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Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ MEDICINE 2022; 1:e000108. [PMID: 36936554 PMCID: PMC10012866 DOI: 10.1136/bmjmed-2021-000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina L Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lene Vase
- Department of Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly A Cawcutt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nuj Tontisirin
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Mahidol University, Bangkok, Thailand
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The methyl donor S-adenosyl methionine reverses the DNA methylation signature of chronic neuropathic pain in mouse frontal cortex. Pain Rep 2021; 6:e944. [PMID: 34278163 PMCID: PMC8280078 DOI: 10.1097/pr9.0000000000000944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Chronic administration of S-adenosylmethionine reverses neuropathic pain–induced changes in DNA methylation in the mouse frontal cortex. Chronic pain is associated with persistent but reversible structural and functional changes in the prefrontal cortex (PFC). This stable yet malleable plasticity implicates epigenetic mechanisms, including DNA methylation, as a potential mediator of chronic pain–induced cortical pathology. We previously demonstrated that chronic oral administration of the methyl donor S-adenosyl methionine (SAM) attenuates long-term peripheral neuropathic pain and alters global frontal cortical DNA methylation. However, the specific genes and pathways associated with the resolution of chronic pain by SAM remain unexplored.
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The role of HHV-6 and HHV-7 infections in the development of fibromyalgia. J Neurovirol 2019; 25:194-207. [PMID: 30617851 PMCID: PMC6505518 DOI: 10.1007/s13365-018-0703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 12/19/2022]
Abstract
Human herpes virus-6 (HHV-6) and human herpes virus-7 (HHV-7) are immunomodulating viruses potentially affecting the nervous system. We evaluated the influence of HHV-6 and HHV-7 infections on fibromyalgia (FM) clinical course. Forty-three FM patients and 50 control group participants were enrolled. 39.50% (n = 17) FM patients had light A delta and C nerve fiber damage, 27.91% (n = 12) had severe A delta and C nerve fiber damage. 67.44% (n = 29) FM patients had loss of warm sensation in feet, loss of heat pain sensation, and increased cold pain sensation (34.90%, n = 15 in both findings). HHV-6 and HHV-7 genomic sequences in peripheral blood DNA in 23/43 (51.00%) and 34/43 (75.50%) of samples from FM patients and in 3/50 (6.00%) and 26/50 (52.00%) of samples from the control group individuals were detected. Active HHV-6 (plasma viremia) or HHV-7 infection was revealed only in FM patients (4/23, 17.40% and 4/34, 11.80%, respectively). A statistically significant moderate positive correlation was found between A delta and C nerve fiber damage severity and HHV-6 infection (p < 0.01, r = 0.410). 23/43 patients from the FM group and control group participants HHV-6 and 34/45 HHV-7 did have infection markers. A statistically significant moderate positive correlation was found between A delta and C nerve fiber damage severity and HHV-6 infection (p < 0.01, r = 0.410). No difference was found between detection frequency of persistent HHV-6 and HHV-7 infection between FM patients and the control group. Statistically significant correlation was observed between quantitation of changes in QST thermal modalities and HHV-6 infection. There was no correlation between A delta and C nerve fiber damage and HHV-7 infection.
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Sang K, Bao C, Xin Y, Hu S, Gao X, Wang Y, Bodner M, Zhou YD, Dong XW. Plastic change of prefrontal cortex mediates anxiety-like behaviors associated with chronic pain in neuropathic rats. Mol Pain 2018; 14:1744806918783931. [PMID: 29871537 PMCID: PMC6077894 DOI: 10.1177/1744806918783931] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Clinical studies show that anxiety and chronic pain are concomitant. The neural
basis for the comorbidity is unclear. The prefrontal cortex (PFC) has been
recognized as a critical area for affective disorders and chronic pain
modulation. In this study, we examined the role of the PFC in the pathogenesis
of anxiety associated with chronic pain in a rat model of neuropathic pain with
spare nerve injury (SNI). The SNI rats showed apparent anxiety-like behaviors in
both open field (OF) test and elevated-plus maze (EPM) test eight weeks after
surgery. Thus, the number of entries to the central area in the OF decreased to
45% (±5%, n = 15) of sham control (n = 17), while the overall motor activity
(i.e., total distance) was unaffected. In the EPM, the percentage of entries
into the open arms significantly (p < 0.001) decreased in SNI rats (SNI:
12.58 ± 2.7%, n = 15; sham: 30.75 ± 2.82%, n = 17), so did the time spent in the
open arms (SNI: 4.35 ± 1.45%, n = 15; Sham: 11.65 ± 2.18%, n = 17). To explore
the neural basis for the association between anxiety and chronic pain, local
field potentials (LFPs) were recorded from the medial PFC (mPFC) and ventral
hippocampus. In SNI rats, there were significantly greater increases in both
theta-frequency power in the mPFC and theta-frequency synchronization between
the mPFC and ventral hippocampus, when animals were displaying elevated
anxiety-like behaviors in avoiding anxiogenic regions in EPM and OF chamber.
Western blot analyses showed a significant elevation of serotonin transporter
expression in the anxious SNI rats. Inhibition of serotonin transporter
effectively alleviated anxiety-like behaviors following sub-chronic (15 days)
treatment with systemic citalopram (10 mg/kg/day, intraperitoneally). Moreover,
the anxiety-like behaviors in the SNI rats were also suppressed by direct mPFC
application of serotonin. Taken together, we conclude that the plasticity of
serotonin transmission in the mPFC likely contribute to the promotion of anxiety
state associated with neuropathic pain.
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Affiliation(s)
- Kangning Sang
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Chaofei Bao
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yushi Xin
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Shunan Hu
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xian Gao
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yongsheng Wang
- 2 School of Life Sciences, East China Normal University, Shanghai, China
| | | | - Yong-Di Zhou
- 4 Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,5 Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Xiao-Wei Dong
- 1 Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,6 NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, China
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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: 347] [Impact Index Per Article: 57.8] [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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Evaluation of Chronic Pain Using Magnetic Resonance (MR) Neuroimaging Approaches: What the Clinician Needs to Know. Clin J Pain 2017; 33:281-290. [PMID: 27518493 DOI: 10.1097/ajp.0000000000000415] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Numerous neuroimaging techniques have been recently used to investigate central mechanisms involved in pain perception and to examine morphological and functional brain alterations associated with chronic pain. Compared to self-reporting approaches, objective imaging techniques are expected to potentially lead to better pain assessment and guide management. This comprehensive scoping review aims to identify recent magnetic resonance imaging (MRI) approaches that have been used to characterize the brain of chronic pain subjects, using structural, chemical and functional MRI techniques. METHODS A systematic search and review of the literature was conducted and the resultant studies were critically examined for relevance. RESULTS MRI neuroimaging of various chronic pain conditions were summarized. We classified the collected studies into: structural brain alterations, VBM (voxel based morphology) examination of structural changes, DTI, changes in brain chemistry, functional and blood flow brain alterations. DISCUSSION From our clinical experience, we have noted that most clinicians are not aware of the capabilities of advanced MRI methods in assessing cortical manifestations of chronic pain. In addition, many clinicians are not aware of the cortical alterations present in individuals with chronic pain. This comprehensive scoping review thus sets out to first summarize MRI neuroimaging techniques that are available in the current literature to examine chronic pain. We then identify cortical MR approaches that have been able to reliably predict transition from acute to chronic pain. Finally, we summarize MRI neuroimaging techniques that have been used to track treatment response of individuals with chronic pain.
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Pan P, Zhong J, Shang H, Zhu Y, Xiao P, Dai Z, Shi H. Quantitative meta-analysis of grey matter anomalies in neuropathic pain. Eur J Pain 2015; 19:1224-31. [PMID: 25708697 DOI: 10.1002/ejp.670] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 02/05/2023]
Affiliation(s)
- P.L. Pan
- Department of Neurology; Affiliated Yancheng Hospital of Southeast University; China
| | - J.G. Zhong
- Department of Neurology; Affiliated Yancheng Hospital of Southeast University; China
| | - H.F. Shang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Y.L. Zhu
- Department of Neurology; Affiliated Yancheng Hospital of Southeast University; China
| | - P.R. Xiao
- Department of Neurology; Affiliated Yancheng Hospital of Southeast University; China
| | - Z.Y. Dai
- Department of Radiology; Affiliated Yancheng Hospital of Southeast University; China
| | - H.C. Shi
- Department of Neurology; Affiliated Yancheng Hospital of Southeast University; China
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Kirveskari E, Vartiainen NV, Kallio-Laine K, Kalso E, Forss N. Normal laser-evoked cortical responses in patients with chronic hemibody pain. Eur J Pain 2014; 19:1168-76. [PMID: 25523148 DOI: 10.1002/ejp.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with widespread unilateral chronic pain associated with recurrent herpes simplex virus (HSV) infections show functional and/or structural changes in the insula, anterior cingulate cortex, frontal and prefrontal cortices, as well as the thalamus, suggesting central dysfunction of the pain system in these patients. Central pain has been associated with attenuated laser-evoked cortical responses. We aimed to clarify whether the observed deficient activation of these areas to acute nociceptive stimuli is due to a lesion at a lower level of pain processing pathways. METHODS We explored the functional integrity of the ascending nociceptive pathways by recording the cortical-evoked responses to noxious laser stimulation using magnetoencephalography and electroencephalography in eight patients (age 41-51 years, mean 46) with recurrent HSV infections and a history of chronic, spontaneous, widespread unilateral pain, and in nine age-matched healthy control subjects. RESULTS The cortical-evoked fields of the HSV patients originating from the secondary somatosensory and posterior parietal cortices, as well as the evoked potentials recorded from the midline, did not differ from those of the control subjects, indicating functionally intact ascending nociceptive pathways. CONCLUSIONS The present results show that our patients with chronic hemibody pain do not show signs of spinothalamic tract lesion. This indicates normal processing of sensory aspects of painful stimuli, while higher pain processing areas show altered activation. We conclude that normal laser-evoked magnetic fields (LEF) or laser-evoked potentials (LEP) may not exclude central pain condition.
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Affiliation(s)
- E Kirveskari
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland.,Department of Neurological Sciences, University of Helsinki, Finland
| | - N V Vartiainen
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland
| | - K Kallio-Laine
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland
| | - E Kalso
- Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, Finland.,Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Finland
| | - N Forss
- Brain Research Unit and MEG Core, O.V. Lounasmaa Laboratory, Aalto Neuroimaging, School of Science, Aalto University, Espoo, Finland.,Department of Neurological Sciences, University of Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Finland
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Yalcin I, Barthas F, Barrot M. Emotional consequences of neuropathic pain: insight from preclinical studies. Neurosci Biobehav Rev 2014; 47:154-64. [PMID: 25148733 DOI: 10.1016/j.neubiorev.2014.08.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/15/2014] [Accepted: 08/03/2014] [Indexed: 01/12/2023]
Abstract
Mood disorders such as depression and anxiety are frequently observed in patients suffering from chronic pain, including neuropathic pain. While this comorbidity is clinically well established, the underlying mechanism(s) remained unclear. The recent development of animal models now allows addressing the consequences of neuropathic pain. In this review, we report the preclinical evidences from anatomical, neuroimaging, behavioral, pharmacological and biochemical studies that address the anxiodepressive consequences of neuropathic pain. We present an overview of rodent models of these consequences and we discuss the challenges and parameters to consider for generating these models. We then discuss the possible mechanism(s) underlying anxiodepressive consequences by describing morphological and functional changes. Information is provided concerning neuroanatomical changes and plasticity, including LTP and LTD, in the anterior cingulate cortex, the insula, the hippocampus, the amygdala and the mesolimbic system, neuroendocrine parameters concerning the hypothalamo-pituitary-adrenal axis, neuroimmune response including the role of glial cells and cytokines, monoamine systems and changes in locus coeruleus noradrenergic system, and neurotrophic factors such as BDNF.
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Affiliation(s)
- Ipek Yalcin
- Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, 67084 Strasbourg, France.
| | - Florent Barthas
- Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, 67084 Strasbourg, France; Université de Strasbourg, 67084 Strasbourg, France
| | - Michel Barrot
- Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, 67084 Strasbourg, France
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Gustin SM, Peck CC, Macey PM, Murray GM, Henderson LA. Unraveling the effects of plasticity and pain on personality. THE JOURNAL OF PAIN 2014; 14:1642-52. [PMID: 24290444 DOI: 10.1016/j.jpain.2013.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 01/03/2023]
Abstract
UNLABELLED Chronic pain resulting from physical stressors is often accompanied by psychological disorders such as depression. Although depressive disorders are associated with changes in brain anatomy, it remains unknown if changes in brain anatomy associated with increased state depression levels also occur in patients with chronic pain. When individuals are experiencing physical stressors such as ongoing pain, depressive personality traits may predispose them to develop depressive states. The aim of this study was to use brain morphometry to determine the interaction among chronic pain, state and trait depression, and regional brain structure. We investigated regional gray matter volume in 42 chronic pain patients and 35 controls using voxel-based morphometry of T1-weighted anatomical images. Significant relationships between regional gray matter volume and state or trait depressive values were determined. In chronic pain patients, state depression scores were significantly correlated to subtle changes in the thalamus and the cingulate, dorsolateral prefrontal, and hippocampal cortices. These same brain regions were also significantly correlated to trait depressive scores. Unexpectedly, gray matter volumes in these regions were not correlated to trait depressive scores in healthy controls. Because trait depressive values were not correlated to gray matter in controls, but were so in chronic pain patients, these data strongly suggest that subtle changes in brain anatomy can evoke changes in individuals' trait depression values. If these regional gray matter changes are severe enough, changes in an individual's personality trait may result. PERSPECTIVE This study demonstrates anatomical brain alterations associated with both state and trait depression in chronic pain patients. Because our study reveals that trait depression is not correlated to the anatomy of these regions in healthy controls, ongoing pain itself may result in anatomical changes that in turn can alter an individual's personality.
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Affiliation(s)
- Sylvia M Gustin
- Department of Anatomy and Histology, University of Sydney, New South Wales, Australia; Neuroscience Research Australia, New South Wales, Australia.
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Borsook D, Erpelding N, Becerra L. Losses and gains: chronic pain and altered brain morphology. Expert Rev Neurother 2013; 13:1221-34. [PMID: 24164053 DOI: 10.1586/14737175.2013.846218] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
As in many fields of neuroscience, alterations in brain morphology, and specifically gray matter volume and cortical thickness, have been repeatedly linked to chronic pain disorders. Numerous studies have shown changes in cortical and subcortical brain regions suggesting a dynamic process that may be a result of chronic pain or contributing to a more generalized phenomenon in chronic pain including comorbid anxiety and depression. In this review, we provide a perspective of pain as an innate state of pain based on alterations in structure and by inference, brain function. A better neurobiological understanding of gray matter changes will contribute to our understanding of how structural changes contribute to chronic pain (disease driver) and how these changes may be reversed (disease modification or treatment).
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Affiliation(s)
- David Borsook
- Center for Pain and the Brain, P.A.I.N. Group, Boston Children's Hospital, Harvard Medical School, c/o 9 Hope Avenue, Waltham, MA, USA
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Smallwood RF, Laird AR, Ramage AE, Parkinson AL, Lewis J, Clauw DJ, Williams DA, Schmidt-Wilcke T, Farrell MJ, Eickhoff SB, Robin DA. Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume. THE JOURNAL OF PAIN 2013; 14:663-75. [PMID: 23685185 DOI: 10.1016/j.jpain.2013.03.001] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/26/2013] [Indexed: 02/07/2023]
Abstract
UNLABELLED The diversity of chronic pain syndromes and the methods employed to study them make integrating experimental findings challenging. This study performed coordinate-based meta-analyses using voxel-based morphometry imaging results to examine gray matter volume (GMV) differences between chronic pain patients and healthy controls. There were 12 clusters where GMV was decreased in patients compared with controls, including many regions thought to be part of the "pain matrix" of regions involved in pain perception, but also including many other regions that are not commonly regarded as pain-processing areas. The right hippocampus and parahippocampal gyrus were the only regions noted to have increased GMV in patients. Functional characterizations were implemented using the BrainMap database to determine which behavioral domains were significantly represented in these regions. The most common behavioral domains associated with these regions were cognitive, affective, and perceptual domains. Because many of these regions are not classically connected with pain and because there was such significance in functionality outside of perception, it is proposed that many of these regions are related to the constellation of comorbidities of chronic pain, such as fatigue and cognitive and emotional impairments. Further research into the mechanisms of GMV changes could provide a perspective on these findings. PERSPECTIVE Quantitative meta-analyses revealed structural differences between brains of individuals with chronic pain and healthy controls. These differences may be related to comorbidities of chronic pain.
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Affiliation(s)
- Rachel F Smallwood
- Joint Program in Biomedical Engineering, University of Texas Health Science Center San Antonio and University of Texas San Antonio, San Antonio, Texas, USA
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Abstract
PURPOSE OF REVIEW The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes. RECENT FINDINGS First, peripheral or central sensitization may result in increased nociceptive input to the brain and also changes the processing of nociceptive information within the brain. Second, chronic nociceptive input from the periphery or from lesions within the central nervous system may result in cortical reorganization and maladaptive neuroplasticity within somatosensory and motor systems. Thirdly, there is evidence for pain-induced changes in large-scale neuronal network connectivity. Fourth, in patients with chronic pain, structural brain changes may occur. Finally, there is discussion that in chronic pain patients the endogenous pain-modulatory system may function aberrantly. SUMMARY Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
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Abstract
Structural imaging is turning our attention regarding the effects of chronic pain on the brain as a possible source of chronicity. Several independent studies have suggested a decrease in gray matter in pain-transmitting areas in patients with constant pain. Most of these data are discussed as representing damage or loss of brain gray matter, reinforcing the idea of chronic pain as a progressive disease. However, any data of an increase or decrease in gray matter in pain syndromes need to be considered in light of all observations gathered in the past 10 years and probably do not justify a discussion of brain damage or consideration of whether the disease is progressive. It is likely that these changes are the consequence and not the cause of the respective pain syndromes as they may reverse once the pain is adequately treated. Moreover, structural changes of the brain may not be specific to a particular pain syndrome and for the moment only mirror the magnitude or duration of pain suffered. The topographical distributions of gray matter changes may well be the consequence of cortical regions having varying susceptibilities. We need to better understand the behavioral consequences and cellular mechanisms underlying these neuroanatomic changes.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University of Hamburg, Hamburg, Germany
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Schweinhardt P, Bushnell MC. Pain imaging in health and disease--how far have we come? J Clin Invest 2010; 120:3788-97. [PMID: 21041961 DOI: 10.1172/jci43498] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Since modern brain imaging of pain began 20 years ago, networks in the brain related to pain processing and those related to different types of pain modulation, including placebo, have been identified. Functional and anatomical connectivity of these circuits has begun to be analyzed. Imaging in patients suggests that chronic pain is associated with altered function and structural abnormalities in pain modulatory circuits. Moreover, biochemical alterations associated with chronic pain are being identified that provide information on cellular correlates as well as potential mechanisms of structural changes. Data from these brain imaging studies reinforce the idea that chronic pain leads to brain changes that could have functional significance.
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Affiliation(s)
- Petra Schweinhardt
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Prasad KM, Bamne MN, Shirts BH, Goradia D, Mannali V, Pancholi KM, Xue B, McClain L, Yolken RH, Keshavan MS, Nimgaonkar VL. Grey matter changes associated with host genetic variation and exposure to Herpes Simplex Virus 1 (HSV1) in first episode schizophrenia. Schizophr Res 2010; 118:232-9. [PMID: 20138739 PMCID: PMC2856756 DOI: 10.1016/j.schres.2010.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 12/31/2009] [Accepted: 01/04/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND We previously reported reduced prefrontal cortex (PFC) grey matter volume among first episode, antipsychotic-naïve schizophrenia subjects (SZ) exposed to HSV1 but not among healthy subjects (HS) (Prasad et al., 2007). Independently, rs1051788, an exonic polymorphism of the MHC Class I polypeptide-related sequence B (MICB) gene was associated with HSV1 seropositivity, as well as SZ risk. In this study, we examined whether PFC grey matter changes associated with HSV1 exposure varied against the background of MICB genotypes. METHODS We examined Caucasian individuals from the sample we studied in our previous report (Prasad et al., 2007) (SZ, n=21 and HS, n=19). Whole brain voxelwise analysis of structural MRI scans was conducted using Statistical Parametric Mapping, ver 5 (SPM5). The impact of rs1051788 variation and HSV1 seropositivity on grey matter volumes was examined using regression models on the combined sample of cases and controls, and then within each diagnostic group. RESULTS In the combined sample of cases and controls, we observed the main effects of HSV1 seropositivity and genotypes, and a significant joint effect of HSV1 seropositivity and genotype mainly in the PFC. The joint effect was more prominent among cases than among controls. DISCUSSION Our observations suggest that rs1051788 and HSV1 seropositivity are associated individually and jointly with reduced PFC grey matter volume. The patterns of these associations differ by diagnostic status, and these factors explain only a "small" portion of the variance in the grey matter volume reductions.
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Affiliation(s)
- Konasale M Prasad
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
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