underwent cerebrovascular surgery and who subsequently lost proprioception in the fingers of her right hand. The results show increased activation in contralesional somatosensory areas, additional recruitment of premotor and posterior parietal areas, and changes in functional connectivity with left postcentral gyrus. These findings demonstrate long-term modifications of cortical organization and as such have important implications for treatment strategies for patients with brain injury.
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Affiliation(s)
- Hana Burianová
- a Centre for Advanced Imaging , The University of Queensland , Brisbane , Australia
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Kirveskari E, Vartiainen NV, Kallio-Laine K, Kalso E, Forss N. Normal laser-evoked cortical responses in patients with chronic hemibody pain. Eur J Pain 2014; 19:1168-76. [PMID: 25523148 DOI: 10.1002/ejp.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with widespread unilateral chronic pain associated with recurrent herpes simplex virus (HSV) infections show functional and/or structural changes in the insula, anterior cingulate cortex, frontal and prefrontal cortices, as well as the thalamus, suggesting central dysfunction of the pain system in these patients. Central pain has been associated with attenuated laser-evoked cortical responses. We aimed to clarify whether the observed deficient activation of these areas to acute nociceptive stimuli is due to a lesion at a lower level of pain processing pathways. METHODS We explored the functional integrity of the ascending nociceptive pathways by recording the cortical-evoked responses to noxious laser stimulation using magnetoencephalography and electroencephalography in eight patients (age 41-51 years, mean 46) with recurrent HSV infections and a history of chronic, spontaneous, widespread unilateral pain, and in nine age-matched healthy control subjects. RESULTS The cortical-evoked fields of the HSV patients originating from the secondary somatosensory and posterior parietal cortices, as well as the evoked potentials recorded from the midline, did not differ from those of the control subjects, indicating functionally intact ascending nociceptive pathways. CONCLUSIONS The present results show that our patients with chronic hemibody pain do not show signs of spinothalamic tract lesion. This indicates normal processing of sensory aspects of painful stimuli, while higher pain processing areas show altered activation. We conclude that normal laser-evoked magnetic fields (LEF) or laser-evoked potentials (LEP) may not exclude central pain condition.
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Affiliation(s)
- E Kirveskari
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland.,Department of Neurological Sciences, University of Helsinki, Finland
| | - N V Vartiainen
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland
| | - K Kallio-Laine
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland
| | - E Kalso
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland.,Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Finland
| | - N Forss
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Neurological Sciences, University of Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Finland
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Martucci KT, Ng P, Mackey S. Neuroimaging chronic pain: what have we learned and where are we going? FUTURE NEUROLOGY 2014; 9:615-626. [PMID: 28163658 PMCID: PMC5289824 DOI: 10.2217/fnl.14.57] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advances in neuroimaging have helped illuminate our understanding of how the brain works in the presence of chronic pain, which often persists with unknown etiology or after the painful stimulus has been removed and any wounds have healed. Neuroimaging has enabled us to make great progress in identifying many of the neural mechanisms that contribute to chronic pain, and to pinpoint the specific regions of the brain that are activated in the presence of chronic pain. It has provided us with a new perception of the nature of chronic pain in general, leading researchers to move toward a whole-brain approach to the study and treatment of chronic pain, and to develop novel technologies and analysis techniques, with real potential for developing new diagnostics and more effective therapies. We review the use of neuroimaging in the study of chronic pain, with particular emphasis on magnetic resonance imaging.
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Affiliation(s)
- Katherine T Martucci
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Pamela Ng
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
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Catley MJ, O'Connell NE, Berryman C, Ayhan FF, Moseley GL. Is Tactile Acuity Altered in People With Chronic Pain? A Systematic Review and Meta-analysis. THE JOURNAL OF PAIN 2014; 15:985-1000. [DOI: 10.1016/j.jpain.2014.06.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 01/28/2023]
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