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Sun G, McCartin M, Liu W, Zhang Q, Kenefati G, Chen ZS, Wang J. Temporal pain processing in the primary somatosensory cortex and anterior cingulate cortex. Mol Brain 2023; 16:3. [PMID: 36604739 PMCID: PMC9817351 DOI: 10.1186/s13041-022-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
Pain is known to have sensory and affective components. The sensory pain component is encoded by neurons in the primary somatosensory cortex (S1), whereas the emotional or affective pain experience is in large part processed by neural activities in the anterior cingulate cortex (ACC). The timing of how a mechanical or thermal noxious stimulus triggers activation of peripheral pain fibers is well-known. However, the temporal processing of nociceptive inputs in the cortex remains little studied. Here, we took two approaches to examine how nociceptive inputs are processed by the S1 and ACC. We simultaneously recorded local field potentials in both regions, during the application of a brain-computer interface (BCI). First, we compared event related potentials in the S1 and ACC. Next, we used an algorithmic pain decoder enabled by machine-learning to detect the onset of pain which was used during the implementation of the BCI to automatically treat pain. We found that whereas mechanical pain triggered neural activity changes first in the S1, the S1 and ACC processed thermal pain with a reasonably similar time course. These results indicate that the temporal processing of nociceptive information in different regions of the cortex is likely important for the overall pain experience.
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Affiliation(s)
- Guanghao Sun
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, 10016, USA
| | - Michael McCartin
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Weizhuo Liu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, 10016, USA
| | - George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, 10016, USA
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, 10016, USA
- Department of Neuroscience & Physiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA.
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, 10016, USA.
- Department of Neuroscience & Physiology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, 10016, USA.
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Balachandran A, Tassone VK, Adamsahib F, Di Passa AM, Kuburi S, Demchenko I, Ladha KS, Bhat V. Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1022767. [PMID: 36353699 PMCID: PMC9638121 DOI: 10.3389/fpain.2022.1022767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experiencing comorbid depression and chronic pain (CDCP), as well as comorbid depression and acute pain (CDAP). A secondary objective was to provide an assessment of dosage, route, and adverse effects of ketamine treatment for CDCP and CDAP. A literature search was conducted on MEDLINE, PsycINFO, and Embase databases, coupled with a manual screening of the bibliography sections of included articles. In addition, registered ongoing and planned trials were searched on Clinicaltrials.gov. The end date of the search was April 9th, 2022. Included studies assessed changes in depression and pain in patients receiving at least one sub-anesthetic dose of ketamine. Assessment of quality was conducted using the GRADE checklist. Of the 7 CDCP clinical trials, 3 reported a reduction in depression and pain, 3 reported a reduction in depression or pain only, and 1 reported no improvement in either comorbidity. Among the 7 CDAP clinical trials, 4 studies found improvements in depression and pain while the remaining 3 reported improvements in only one parameter. Ten of the 12 case studies and 2 of the 3 observational studies assessing CDCP and CDAP found improvements in pain and depression scores post-treatment with effects of variable duration. The planned methodologies of the registered clinical trials are in line with those of the published research. Preliminary evidence supports the efficacy of ketamine in treating CDCP and CDAP. However, the current review identified a small number of heterogeneous studies with mixed results, preventing comprehensive conclusions. More longitudinal placebo-controlled studies are needed to identify the effects of ketamine for patients with CDCP and CDAP.
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Affiliation(s)
- Aksharra Balachandran
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa K. Tassone
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Fathima Adamsahib
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Anne-Marie Di Passa
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah Kuburi
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Karim S. Ladha
- Department of Anesthesia, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada,Krembil Research Institute, University Health Network, Toronto, ON, Canada,Correspondence: Venkat Bhat
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McCarberg B, Peppin J. Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain. PAIN MEDICINE 2020; 20:2421-2437. [PMID: 30865778 DOI: 10.1093/pm/pnz017] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective This article reviews the structural and functional changes in pain chronification and explores the association between memory and the development of chronic pain. Methods PubMed was searched using the terms "chronic pain," "central sensitization," "learning," "memory," "long-term potentiation," "long-term depression," and "pain memory." Relevant findings were synthesized into a narrative of the processes affecting pain chronification. Results Pain pathways represent a complex sensory system with cognitive, emotional, and behavioral influences. Anatomically, the hippocampus, amygdala, and anterior cortex-central to the encoding and consolidation of memory-are also implicated in experiential aspects of pain. Common neurotransmitters and similar mechanisms of neural plasticity (eg, central sensitization, long-term potentiation) suggest a mechanistic overlap between chronic pain and memory. These anatomic and mechanistic correlates indicate that chronic pain and memory intimately interact on several levels. Longitudinal imaging studies suggest that spatiotemporal reorganization of brain activity accompanies the transition to chronic pain, during which the representation of pain gradually shifts from sensory to emotional and limbic structures. Conclusions The chronification of pain can be conceptualized as activity-induced plasticity of the limbic-cortical circuitry resulting in reorganization of the neocortex. The state of the limbic-cortical network determines whether nociceptive signals are transient or chronic by extinguishing pathways or amplifying signals that intensify the emotional component of nociceptive inputs. Thus, chronic pain can be seen as the persistence of the memory of pain and/or the inability to extinguish painful memories. Ideally, pharmacologic, physical, and/or psychological approaches should reverse the reorganization accompanying chronic pain.
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Affiliation(s)
- Bill McCarberg
- Chronic Pain Management Program, Kaiser Permanente, San Diego, California; †University of California, San Diego, California; ‡Neighborhood Health, San Diego, California; §College of Osteopathic Medicine, Marian University, Indianapolis, Indiana; ¶John F. Peppin, DO, LLC, Hamden, Connecticut
| | - John Peppin
- Chronic Pain Management Program, Kaiser Permanente, San Diego, California; †University of California, San Diego, California; ‡Neighborhood Health, San Diego, California; §College of Osteopathic Medicine, Marian University, Indianapolis, Indiana; ¶John F. Peppin, DO, LLC, Hamden, Connecticut
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Local field potential decoding of the onset and intensity of acute pain in rats. Sci Rep 2018; 8:8299. [PMID: 29844576 PMCID: PMC5974270 DOI: 10.1038/s41598-018-26527-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022] Open
Abstract
Pain is a complex sensory and affective experience. The current definition for pain relies on verbal reports in clinical settings and behavioral assays in animal models. These definitions can be subjective and do not take into consideration signals in the neural system. Local field potentials (LFPs) represent summed electrical currents from multiple neurons in a defined brain area. Although single neuronal spike activity has been shown to modulate the acute pain, it is not yet clear how ensemble activities in the form of LFPs can be used to decode the precise timing and intensity of pain. The anterior cingulate cortex (ACC) is known to play a role in the affective-aversive component of pain in human and animal studies. Few studies, however, have examined how neural activities in the ACC can be used to interpret or predict acute noxious inputs. Here, we recorded in vivo extracellular activity in the ACC from freely behaving rats after stimulus with non-noxious, low-intensity noxious, and high-intensity noxious stimuli, both in the absence and chronic pain. Using a supervised machine learning classifier with selected LFP features, we predicted the intensity and the onset of acute nociceptive signals with high degree of precision. These results suggest the potential to use LFPs to decode acute pain.
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Zhang Q, Manders T, Tong AP, Yang R, Garg A, Martinez E, Zhou H, Dale J, Goyal A, Urien L, Yang G, Chen Z, Wang J. Chronic pain induces generalized enhancement of aversion. eLife 2017; 6:e25302. [PMID: 28524819 PMCID: PMC5438248 DOI: 10.7554/elife.25302] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/01/2017] [Indexed: 12/25/2022] Open
Abstract
A hallmark feature of chronic pain is its ability to impact other sensory and affective experiences. It is notably associated with hypersensitivity at the site of tissue injury. It is less clear, however, if chronic pain can also induce a generalized site-nonspecific enhancement in the aversive response to nociceptive inputs. Here, we showed that chronic pain in one limb in rats increased the aversive response to acute pain stimuli in the opposite limb, as assessed by conditioned place aversion. Interestingly, neural activities in the anterior cingulate cortex (ACC) correlated with noxious intensities, and optogenetic modulation of ACC neurons showed bidirectional control of the aversive response to acute pain. Chronic pain, however, altered acute pain intensity representation in the ACC to increase the aversive response to noxious stimuli at anatomically unrelated sites. Thus, chronic pain can disrupt cortical circuitry to enhance the aversive experience in a generalized anatomically nonspecific manner.
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Affiliation(s)
- Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Toby Manders
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Ai Phuong Tong
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Runtao Yang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Arpan Garg
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Erik Martinez
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
| | - Haocheng Zhou
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
| | - Jahrane Dale
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Abhinav Goyal
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Louise Urien
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
| | - Guang Yang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
| | - Zhe Chen
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
- Department of Psychiatry, New York University School of Medicine, New York, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, United States
- Department of Neuroscience and Physiology, New York University School of Medicine, New York, United States
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Neuroplasticity underlying the comorbidity of pain and depression. Neural Plast 2015; 2015:504691. [PMID: 25810926 PMCID: PMC4355564 DOI: 10.1155/2015/504691] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/10/2015] [Indexed: 02/07/2023] Open
Abstract
Acute pain induces depressed mood, and chronic pain is known to cause depression. Depression, meanwhile, can also adversely affect pain behaviors ranging from symptomology to treatment response. Pain and depression independently induce long-term plasticity in the central nervous system (CNS). Comorbid conditions, however, have distinct patterns of neural activation. We performed a review of the changes in neural circuitry and molecular signaling pathways that may underlie this complex relationship between pain and depression. We also discussed some of the current and future therapies that are based on this understanding of the CNS plasticity that occurs with pain and depression.
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Abstract
The year 2013-2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short- and long-term safety (i.e., no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention.
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Affiliation(s)
| | - Barry J Sessle
- Correspondence: Dr Gilles J Lavigne, Faculté de medecine dentaire, Universite de Montreal, CP 6128, Succ Centre ville, Montreal, Quebec H3C 3J7. Telephone 514-343-6005, fax 514-343-2233, e-mail
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