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Abstract
Pain is an unpleasant sensory and emotional experience. Understanding the neural mechanisms of acute and chronic pain and the brain changes affecting pain factors is important for finding pain treatment methods. The emergence and progress of non-invasive neuroimaging technology can help us better understand pain at the neural level. Recent developments in identifying brain-based biomarkers of pain through advances in advanced imaging can provide some foundations for predicting and detecting pain. For example, a neurologic pain signature (involving brain regions that receive nociceptive afferents) and a stimulus intensity-independent pain signature (involving brain regions that do not show increased activity in proportion to noxious stimulus intensity) were developed based on multivariate modeling to identify processes related to the pain experience. However, an accurate and comprehensive review of common neuroimaging techniques for evaluating pain is lacking. This paper reviews the mechanism, clinical application, reliability, strengths, and limitations of common neuroimaging techniques for assessing pain to promote our further understanding of pain.
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Affiliation(s)
- Jing Luo
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hui-Qi Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Bo Gou
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China.
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
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Miyata H, Tani R, Toratani S, Okamoto T. Effects of Tongue Pressure on Cerebral Blood Volume Dynamics: A Functional Near-Infrared Spectroscopy Study. Brain Sci 2022; 12:brainsci12020296. [PMID: 35204059 PMCID: PMC8870264 DOI: 10.3390/brainsci12020296] [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: 12/09/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
Tongue pressure measurement (TPM) is an indicator of oral function. However, the association between tongue pressure and cerebral activation remains unclear. We used near-infrared spectroscopy (NIRS) to examine the correlation between cerebral cortex activation and tongue pressure stimulation against the anterior palatal mucosa. We measured voluntary maximum tongue pressure (MTP) using a TPM device; a pressure value of approximately 60% of the MTP was used for the experimental tongue pressure (MTP60%). We examined the effect of oral functional tongue pressure stimulation against the anterior palatal mucosa on cerebral activation using NIRS in 13 adults. Tongue pressure stimulation caused significant changes in cerebral blood flow in some areas compared with controls (p < 0.05). We performed a correlation analysis (p < 0.05) between MTP60% and changes in oxygenated hemoglobin in all 47 NIRS channels. MTP60% triggered activation of the right somatosensory motor area and right dorsolateral prefrontal cortex and deactivation of the anterior prefrontal cortex (APFC). TPM balloon-probe insertion in the oral cavity activated the bilateral somatosensory motor area and deactivated the wide area of the APFC. Moreover, MTP60% via the TPM balloon probe activated the bilateral somatosensory and motor cortex areas. Tongue pressure stimulation changes cerebral blood flow, and NIRS is useful in investigating the relationship between oral stimulation and brain function.
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Affiliation(s)
- Hidemasa Miyata
- Department of Molecular Oral Medicine and Maxillofacial Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan; (H.M.); (S.T.)
| | - Ryouji Tani
- Oral and Maxillofacial Surgery, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan
- Correspondence: ; Tel.: +81-82-257-5665; Fax: +81-82-257-5669
| | - Shigeaki Toratani
- Department of Molecular Oral Medicine and Maxillofacial Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan; (H.M.); (S.T.)
| | - Tetsuji Okamoto
- School of Medical Sciences, University of East Asia, 2-1 Ichinomiyagakuenchō, Shimonoseki 751-8503, Japan;
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Hu XS, Nascimento TD, DaSilva AF. Shedding light on pain for the clinic: a comprehensive review of using functional near-infrared spectroscopy to monitor its process in the brain. Pain 2021; 162:2805-2820. [PMID: 33990114 PMCID: PMC8490487 DOI: 10.1097/j.pain.0000000000002293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Pain is a complex experience that involves sensation, emotion, and cognition. The subjectivity of the traditional pain measurement tools has expedited the interest in developing neuroimaging techniques to monitor pain objectively. Among noninvasive neuroimaging techniques, functional near-infrared spectroscopy (fNIRS) has balanced spatial and temporal resolution; yet, it is portable, quiet, and cost-effective. These features enable fNIRS to image the cortical mechanisms of pain in a clinical environment. In this article, we evaluated pain neuroimaging studies that used the fNIRS technique in the past decade. Starting from the experimental design, we reviewed the regions of interest, probe localization, data processing, and primary findings of these existing fNIRS studies. We also discussed the fNIRS imaging's potential as a brain surveillance technique for pain, in combination with artificial intelligence and extended reality techniques. We concluded that fNIRS is a brain imaging technique with great potential for objective pain assessment in the clinical environment.
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Affiliation(s)
- Xiao-Su Hu
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Thiago D. Nascimento
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Alexandre F. DaSilva
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
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Sakuma S, Inamoto K, Yamaguchi Y, Takagi S, Higuchi N. Changes in prefrontal cerebral hemodynamics during intermittent pain stimulation to gingiva: Preliminary study using functional near infrared spectroscopy. J Dent Sci 2021; 16:980-986. [PMID: 34141113 PMCID: PMC8189836 DOI: 10.1016/j.jds.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/PURPOSE Elucidating the transmission mechanism of pain signals from the orofacial area and the corresponding modification mechanism will not only aid in the understanding of pain mechanisms but also provide useful information regarding the development of pain mitigation methods. In this study, the involvement of the pain suppression system in the trigeminal area was investigated through an analysis of the activation status over time in the prefrontal cortex using functional near-infrared spectroscopy (fNIRS). MATERIALS AND METHODS In 28 healthy, right-handed male volunteers (average age, 30.1 ± 4.2 years) as subjects, a mild, intermittent, acute pain stimulus was administered through the implementation of pocket probing of the gingiva surrounding the right maxillary central incisor. In the prefrontal cortex, the levels of hemoglobin (Hb) were measured using the fNIRS measurement system. Average values of both oxy-Hb and deoxy-Hb were calculated at four stages: rest stage, 20 s prior to the pain stimulus application, and three stages at 20-s intervals within 1 min of stimulation. One-way analysis of variance and multiple comparisons were used to compare representative values to investigate the changes due to pain. RESULTS Oxy-Hb levels decreased the most during the 20 s stage directly after stimulus application. This change was seen mainly on the contralateral side, after which it returned to the resting baseline level before the stimulus application. CONCLUSION Our data demonstrate that in healthy males, a mechanism exists to mitigate pain involving the pain suppression system in the 20 s after feeling mild pain to the gingiva.
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Affiliation(s)
- Shigemitsu Sakuma
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kyoko Inamoto
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yoshihiro Yamaguchi
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Shinya Takagi
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Naoya Higuchi
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Hall M, Kidgell D, Perraton L, Morrissey J, Jaberzadeh S. Pain Induced Changes in Brain Oxyhemoglobin: A Systematic Review and Meta-Analysis of Functional NIRS Studies. PAIN MEDICINE 2021; 22:1399-1410. [PMID: 33659994 DOI: 10.1093/pm/pnaa453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuroimaging studies show that nociceptive stimuli elicit responses in an extensive cortical network. Functional near-infrared spectroscopy (fNIRS) allows for functional assessment of changes in oxyhemoglobin (HbO), an indirect index for cortical activity. Unlike functional magnetic resonance imaging (fMRI), fNIRS is portable, relatively inexpensive, and allows subjects greater function. No systematic review or meta-analysis has drawn together the data from existing literature of fNIRS studies on the effects of experimental pain on oxyhemoglobin changes in the superficial areas of the brain. OBJECTIVES To investigate the effects of experimental pain on brain fNIRS measures in the prefrontal-cortex and the sensory-motor-area; to determine whether there is a difference in oxyhemodynamics between the prefrontal-cortex and sensory-motor-area during pain processing; to determine if there are differences in HbO between patients with centralized persistent pain and healthy controls. METHODS Studies that used fNIRS to record changes in oxyhemodynamics in prefrontal-cortex or sensory-motor-cortex in noxious and innoxious conditions were included. In total, 13 studies were included in the meta-analysis. RESULTS Pain has a significantly greater effect on pre-frontal-cortex and sensory-motor areas than nonpainful stimulation on oxyhemodynamics. The effect of pain on sensory-motor areas was greater than the effect of pain on the prefrontal-cortex. There was an effect of centralized pain in the CPP group on oxyhemodynamics from a noxious stimulus compared to control's response to pain. CONCLUSIONS Pain affects the prefrontal and sensory-motor cortices of the brain and can be measured using fNIRS. Implications of this study may lead to a simple and readily accessible objective measure of pain.
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Affiliation(s)
- MacGregor Hall
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | - Luke Perraton
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | | | - Shapour Jaberzadeh
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
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Karunakaran KD, Peng K, Berry D, Green S, Labadie R, Kussman B, Borsook D. NIRS measures in pain and analgesia: Fundamentals, features, and function. Neurosci Biobehav Rev 2020; 120:335-353. [PMID: 33159918 DOI: 10.1016/j.neubiorev.2020.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/28/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Current pain assessment techniques based only on clinical evaluation and self-reports are not objective and may lead to inadequate treatment. Having a functional biomarker will add to the clinical fidelity, diagnosis, and perhaps improve treatment efficacy in patients. While many approaches have been deployed in pain biomarker discovery, functional near-infrared spectroscopy (fNIRS) is a technology that allows for non-invasive measurement of cortical hemodynamics. The utility of fNIRS is especially attractive given its ability to detect specific changes in the somatosensory and high-order cortices as well as its ability to measure (1) brain function similar to functional magnetic resonance imaging, (2) graded responses to noxious and innocuous stimuli, (3) analgesia, and (4) nociception under anesthesia. In this review, we evaluate the utility of fNIRS in nociception/pain with particular focus on its sensitivity and specificity, methodological advantages and limitations, and the current and potential applications in various pain conditions. Everything considered, fNIRS technology could enhance our ability to evaluate evoked and persistent pain across different age groups and clinical populations.
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Affiliation(s)
- Keerthana Deepti Karunakaran
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
| | - Ke Peng
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States; Département en Neuroscience, Centre de Recherche du CHUM, l'Université de Montréal Montreal, QC, Canada
| | - Delany Berry
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Stephen Green
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Robert Labadie
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Barry Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
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Takagi S, Sakuma S, Morita I, Sugimoto E, Yamaguchi Y, Higuchi N, Inamoto K, Ariji Y, Ariji E, Murakami H. Application of Deep Learning in the Identification of Cerebral Hemodynamics Data Obtained from Functional Near-Infrared Spectroscopy: A Preliminary Study of Pre- and Post-Tooth Clenching Assessment. J Clin Med 2020; 9:E3475. [PMID: 33126595 PMCID: PMC7693464 DOI: 10.3390/jcm9113475] [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: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/05/2022] Open
Abstract
In fields using functional near-infrared spectroscopy (fNIRS), there is a need for an easy-to-understand method that allows visual presentation and rapid analysis of data and test results. This preliminary study examined whether deep learning (DL) could be applied to the analysis of fNIRS-derived brain activity data. To create a visual presentation of the data, an imaging program was developed for the analysis of hemoglobin (Hb) data from the prefrontal cortex in healthy volunteers, obtained by fNIRS before and after tooth clenching. Three types of imaging data were prepared: oxygenated hemoglobin (oxy-Hb) data, deoxygenated hemoglobin (deoxy-Hb) data, and mixed data (using both oxy-Hb and deoxy-Hb data). To differentiate between rest and tooth clenching, a cross-validation test using the image data for DL and a convolutional neural network was performed. The network identification rate using Hb imaging data was relatively high (80‒90%). These results demonstrated that a method using DL for the assessment of fNIRS imaging data may provide a useful analysis system.
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Affiliation(s)
- Shinya Takagi
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan;
| | - Shigemitsu Sakuma
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan;
| | - Ichizo Morita
- Japanese Red Cross Toyota College of Nursing, Toyota 471-8565, Japan;
| | - Eri Sugimoto
- Department of Pediatric Dentistry, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan;
| | - Yoshihiro Yamaguchi
- Department of Fixed Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan;
| | - Naoya Higuchi
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan; (N.H.); (K.I.)
| | - Kyoko Inamoto
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan; (N.H.); (K.I.)
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan; (Y.A.); (E.A.)
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan; (Y.A.); (E.A.)
| | - Hiroshi Murakami
- Department of Gerodontology and Home Care Dentistry, School of Dentistry, Aichi Gakuin University, Nagoya 464-8651, Japan;
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Ghafoor U, Lee JH, Hong KS, Park SS, Kim J, Yoo HR. Effects of Acupuncture Therapy on MCI Patients Using Functional Near-Infrared Spectroscopy. Front Aging Neurosci 2019; 11:237. [PMID: 31543811 PMCID: PMC6730485 DOI: 10.3389/fnagi.2019.00237] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/16/2019] [Indexed: 01/25/2023] Open
Abstract
Acupuncture therapy (AT) is a non-pharmacological method of treatment that has been applied to various neurological diseases. However, studies on its longitudinal effect on the neural mechanisms of patients with mild cognitive impairment (MCI) for treatment purposes are still lacking in the literature. In this clinical study, we assess the longitudinal effects of ATs on MCI patients using two methods: (i) Montreal Cognitive Assessment test (MoCA-K, Korean version), and (ii) the hemodynamic response (HR) analyses using functional near-infrared spectroscopy (fNIRS). fNIRS signals of a working memory (WM) task were acquired from the prefrontal cortex. Twelve elderly MCI patients and 12 healthy people were recruited as target and healthy control (HC) groups, respectively. Each group went through an fNIRS scanning procedure three times: The initial data were obtained without any ATs, and subsequently a total of 24 AT sessions were conducted for MCI patients (i.e., MCI-0: the data prior to ATs, MCI-1: after 12 sessions of ATs for 6 weeks, MCI-2: another 12 sessions of ATs for 6 weeks). The mean HR responses of all MCI-0–2 cases were lower than those of HCs. To compare the effects of AT on MCI patients, MoCA-K results, temporal HR data, and spatial activation patterns (i.e., t-maps) were examined. In addition, analyses of functional connectivity (FC) and graph theory upon WM tasks were conducted. With ATs, (i) the averaged MoCA-K test scores were improved (MCI-1, p = 0.002; MCI-2, p = 2.9e–4); (ii) the mean HR response of WM tasks was increased (p < 0.001); and (iii) the t-maps of MCI-1 and MCI-2 were enhanced. Furthermore, an increased FC in the prefrontal cortex in both MCI-1/MCI-2 cases in comparison to MCI-0 was obtained (p < 0.01), and an increasing trend in the graph theory parameters was observed. All these findings reveal that ATs have a positive impact on improving the cognitive function of MCI patients. In conclusion, ATs can be used as a therapeutic tool for MCI patients as a non-pharmacological method (Clinical trial registration number: KCT 0002451 https://cris.nih.go.kr/cris/en/).
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Affiliation(s)
- Usman Ghafoor
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Sang-Soo Park
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Daejeon University, Daejeon, South Korea
| | - Jieun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ho-Ryong Yoo
- Department of Neurology Disorders, Dunsan Hospital, Daejeon University, Daejeon, South Korea
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Fernandez Rojas R, Liao M, Romero J, Huang X, Ou KL. Cortical Network Response to Acupuncture and the Effect of the Hegu Point: An fNIRS Study. SENSORS 2019; 19:s19020394. [PMID: 30669377 PMCID: PMC6359459 DOI: 10.3390/s19020394] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
Abstract
Acupuncture is a practice of treatment based on influencing specific points on the body by inserting needles. According to traditional Chinese medicine, the aim of acupuncture treatment for pain management is to use specific acupoints to relieve excess, activate qi (or vital energy), and improve blood circulation. In this context, the Hegu point is one of the most widely-used acupoints for this purpose, and it has been linked to having an analgesic effect. However, there exists considerable debate as to its scientific validity. In this pilot study, we aim to identify the functional connectivity related to the three main types of acupuncture manipulations and also identify an analgesic effect based on the hemodynamic response as measured by functional near-infrared spectroscopy (fNIRS). The cortical response of eleven healthy subjects was obtained using fNIRS during an acupuncture procedure. A multiscale analysis based on wavelet transform coherence was employed to assess the functional connectivity of corresponding channel pairs within the left and right somatosensory region. The wavelet analysis was focused on the very-low frequency oscillations (VLFO, 0.01–0.08 Hz) and the low frequency oscillations (LFO, 0.08–0.15 Hz). A mixed model analysis of variance was used to appraise statistical differences in the wavelet domain for the different acupuncture stimuli. The hemodynamic response after the acupuncture manipulations exhibited strong activations and distinctive cortical networks in each stimulus. The results of the statistical analysis showed significant differences (p<0.05) between the tasks in both frequency bands. These results suggest the existence of different stimuli-specific cortical networks in both frequency bands and the anaesthetic effect of the Hegu point as measured by fNIRS.
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Affiliation(s)
- Raul Fernandez Rojas
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Mingyu Liao
- Department of Industrial Engineering and Management, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan.
| | - Julio Romero
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Xu Huang
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Keng-Liang Ou
- Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan.
- Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan.
- School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
- Department of Prosthodontics, Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia.
- Department of Prosthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
- Department of Oral Hygiene Care, Ching Kuo Institute of Management and Health, Keelung 203, Taiwan.
- 3D Global Biotech Inc., New Taipei City 221, Taiwan.
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Brain activity in response to the touch of a hand on the center of the back. PLoS One 2018; 13:e0206451. [PMID: 30372462 PMCID: PMC6205618 DOI: 10.1371/journal.pone.0206451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to validate the possibility of using functional Near-Infrared Spectroscopy (fNIRS) to measure changes in cerebral blood flow in response to a hand being placed on a participant's back, and to identify the areas of enhanced activity in the brain. Nineteen female adult volunteers participated in the study. An experienced school nurse touched the center of the participant's back between the shoulder blades with the palm of her hand. Cerebral blood volume dynamics were measured with a 52-channel fNIRS system. Significantly higher oxygenated hemoglobin (oxy-Hb) concentration levels were recorded by channels 11, 14, 21, 22, 24, 32, 35, 45, 46, and 49 during the touching period than during the resting period. These channels indicated enhanced activity in the supramarginal gyrus, the middle frontal gyrus, the superior temporal gyrus, and the inferior frontal gyrus. The ability to detect changes in cerebral blood flow using this method indicates the possibility of measuring changes in cerebral blood flow using fNIRS when a person is touched on the back. fNIRS has been shown to be useful for studying the effects of touch.
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Peng K, Yücel MA, Steele SC, Bittner EA, Aasted CM, Hoeft MA, Lee A, George EE, Boas DA, Becerra L, Borsook D. Morphine Attenuates fNIRS Signal Associated With Painful Stimuli in the Medial Frontopolar Cortex (medial BA 10). Front Hum Neurosci 2018; 12:394. [PMID: 30349466 PMCID: PMC6186992 DOI: 10.3389/fnhum.2018.00394] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/12/2018] [Indexed: 11/26/2022] Open
Abstract
Functional near infrared spectroscopy (fNIRS) is a non-invasive optical imaging method that provides continuous measure of cortical brain functions. One application has been its use in the evaluation of pain. Previous studies have delineated a deoxygenation process associated with pain in the medial anterior prefrontal region, more specifically, the medial Brodmann Area 10 (BA 10). Such response to painful stimuli has been consistently observed in awake, sedated and anesthetized patients. In this study, we administered oral morphine (15 mg) or placebo to 14 healthy male volunteers with no history of pain or opioid abuse in a crossover double blind design, and performed fNIRS scans prior to and after the administration to assess the effect of morphine on the medial BA 10 pain signal. Morphine is the gold standard for inhibiting nociceptive processing, most well described for brain effects on sensory and emotional regions including the insula, the somatosensory cortex (the primary somatosensory cortex, S1, and the secondary somatosensory cortex, S2), and the anterior cingulate cortex (ACC). Our results showed an attenuation effect of morphine on the fNIRS-measured pain signal in the medial BA 10, as well as in the contralateral S1 (although observed in a smaller number of subjects). Notably, the extent of signal attenuation corresponded with the temporal profile of the reported plasma concentration for the drug. No clear attenuation by morphine on the medial BA 10 response to innocuous stimuli was observed. These results provide further evidence for the role of medial BA 10 in the processing of pain, and also suggest that fNIRS may be used as an objective measure of drug-brain profiles independent of subjective reports.
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Affiliation(s)
- Ke Peng
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Meryem A. Yücel
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Neurophotonics Center, Boston University, Boston, MA, United States
| | - Sarah C. Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christopher M. Aasted
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mark A. Hoeft
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Arielle Lee
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Edward E. George
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David A. Boas
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Neurophotonics Center, Boston University, Boston, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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12
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Ong WY, Stohler CS, Herr DR. Role of the Prefrontal Cortex in Pain Processing. Mol Neurobiol 2018; 56:1137-1166. [PMID: 29876878 PMCID: PMC6400876 DOI: 10.1007/s12035-018-1130-9] [Citation(s) in RCA: 343] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
The prefrontal cortex (PFC) is not only important in executive functions, but also pain processing. The latter is dependent on its connections to other areas of the cerebral neocortex, hippocampus, periaqueductal gray (PAG), thalamus, amygdala, and basal nuclei. Changes in neurotransmitters, gene expression, glial cells, and neuroinflammation occur in the PFC during acute and chronic pain, that result in alterations to its structure, activity, and connectivity. The medial PFC (mPFC) could serve dual, opposing roles in pain: (1) it mediates antinociceptive effects, due to its connections with other cortical areas, and as the main source of cortical afferents to the PAG for modulation of pain. This is a ‘loop’ where, on one side, a sensory stimulus is transformed into a perceptual signal through high brain processing activity, and perceptual activity is then utilized to control the flow of afferent sensory stimuli at their entrance (dorsal horn) to the CNS. (2) It could induce pain chronification via its corticostriatal projection, possibly depending on the level of dopamine receptor activation (or lack of) in the ventral tegmental area-nucleus accumbens reward pathway. The PFC is involved in biopsychosocial pain management. This includes repetitive transcranial magnetic stimulation, transcranial direct current stimulation, antidepressants, acupuncture, cognitive behavioral therapy, mindfulness, music, exercise, partner support, empathy, meditation, and prayer. Studies demonstrate the role of the PFC during placebo analgesia, and in establishing links between pain and depression, anxiety, and loss of cognition. In particular, losses in PFC grey matter are often reversible after successful treatment of chronic pain.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology and Ageing Research Programme, National University of Singapore, Singapore, 119260, Singapore.
| | | | - Deron R Herr
- Department of Pharmacology, National University of Singapore, Singapore, 119260, Singapore.
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13
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Olbrecht VA, Jiang Y, Viola L, Walter CM, Liu H, Kurth CD. Characterization of the functional near-infrared spectroscopy response to nociception in a pediatric population. Paediatr Anaesth 2018; 28:103-111. [PMID: 29280254 DOI: 10.1111/pan.13301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Near-infrared spectroscopy can interrogate functional optical signal changes in regional brain oxygenation and blood volume to nociception analogous to functional magnetic resonance imaging. AIMS This exploratory study aimed to characterize the near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin from the brain in response to nociceptive stimulation of varying intensity and duration, and after analgesic and neuromuscular paralytic in a pediatric population. METHODS We enrolled children 6 months-21 years during propofol sedation before surgery. The near-infrared spectroscopy sensor was placed on the forehead and nociception was produced from an electrical current applied to the wrist. We determined the near-infrared spectroscopy signal response to increasing current intensity and duration, and after fentanyl, sevoflurane, and neuromuscular paralytic. Heart rate and arm movement during electrical stimulation was also recorded. The near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin were calculated as optical density*time (area under curve). RESULTS During electrical stimulation, nociception was evident: tachycardia and arm withdrawal was observed that disappeared after fentanyl and sevoflurane, whereas after paralytic, tachycardia persisted while arm withdrawal disappeared. The near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin increased during stimulation and decreased after stimulation; the areas under the curves were greater for stimulations 30 mA vs 15 mA (13.9 [5.6-22.2], P = .0021; 5.6 [0.8-10.5], P = .0254, and 19.8 [10.5-29.1], P = .0002 for HbO2 , Hb, and HbT , respectively), 50 Hz vs 1 Hz (17.2 [5.8-28.6], P = .0046; 7.5 [0.7-14.3], P = .0314, and 21.9 [4.2-39.6], P = .0177 for HbO2 , Hb, and HbT , respectively) and 45 seconds vs 15 seconds (16.3 [3.4-29.2], P = .0188 and 22.0 [7.5-36.5], P = .0075 for HbO2 and HbT , respectively); the areas under the curves were attenuated by analgesics but not by paralytic. CONCLUSION Near-infrared spectroscopy detected functional activation to nociception in a broad pediatric population. The near-infrared spectroscopy response appears to represent nociceptive processing because the signals increased with noxious stimulus intensity and duration, and were blocked by analgesics but not paralytics.
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Affiliation(s)
- Vanessa A Olbrecht
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yifei Jiang
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Luigi Viola
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charlotte M Walter
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Charles D Kurth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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14
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Peng K, Yücel MA, Aasted CM, Steele SC, Boas DA, Borsook D, Becerra L. Using prerecorded hemodynamic response functions in detecting prefrontal pain response: a functional near-infrared spectroscopy study. NEUROPHOTONICS 2018; 5:011018. [PMID: 29057285 PMCID: PMC5641587 DOI: 10.1117/1.nph.5.1.011018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 05/03/2023]
Abstract
Currently, there is no method for providing a nonverbal objective assessment of pain. Recent work using functional near-infrared spectroscopy (fNIRS) has revealed its potential for objective measures. We conducted two fNIRS scans separated by 30 min and measured the hemodynamic response to the electrical noxious and innocuous stimuli over the anterior prefrontal cortex (aPFC) in 14 subjects. Based on the estimated hemodynamic response functions (HRFs), we first evaluated the test-retest reliability of using fNIRS in measuring the pain response over the aPFC. We then proposed a general linear model (GLM)-based detection model that employs the subject-specific HRFs from the first scan to detect the pain response in the second scan. Our results indicate that fNIRS has a reasonable reliability in detecting the hemodynamic changes associated with noxious events, especially in the medial portion of the aPFC. Compared with a standard HRF with a fixed shape, including the subject-specific HRFs in the GLM allows for a significant improvement in the detection sensitivity of aPFC pain response. This study supports the potential application of individualized analysis in using fNIRS and provides a robust model to perform objective determination of pain perception.
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Affiliation(s)
- Ke Peng
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Address all correspondence to: Ke Peng, E-mail: Ke.
| | - Meryem A. Yücel
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Christopher M. Aasted
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Sarah C. Steele
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - David A. Boas
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Boston University, Boston University Neurophotonics Center, Boston, Massachusetts, United States
| | - David Borsook
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Lino Becerra
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
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15
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Peng K, Steele SC, Becerra L, Borsook D. Brodmann area 10: Collating, integrating and high level processing of nociception and pain. Prog Neurobiol 2017; 161:1-22. [PMID: 29199137 DOI: 10.1016/j.pneurobio.2017.11.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/08/2023]
Abstract
Multiple frontal cortical brain regions have emerged as being important in pain processing, whether it be integrative, sensory, cognitive, or emotional. One such region, Brodmann Area 10 (BA 10), is the largest frontal brain region that has been shown to be involved in a wide variety of functions including risk and decision making, odor evaluation, reward and conflict, pain, and working memory. BA 10, also known as the anterior prefrontal cortex, frontopolar prefrontal cortex or rostral prefrontal cortex, is comprised of at least two cytoarchitectonic sub-regions, medial and lateral. To date, the explicit role of BA 10 in the processing of pain hasn't been fully elucidated. In this paper, we first review the anatomical pathways and functional connectivity of BA 10. Numerous functional imaging studies of experimental or clinical pain have also reported brain activations and/or deactivations in BA 10 in response to painful events. The evidence suggests that BA 10 may play a critical role in the collation, integration and high-level processing of nociception and pain, but also reveals possible functional distinctions between the subregions of BA 10 in this process.
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Affiliation(s)
- Ke Peng
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States.
| | - Sarah C Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
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16
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Peru D, Maloney VP, Najafizadeh L. Cortical activity changes as related to oral irritation-an fNIRS study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2558-2561. [PMID: 29060421 DOI: 10.1109/embc.2017.8037379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present the first investigation of how the cortical regions of the brain respond to the sensations related to oral irritation, using functional near-infrared spectroscopy (fNIRS). fNIRS is used to record irritant-induced activities in the prefrontal and somatosensory regions of nine healthy individuals. Two types of solutions, irritant-free and soft tissue-irritant-contained, are adopted as the stimuli for the control and task experiments, respectively. Our findings reveal that both somatosensory and prefrontal regions show activity as a result of oral irritation. Furthermore, using moving window analysis, we identify the time interval during which the largest number of channels (indicative of high involvement of cortical regions) show irritant-induced activity. Our results indicate that fNIRS can be used to study brain activities related to oral irritation.
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17
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Aasted CM, Yücel MA, Steele SC, Peng K, Boas DA, Becerra L, Borsook D. Frontal Lobe Hemodynamic Responses to Painful Stimulation: A Potential Brain Marker of Nociception. PLoS One 2016; 11:e0165226. [PMID: 27806119 PMCID: PMC5091745 DOI: 10.1371/journal.pone.0165226] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/07/2016] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to use functional near-infrared spectroscopy (fNIRS) to examine patterns of both activation and deactivation that occur in the frontal lobe in response to noxious stimuli. The frontal lobe was selected because it has been shown to be activated by noxious stimuli in functional magnetic resonance imaging studies. The brain region is located behind the forehead which is devoid of hair, providing a relative ease of placement for fNIRS probes on this area of the head. Based on functional magnetic resonance imaging studies showing blood-oxygenation-level dependent changes in the frontal lobes, we evaluated functional near-infrared spectroscopy measures in response to two levels of electrical pain in awake, healthy human subjects (n = 10; male = 10). Each subject underwent two recording sessions separated by a 30-minute resting period. Data collected from 7 subjects were analyzed, containing a total of 38/36 low/high intensity pain stimuli for the first recording session and 27/31 pain stimuli for the second session. Our results show that there is a robust and significant deactivation in sections of the frontal cortices. Further development and definition of the specificity and sensitivity of the approach may provide an objective measure of nociceptive activity in the brain that can be easily applied in the surgical setting.
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Affiliation(s)
- Christopher M Aasted
- Center for Pain and the Brain, Harvard Medical School; Boston, Massachusetts, United States of America.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School; Boston, Massachusetts, United States of America.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - Meryem A Yücel
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - Sarah C Steele
- Center for Pain and the Brain, Harvard Medical School; Boston, Massachusetts, United States of America.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School; Boston, Massachusetts, United States of America.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - Ke Peng
- Center for Pain and the Brain, Harvard Medical School; Boston, Massachusetts, United States of America.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School; Boston, Massachusetts, United States of America.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - David A Boas
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School; Boston, Massachusetts, United States of America.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School; Boston, Massachusetts, United States of America.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School; Boston, Massachusetts, United States of America.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School; Boston, Massachusetts, United States of America.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts, United States of America
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18
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Kussman BD, Aasted CM, Yücel MA, Steele SC, Alexander ME, Boas DA, Borsook D, Becerra L. Capturing Pain in the Cortex during General Anesthesia: Near Infrared Spectroscopy Measures in Patients Undergoing Catheter Ablation of Arrhythmias. PLoS One 2016; 11:e0158975. [PMID: 27415436 PMCID: PMC4944937 DOI: 10.1371/journal.pone.0158975] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/25/2016] [Indexed: 12/20/2022] Open
Abstract
The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia. Anesthetic technique was standardized and intraoperative NIRS signals recorded continuously with markers placed in the data set for the timing and duration of each cardiac ablation event. Frontal cortical signals only were suitable for analysis in five of eight patients studied (mean age 14 ± 1 years, weight 66.7 ± 17.6 kg, 2 males). Thirty ablative lesions were recorded for the five patients. Radiofrequency or cryoablation was temporally associated with a hemodynamic response function in the frontal cortex characterized by a significant decrease in oxyhemoglobin concentration (paired t-test, p<0.05) with the nadir occurring in the period 4 to 6 seconds after application of the ablative lesion. Cortical signals produced by catheter ablation of arrhythmias in patients under general anesthesia mirrored those seen with noxious stimulation in awake, healthy volunteers, during sedation for colonoscopy, and functional Magnetic Resonance Imaging activations in response to pain. This study demonstrates the feasibility and potential utility of functional near-infrared spectroscopy as an objective measure of cortical activation under general anesthesia.
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Affiliation(s)
- Barry D. Kussman
- Center for Pain and the Brain, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christopher M. Aasted
- Center for Pain and the Brain, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Meryem A. Yücel
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarah C. Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - David A. Boas
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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19
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Racek A, Hu X, Nascimento T, Bender M, Khatib L, Chiego D, Holland G, Bauer P, McDonald N, Ellwood R, DaSilva A. Different Brain Responses to Pain and Its Expectation in the Dental Chair. J Dent Res 2015; 94:998-1003. [DOI: 10.1177/0022034515581642] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A dental appointment commonly prompts fear of a painful experience, yet we have never fully understood how our brains react to the expectation of imminent tooth pain once in a dental chair. In our study, 21 patients with hypersensitive teeth were tested using nonpainful and painful stimuli in a clinical setting. Subjects were tested in a dental chair using functional near-infrared spectroscopy to measure cortical activity during a stepwise cold stimulation of a hypersensitive tooth, as well as nonpainful control stimulation on the same tooth. Patients’ sensory-discriminative and emotional-cognitive cortical regions were studied through the transition of a neutral to a painful stimulation. In the putative somatosensory cortex contralateral to the stimulus, 2 well-defined hemodynamic peaks were detected in the homuncular orofacial region: the first peak during the nonpainful phase and a second peak after the pain threshold was reached. Moreover, in the upper-left and lower-right prefrontal cortices, there was a significant active hemodynamic response in only the first phase, before the pain. Subsequently, the same prefrontal cortical areas deactivated after a painful experience had been reached. Our study indicates for the first time that pain perception and expectation elicit different hemodynamic cortical responses in a dental clinical setting.
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Affiliation(s)
- A.J. Racek
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - X. Hu
- Headache and Orofacial Pain Effort Lab, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - T.D. Nascimento
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Headache and Orofacial Pain Effort Lab, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - M.C. Bender
- Headache and Orofacial Pain Effort Lab, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - L. Khatib
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - D. Chiego
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - G.R. Holland
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - P. Bauer
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - N. McDonald
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - R.P. Ellwood
- Clinical Method Development, Colgate Palmolive, Piscataway, NJ, USA
| | - A.F. DaSilva
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Headache and Orofacial Pain Effort Lab, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- Biologic and Material Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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20
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Specificity of hemodynamic brain responses to painful stimuli: a functional near-infrared spectroscopy study. Sci Rep 2015; 5:9469. [PMID: 25820289 PMCID: PMC4377554 DOI: 10.1038/srep09469] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/04/2015] [Indexed: 12/02/2022] Open
Abstract
Assessing pain in individuals not able to communicate (e.g. infants, under surgery, or following stroke) is difficult due to the lack of non-verbal objective measures of pain. Near-infrared spectroscopy (NIRS) being a portable, non-invasive and inexpensive method of monitoring cerebral hemodynamic activity has the potential to provide such a measure. Here we used functional NIRS to evaluate brain activation to an innocuous and a noxious electrical stimulus on healthy human subjects (n = 11). For both innocuous and noxious stimuli, we observed a signal change in the primary somatosensory cortex contralateral to the stimulus. The painful and non-painful stimuli can be differentiated based on their signal size and profile. We also observed that repetitive noxious stimuli resulted in adaptation of the signal. Furthermore, the signal was distinguishable from a skin sympathetic response to pain that tended to mask it. Our results support the notion that functional NIRS has a potential utility as an objective measure of pain.
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