1
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Li M, Racey C, Rae CL, Strawson W, Critchley HD, Ward J. Can the neural representation of physical pain predict empathy for pain in others? Soc Cogn Affect Neurosci 2024; 19:nsae023. [PMID: 38481007 PMCID: PMC11008503 DOI: 10.1093/scan/nsae023] [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: 07/25/2023] [Revised: 01/16/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
The question of whether physical pain and vicarious pain have some shared neural substrates is unresolved. Recent research has argued that physical and vicarious pain are represented by dissociable multivariate brain patterns by creating biomarkers for physical pain (Neurologic Pain Signature, NPS) and vicarious pain (Vicarious Pain Signature, VPS), respectively. In the current research, the NPS and two versions of the VPS were applied to three fMRI datasets (one new, two published) relating to vicarious pain which focused on between-subject differences in vicarious pain (Datasets 1 and 3) and within-subject manipulations of perspective taking (Dataset 2). Results show that (i) NPS can distinguish brain responses to images of pain vs no-pain and to a greater extent in vicarious pain responders who report experiencing pain when observing pain and (ii) neither version of the VPS mapped on to individual differences in vicarious pain and the two versions differed in their success in predicting vicarious pain overall. This study suggests that the NPS (created to detect physical pain) is, under some circumstances, sensitive to vicarious pain and there is significant variability in VPS measures (created to detect vicarious pain) to act as generalizable biomarkers of vicarious pain.
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Affiliation(s)
- M Li
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - C Racey
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - C L Rae
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - W Strawson
- Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - H D Critchley
- Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - J Ward
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
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2
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Huang C, van Wijnen AJ, Im HJ. Serotonin Transporter (5-Hydroxytryptamine Transporter, SERT, SLC6A4) and Sodium-dependent Reuptake Inhibitors as Modulators of Pain Behaviors and Analgesic Responses. THE JOURNAL OF PAIN 2024; 25:618-631. [PMID: 37852405 DOI: 10.1016/j.jpain.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
The serotonin transporter (5-hydroxytryptamine transporter [5-HTT], Serotonin Transporter (SERT), SLC6A4) modulates the activity of serotonin via sodium-dependent reuptake. Given the established importance of serotonin in the control of pain, 5-HTT has received much interest in studies of pain states and as a pharmacological target for serotonin reuptake inhibitors (SRIs). Animal models expressing varying levels of 5-HTT activity show marked differences in pain behaviors and analgesic responses, as well as many serotonin-related physiological effects. In humans, functional nucleotide variations in the SLC6A4 gene, which encodes the serotonin transporter 5-HTT, are associated with certain pathologic pain conditions and differences in responses to pharmacological therapy. These findings collectively reflect the importance of 5-HTT in the intricate physiology and management of pain, as well as the scientific and clinical challenges that need to be considered for the optimization of 5-HTT-related analgesic therapies. PERSPECTIVE: The serotonin transporter 5-HTT/SCL6A4 is sensitive to pharmacological SRIs. Experimental studies on the physiological functions of serotonin, as well as genetic mouse models and clinical phenotype/genotype correlations of nucleotide variation in the human 5-HTT/SCL6A4 gene, provide new insights for the use of SRIs in chronic pain management.
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Affiliation(s)
- Cary Huang
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois; Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York.
| | - Andre J van Wijnen
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois; Department of Biochemistry, University of Vermont, Burlington, Vermont.
| | - Hee-Jeong Im
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veterans Affairs Medical Center (JBVAMC), Chicago, Illinois.
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3
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Anderson AR, Monroe TB, Dietrich MS, Bruehl SP, Iversen WL, Cowan RL, Failla MD. Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease. FRONTIERS IN PAIN RESEARCH 2022; 3:914473. [PMID: 36387417 PMCID: PMC9650512 DOI: 10.3389/fpain.2022.914473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Background Pain continues to be underrecognized and undertreated in people with Alzheimer's disease (AD). The periaqueductal gray (PAG) is essential to pain processing and modulation yet is damaged by AD. While evidence exists of altered neural processing of pain in AD, there has not been a focused investigation of the PAG during pain in people with AD. Purpose To investigate the role of the PAG in sensory and affective pain processing for people living with AD. Methods Participants from a larger study completed pain psychophysics assessments and then a perceptually-matched heat pain task (warmth, mild, and moderate pain) during a functional MRI scan. In this cross-sectional study, we examined blood oxygenation level-dependent (BOLD) responses in the PAG and other pain-related regions in participants with AD (n = 18) and cognitively intact older adults (age- and sex-matched, n = 18). Associations of BOLD percent signal change and psychophysics were also examined. Results There were significant main effects of AD status on the temperature needed to reach each perception of warmth or pain, where people with AD reached higher temperatures. Furthermore, participants with AD rated mild and moderate pain as more unpleasant than controls. PAG BOLD activation was greater in AD relative to controls during warmth and mild pain percepts. No significant differences were found for moderate pain or in other regions of interest. Greater PAG activation during mild pain was associated with higher affective/unpleasantness ratings of mild pain in participants with AD but not in controls. Conclusion Results suggest a role for the PAG in altered pain responses in people with AD. The PAG is the primary source of endogenous opioid pain inhibition in the neuroaxis, thus, altered PAG function in AD suggests possible changes in descending pain inhibitory circuits. People with AD may have a greater risk of suffering from pain compared to cognitively intact older adults.
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Affiliation(s)
- Alison R. Anderson
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
| | - Todd B. Monroe
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephen P. Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - W. Larkin Iversen
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
| | - Ronald L. Cowan
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
- Departments of Psychiatry and Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michelle D. Failla
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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4
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den Boer JA, de Vries EJ, Borra RJ, Waarde AV, Lammertsma AA, Dierckx RA. Role of Brain Imaging in Drug Development for Psychiatry. Curr Rev Clin Exp Pharmacol 2022; 17:46-71. [DOI: 10.2174/1574884716666210322143458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/17/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
Background:
Over the last decades, many brain imaging studies have contributed to
new insights in the pathogenesis of psychiatric disease. However, in spite of these developments,
progress in the development of novel therapeutic drugs for prevalent psychiatric health conditions
has been limited.
Objective:
In this review, we discuss translational, diagnostic and methodological issues that have
hampered drug development in CNS disorders with a particular focus on psychiatry. The role of
preclinical models is critically reviewed and opportunities for brain imaging in early stages of drug
development using PET and fMRI are discussed. The role of PET and fMRI in drug development
is reviewed emphasizing the need to engage in collaborations between industry, academia and
phase I units.
Conclusion:
Brain imaging technology has revolutionized the study of psychiatric illnesses, and
during the last decade, neuroimaging has provided valuable insights at different levels of analysis
and brain organization, such as effective connectivity (anatomical), functional connectivity patterns
and neurochemical information that may support both preclinical and clinical drug development.
Since there is no unifying pathophysiological theory of individual psychiatric syndromes and since
many symptoms cut across diagnostic boundaries, a new theoretical framework has been proposed
that may help in defining new targets for treatment and thus enhance drug development in CNS diseases.
In addition, it is argued that new proposals for data-mining and mathematical modelling as
well as freely available databanks for neural network and neurochemical models of rodents combined
with revised psychiatric classification will lead to new validated targets for drug development.
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Affiliation(s)
| | - Erik J.F. de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ronald J.H. Borra
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Aren van Waarde
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adriaan A. Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudi A. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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López-Solà M, Pujol J, Monfort J, Deus J, Blanco-Hinojo L, Harrison BJ, Wager TD. The neurologic pain signature responds to nonsteroidal anti-inflammatory treatment vs placebo in knee osteoarthritis. Pain Rep 2022; 7:e986. [PMID: 35187380 PMCID: PMC8853614 DOI: 10.1097/pr9.0000000000000986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. fMRI-based measures, validated for nociceptive pain, respond to acute osteoarthritis pain, are not sensitive to placebo, and are mild-to-moderately sensitive to naproxen. Introduction: Many drug trials for chronic pain fail because of high placebo response rates in primary endpoints. Neurophysiological measures can help identify pain-linked pathophysiology and treatment mechanisms. They can also help guide early stop/go decisions, particularly if they respond to verum treatment but not placebo. The neurologic pain signature (NPS), an fMRI-based measure that tracks evoked pain in 40 published samples and is insensitive to placebo in healthy adults, provides a potentially useful neurophysiological measure linked to nociceptive pain. Objectives: This study aims to validate the NPS in knee osteoarthritis (OA) patients and test the effects of naproxen on this signature. Methods: In 2 studies (50 patients, 64.6 years, 75% females), we (1) test the NPS and other control signatures related to negative emotion in knee OA pain patients; (2) test the effect of placebo treatments; and (3) test the effect of naproxen, a routinely prescribed nonsteroidal anti-inflammatory drug in OA. Results: The NPS was activated during knee pain in OA (d = 1.51, P < 0.001) and did not respond to placebo (d = 0.12, P = 0.23). A single dose of naproxen reduced NPS responses (vs placebo, NPS d = 0.34, P = 0.03 and pronociceptive NPS component d = 0.38, P = 0.02). Naproxen effects were specific for the NPS and did not appear in other control signatures. Conclusion: This study provides preliminary evidence that fMRI-based measures, validated for nociceptive pain, respond to acute OA pain, do not appear sensitive to placebo, and are mild-to-moderately sensitive to naproxen.
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Affiliation(s)
- Marina López-Solà
- Department of Medicine, School of Medicine and Health Sciences, Serra Hunter Faculty Program, University of Barcelona, Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Jordi Monfort
- Rheumatology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Ben J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Dartmouth, MA, USA
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6
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Han X, Ashar YK, Kragel P, Petre B, Schelkun V, Atlas LY, Chang LJ, Jepma M, Koban L, Losin EAR, Roy M, Woo CW, Wager TD. Effect sizes and test-retest reliability of the fMRI-based neurologic pain signature. Neuroimage 2022; 247:118844. [PMID: 34942367 PMCID: PMC8792330 DOI: 10.1016/j.neuroimage.2021.118844] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 01/28/2023] Open
Abstract
Identifying biomarkers that predict mental states with large effect sizes and high test-retest reliability is a growing priority for fMRI research. We examined a well-established multivariate brain measure that tracks pain induced by nociceptive input, the Neurologic Pain Signature (NPS). In N = 295 participants across eight studies, NPS responses showed a very large effect size in predicting within-person single-trial pain reports (d = 1.45) and medium effect size in predicting individual differences in pain reports (d = 0.49). The NPS showed excellent short-term (within-day) test-retest reliability (ICC = 0.84, with average 69.5 trials/person). Reliability scaled with the number of trials within-person, with ≥60 trials required for excellent test-retest reliability. Reliability was tested in two additional studies across 5-day (N = 29, ICC = 0.74, 30 trials/person) and 1-month (N = 40, ICC = 0.46, 5 trials/person) test-retest intervals. The combination of strong within-person correlations and only modest between-person correlations between the NPS and pain reports indicate that the two measures have different sources of between-person variance. The NPS is not a surrogate for individual differences in pain reports but can serve as a reliable measure of pain-related physiology and mechanistic target for interventions.
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Affiliation(s)
- Xiaochun Han
- Faculty of Psychology, Beijing Normal University, Beijing, China; Dartmouth College, Hanover, NH, United States
| | - Yoni K Ashar
- Weill Cornell Medical College, New York, NY, United States
| | | | | | | | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, United States; National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | | | | | | | | | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Gyeonggi-do, South Korea
| | - Tor D Wager
- Dartmouth College, Hanover, NH, United States.
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7
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Harrison OK, Hayen A, Wager TD, Pattinson KT. Investigating the specificity of the neurologic pain signature against breathlessness and finger opposition. Pain 2021; 162:2933-2944. [PMID: 33990110 PMCID: PMC8600542 DOI: 10.1097/j.pain.0000000000002327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Brain biomarkers of pain, including pain-predictive "signatures" based on brain activity, can provide measures of neurophysiological processes and potential targets for interventions. A central issue relates to the specificity of such measures, and understanding their current limits will both advance their development and explore potentially generalizable properties of pain to other states. Here, we used 2 data sets to test the neurologic pain signature (NPS), an established pain neuromarker. In study 1, brain activity was measured using high-field functional magnetic resonance imaging (7T fMRI, N = 40) during 5 to 25 seconds of experimental breathlessness (induced by inspiratory resistive loading), conditioned breathlessness anticipation, and finger opposition. In study 2, we assessed anticipation and breathlessness perception (3T, N = 19) under blinded saline (placebo) and remifentanil administration. The NPS responded to breathlessness, anticipation, and finger opposition, although no direct comparisons with painful events were possible. Local NPS patterns in anterior or midinsula, S2, and dorsal anterior cingulate responded to breathlessness and finger opposition and were reduced by remifentanil. Local NPS responses in the dorsal posterior insula did not respond to any manipulations. Therefore, significant global NPS activity alone is not specific for pain, and we offer insight into the overlap between NPS responses, breathlessness, and somatomotor demand.
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Affiliation(s)
- Olivia K. Harrison
- Translational Neuromodeling Unit, Institute of Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- School of Pharmacy, University of Otago, New Zealand
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
| | - Anja Hayen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Tor D. Wager
- USA Department of Psychological and Brain Sciences, Dartmouth College, Hanover, United States.
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
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8
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Measuring the mental. Conscious Cogn 2021; 90:103106. [PMID: 33740549 DOI: 10.1016/j.concog.2021.103106] [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: 06/18/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
Many philosophers have argued that the subjective character of conscious experience results in a fundamental deficit of third-person (henceforth: extrospective) access to first-person experience. By comparing extrospective measurement techniques with measurement techniques in the natural sciences, we will argue that extrospective methods suffer from no such deficit. After a rejection of some principled objections against extrospective methods, a historical comparison with the development of measurement techniques in the natural sciences will show that extrospective measuring methods are still in an early stage of development. However, they can be significantly improved by way of a bootstrapping strategy, similar to that which has proven successful in the development of physical measurement techniques. One reason to expect such improvement is the availability of multiple sources of evidence, which should allow for substantial advances in extrospective measurement techniques. Finally, we will discuss new developments in pain measurement in order to show that the bootstrapping strategy is already bearing fruit.
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9
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Differential neural processing of unpleasant sensory stimulation in patients with major depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:557-565. [PMID: 32279144 PMCID: PMC7981307 DOI: 10.1007/s00406-020-01123-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD.
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10
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Suntsov V, Jovanovic F, Knezevic E, Candido KD, Knezevic NN. Can Implementation of Genetics and Pharmacogenomics Improve Treatment of Chronic Low Back Pain? Pharmaceutics 2020; 12:pharmaceutics12090894. [PMID: 32967120 PMCID: PMC7558486 DOI: 10.3390/pharmaceutics12090894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
Etiology of back pain is multifactorial and not completely understood, and for the majority of people who suffer from chronic low back pain (cLBP), the precise cause cannot be determined. We know that back pain is somewhat heritable, chronic pain more so than acute. The aim of this review is to compile the genes identified by numerous genetic association studies of chronic pain conditions, focusing on cLBP specifically. Higher-order neurologic processes involved in pain maintenance and generation may explain genetic contributions and functional predisposition to formation of cLBP that does not involve spine pathology. Several genes have been identified in genetic association studies of cLBP and roughly, these genes could be grouped into several categories, coding for: receptors, enzymes, cytokines and related molecules, and transcription factors. Treatment of cLBP should be multimodal. In this review, we discuss how an individual's genotype could affect their response to therapy, as well as how genetic polymorphisms in CYP450 and other enzymes are crucial for affecting the metabolic profile of drugs used for the treatment of cLBP. Implementation of gene-focused pharmacotherapy has the potential to deliver select, more efficacious drugs and avoid unnecessary, polypharmacy-related adverse events in many painful conditions, including cLBP.
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Affiliation(s)
- Vladislav Suntsov
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Filip Jovanovic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Emilija Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Kenneth D. Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-773-296-5619; Fax: +1-773-296-5362
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11
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Losin EAR, Woo CW, Medina NA, Andrews-Hanna JR, Eisenbarth H, Wager TD. Neural and sociocultural mediators of ethnic differences in pain. Nat Hum Behav 2020; 4:517-530. [PMID: 32015488 PMCID: PMC7494052 DOI: 10.1038/s41562-020-0819-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 01/05/2020] [Indexed: 02/07/2023]
Abstract
Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity- and gender-balanced sample of African Americans, Hispanics and non-Hispanic Whites using functional magnetic resonance imaging during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased frontostriatal circuit activations associated with pain rating, discrimination, experimenter trust and extranociceptive aspects of pain elsewhere. In contrast, the neurologic pain signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extranociceptive central pain mechanisms and suggest that nociceptive pain processing may be similar across ethnicities.
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Affiliation(s)
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Natalia A Medina
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | - Tor D Wager
- Dartmouth College, Department of Psychology and Brain Sciences, Hanover, NH, USA.
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12
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Weber Ii KA, Wager TD, Mackey S, Elliott JM, Liu WC, Sparks CL. Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain. NEUROIMAGE-CLINICAL 2019; 24:102042. [PMID: 31670070 PMCID: PMC6831903 DOI: 10.1016/j.nicl.2019.102042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
The use of brain-based models of pain were explored in two clinical studies. Neurologic pain signature activation decreased following spinal manipulation. Spinal manipulation altered the processing of pain-related brain activity. We provide evidence for a centrally mediated therapeutic action of spinal manipulation. Brain-based models have potential as objective clinical biomarkers of pain.
Background Context Spinal manipulation (SM) is a common treatment for neck and back pain, theorized to mechanically affect the spine leading to therapeutic mechanical changes. The link between specific mechanical effects and clinical improvement is not well supported. SM's therapeutic action may instead be partially mediated within the central nervous system. Purpose To introduce brain-based models of pain for spinal pain and manual therapy research, characterize the distributed central mechanisms of SM, and advance the preliminary validation of brain-based models as potential clinical biomarkers of pain. Study Design Secondary analysis of two functional magnetic resonance imaging studies investigating the effect of thoracic SM on pain-related brain activity: A non-controlled, non-blinded study in healthy volunteers (Study 1, n = 10, 5 females, and mean age = 31.2 ± 10.0 years) and a randomized controlled study in participants with acute to subacute neck pain (Study 2, n = 24, 16 females, mean age = 38.0 ± 15.1 years). Methods Functional magnetic resonance imaging was performed during noxious mechanical stimulation of the right index finger cuticle pre- and post-intervention. The effect of SM on pain-related activity was studied within brain regions defined by the Neurologic Pain Signature (NPS) that are predictive of physical pain. Results In Study 1, evoked mechanical pain (p < 0.001) and NPS activation (p = 0.010) decreased following SM, and the changes in evoked pain and NPS activation were correlated (rRM2 = 0.418, p = 0.016). Activation within the NPS subregions of the dorsal anterior cingulate cortex (dACC, p = 0.012) and right secondary somatosensory cortex/operculum (rS2_Op, p = 0.045) also decreased following SM, and evoked pain was correlated with dACC activity (rRM2 = 0.477, p = 0.019). In Study 2, neck pain (p = 0.046) and NPS (p = 0.033) activation decreased following verum but not sham SM. Associations between evoked pain, neck pain, and NPS activation, were not significant and less clear, possibly due to inadequate power, methodological limitations, or other confounding factors. Conclusions The findings provide preliminary evidence that SM may alter the processing of pain-related brain activity within specific pain-related brain regions and support the use of brain-based models as clinical biomarkers of pain.
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Affiliation(s)
- Kenneth A Weber Ii
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.
| | - Tor D Wager
- Psychology and Neuroscience, Center for Neuroscience, Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - James M Elliott
- Northern Sydney Local Health District, The Kolling Research Institute and The Faculty of Health Sciences, The University of Sydney, St. Leonards, NSW, Australia
| | - Wen-Ching Liu
- Center for Collaborative Brain Research, Department of Radiology, OSF HealthCare Saint Francis Medical Center, Peoria, IL, United States
| | - Cheryl L Sparks
- Center of Expertise, Rehabilitation and Occupational Health, OSF HealthCare, Peoria, IL, United States; School of Physical Therapy, South College, Knoxville, TN, United States
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Jepma M, Koban L, van Doorn J, Jones M, Wager TD. Behavioural and neural evidence for self-reinforcing expectancy effects on pain. Nat Hum Behav 2018; 2:838-855. [PMID: 31558818 PMCID: PMC6768437 DOI: 10.1038/s41562-018-0455-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/19/2018] [Indexed: 01/30/2023]
Abstract
Beliefs and expectations often persist despite evidence to the contrary. Here we examine two potential mechanisms underlying such 'self-reinforcing' expectancy effects in the pain domain: modulation of perception and biased learning. In two experiments, cues previously associated with symbolic representations of high or low temperatures preceded painful heat. We examined trial-to-trial dynamics in participants' expected pain, reported pain and brain activity. Subjective and neural pain responses assimilated towards cue-based expectations, and pain responses in turn predicted subsequent expectations, creating a positive dynamic feedback loop. Furthermore, we found evidence for a confirmation bias in learning: higher- and lower-than-expected pain triggered greater expectation updating for high- and low-pain cues, respectively. Individual differences in this bias were reflected in the updating of pain-anticipatory brain activity. Computational modelling provided converging evidence that expectations influence both perception and learning. Together, perceptual assimilation and biased learning promote self-reinforcing expectations, helping to explain why beliefs can be resistant to change.
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Affiliation(s)
- Marieke Jepma
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Psychology and Neuroscience and Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
| | - Leonie Koban
- Department of Psychology and Neuroscience and Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Johnny van Doorn
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Matt Jones
- Department of Psychology and Neuroscience and Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Tor D Wager
- Department of Psychology and Neuroscience and Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
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Kragel PA, Koban L, Barrett LF, Wager TD. Representation, Pattern Information, and Brain Signatures: From Neurons to Neuroimaging. Neuron 2018; 99:257-273. [PMID: 30048614 PMCID: PMC6296466 DOI: 10.1016/j.neuron.2018.06.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/22/2023]
Abstract
Human neuroimaging research has transitioned from mapping local effects to developing predictive models of mental events that integrate information distributed across multiple brain systems. Here we review work demonstrating how multivariate predictive models have been utilized to provide quantitative, falsifiable predictions; establish mappings between brain and mind with larger effects than traditional approaches; and help explain how the brain represents mental constructs and processes. Although there is increasing progress toward the first two of these goals, models are only beginning to address the latter objective. By explicitly identifying gaps in knowledge, research programs can move deliberately and programmatically toward the goal of identifying brain representations underlying mental states and processes.
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Affiliation(s)
- Philip A Kragel
- Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado, Boulder, CO, USA
| | - Leonie Koban
- Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado, Boulder, CO, USA
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, USA; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tor D Wager
- Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado, Boulder, CO, USA.
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Luo S, Zhu Y, Xu Y, Kong Q. The oxytocinergic system modulates sadistic context-dependent empathy in humans. Sci Rep 2017; 7:12463. [PMID: 28963465 PMCID: PMC5622090 DOI: 10.1038/s41598-017-12671-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/18/2017] [Indexed: 12/24/2022] Open
Abstract
The oxytocinergic system is crucial for sociality and well-being and is associated with empathy. It is suggested that the oxytocinergic system exerts context- and person-dependent effects. We examined how sexual sadistic contexts influenced the effects of the oxytocinergic system on empathic-related behaviors and brain activity in healthy adults. Combining genetic neuroimaging, pharmacological techniques and a psychological paradigm of empathy, we recorded EEG neural responses in female OXTR rs53756 G/G and A/A carriers and measured subjective empathic ratings after intranasal administration of oxytocin/placebo in healthy male adults during the perception of painful facial expressions in sadistic/general social contexts. The results revealed that sadistic contexts modulate oxytocinergic effects on empathy at both behavioral and neural levels. The oxytocinergic system preferentially modulated empathic responses to sadistic contexts. These effects are moderated by individual’s trait empathy. Our combined genetic-pharmacological-imaging results provide a neurochemical mechanism for sadistic context-dependent effects of the oxytocinergic system on empathy.
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Affiliation(s)
- Siyang Luo
- Department of Psychology, Guangdong Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou, 510006, China.
| | - Yiyi Zhu
- Department of Psychology, Guangdong Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Ying Xu
- Department of Psychology, Guangdong Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Qianting Kong
- Department of Psychology, Guangdong Key Laboratory of Social Cognitive Neuroscience and Mental Health, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-Sen University, Guangzhou, 510006, China
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Abstract
Pain is a subjective and complex phenomenon. Its complexity is related to its heterogeneity: multiple component processes, including sensation, affect, and cognition, contribute to pain experience and reporting. These components are likely to be encoded in distributed brain networks that interact to create pain experience and pain-related decision-making. Therefore, to understand pain, we must identify these networks and build models of these interactions that yield testable predictions about pain-related outcomes. We have developed several such models or 'signatures' of pain, by (1) integrating activity across multiple systems, and (2) using pattern-recognition to identify processes related to pain experience. One model, the Neurologic Pain Signature, is sensitive and specific to pain in individuals, involves brain regions that receive nociceptive afferents, and shows little effect of expectation or self-regulation in tests to date. Another, the 'Stimulus Intensity-Independent Pain Signature', explains substantial additional variation in trial-to-trial pain reports. It involves many brain regions that do not show increased activity in proportion to noxious stimulus intensity, including medial and lateral prefrontal cortex, nucleus accumbens, and hippocampus. Responses in this system mediate expectancy and perceived control effects in several studies. Overall, this approach provides a pathway to understanding pain by identifying multiple systems that track different aspects of pain. Such componential models can be combined in unique ways on a subject-by-subject basis to explain an individual's pain experience.
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Affiliation(s)
- Marianne C Reddan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80303, USA
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80303, USA.
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Homberg JR, Kozicz T, Fernández G. Large-scale network balances in the transition from adaptive to maladaptive stress responses. Curr Opin Behav Sci 2017. [DOI: 10.1016/j.cobeha.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Woo CW, Chang LJ, Lindquist MA, Wager TD. Building better biomarkers: brain models in translational neuroimaging. Nat Neurosci 2017; 20:365-377. [PMID: 28230847 PMCID: PMC5988350 DOI: 10.1038/nn.4478] [Citation(s) in RCA: 583] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 12/11/2016] [Indexed: 02/07/2023]
Abstract
Despite its great promise, neuroimaging has yet to substantially impact clinical practice and public health. However, a developing synergy between emerging analysis techniques and data-sharing initiatives has the potential to transform the role of neuroimaging in clinical applications. We review the state of translational neuroimaging and outline an approach to developing brain signatures that can be shared, tested in multiple contexts and applied in clinical settings. The approach rests on three pillars: (i) the use of multivariate pattern-recognition techniques to develop brain signatures for clinical outcomes and relevant mental processes; (ii) assessment and optimization of their diagnostic value; and (iii) a program of broad exploration followed by increasingly rigorous assessment of generalizability across samples, research contexts and populations. Increasingly sophisticated models based on these principles will help to overcome some of the obstacles on the road from basic neuroscience to better health and will ultimately serve both basic and applied goals.
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Affiliation(s)
- Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado, USA
| | | | | | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado, USA
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Quantifying cerebral contributions to pain beyond nociception. Nat Commun 2017; 8:14211. [PMID: 28195170 PMCID: PMC5316889 DOI: 10.1038/ncomms14211] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/05/2016] [Indexed: 12/21/2022] Open
Abstract
Cerebral processes contribute to pain beyond the level of nociceptive input and mediate psychological and behavioural influences. However, cerebral contributions beyond nociception are not yet well characterized, leading to a predominant focus on nociception when studying pain and developing interventions. Here we use functional magnetic resonance imaging combined with machine learning to develop a multivariate pattern signature-termed the stimulus intensity independent pain signature-1 (SIIPS1)-that predicts pain above and beyond nociceptive input in four training data sets (Studies 1-4, N=137). The SIIPS1 includes patterns of activity in nucleus accumbens, lateral prefrontal and parahippocampal cortices, and other regions. In cross-validated analyses of Studies 1-4 and in two independent test data sets (Studies 5-6, N=46), SIIPS1 responses explain variation in trial-by-trial pain ratings not captured by a previous fMRI-based marker for nociceptive pain. In addition, SIIPS1 responses mediate the pain-modulating effects of three psychological manipulations of expectations and perceived control. The SIIPS1 provides an extensible characterization of cerebral contributions to pain and specific brain targets for interventions.
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Bannister K, Lockwood S, Goncalves L, Patel R, Dickenson AH. An investigation into the inhibitory function of serotonin in diffuse noxious inhibitory controls in the neuropathic rat. Eur J Pain 2016; 21:750-760. [PMID: 27891703 DOI: 10.1002/ejp.979] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Following neuropathy α2-adrenoceptor-mediated diffuse noxious inhibitory controls (DNIC), whereby a noxious conditioning stimulus inhibits the activity of spinal wide dynamic range (WDR) neurons, are abolished, and spinal 5-HT7 receptor densities are increased. Here, we manipulate spinal 5-HT content in spinal nerve ligated (SNL) animals and investigate which 5-HT receptor mediated actions predominate. METHODS Using in vivo electrophysiology we recorded WDR neuronal responses to von frey filaments applied to the hind paw before, and concurrent to, a noxious ear pinch (the conditioning stimulus) in isoflurane-anaesthetised rats. The expression of DNIC was quantified as a reduction in WDR neuronal firing in the presence of conditioning stimulus and was investigated in SNL rats following spinal application of (1) selective serotonin reuptake inhibitors (SSRIs) citalopram or fluoxetine, or dual application of (2) SSRI plus 5-HT7 receptor antagonist SB269970, or (3) SSRI plus α2 adrenoceptor antagonist atipamezole. RESULTS DNIC were revealed in SNL animals following spinal application of SSRI, but this effect was abolished upon joint application of SSRI plus SB269970 or atipamezole. CONCLUSIONS We propose that in SNL animals the inhibitory actions (quantified as the presence of DNIC) of excess spinal 5-HT (presumed present following application of SSRI) were mediated via 5-HT7 receptors. The anti-nociception depends upon an underlying tonic noradrenergic inhibitory tone via the α2-adrenoceptor. SIGNIFICANCE Following neuropathy enhanced spinal serotonin availability switches the predominant spinal 5-HT receptor-mediated actions but also alters noradrenergic signalling. We highlight the therapeutic complexity of SSRIs and monoamine modulators for the treatment of neuropathic pain.
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Affiliation(s)
- K Bannister
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - S Lockwood
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - L Goncalves
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - R Patel
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - A H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
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