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Sun Q, Xiong N, Wang Y, Xia Z, Chen J, Yan C, Sun H. Shared and distinct aberrations in frontal-striatal system functional patterns among patients with irritable bowel syndrome and major depressive disorder. J Affect Disord 2024; 362:391-403. [PMID: 38986877 DOI: 10.1016/j.jad.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/09/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Considering the high comorbidity, shared risk factors, and genetic pathways between irritable bowel syndrome (IBS) and major depressive disorder (MDD), we hypothesized that there would be both shared and disorder-specific alterations in brain function. METHODS A total of 39 IBS patients, 39 MDD patients, and 40 healthy controls (HCs) were enrolled and matched for sex, age, and educational level. All subjects underwent resting-state functional MRI. The clinical variables of anxiety, depression, gastrointestinal symptoms and alexithymia were recorded. The 12 subregions of the striatum were employed as seeds to assess their functional connectivity (FC) with every voxel throughout the whole brain. RESULTS Compared to HC, IBS and MDD patients exhibited aberrant frontal-striatal circuitry. We observed a common decrease in FC between the dorsal striatum and regions of the hippocampus, sensorimotor cortex, and prefrontal cortex (PFC) in both IBS and MDD patients. Patients with IBS exhibited disorder-specific decreases in FC within the striatum, along with reduced connectivity between the ventral striatum and sensorimotor cortex. In contrast, MDD patients showed disorder-specific hyperconnectivity in the medial PFC-limbic system. Receiver operating characteristic curve analysis showed that frontal-striatal FC values could serve as transdiagnostic markers of IBS and MDD. Within the IBS group, striatal connectivity was not only negatively associated with weekly abdominal pain days but also negatively correlated with the levels of anxiety and alexithymia. CONCLUSIONS This exploratory analysis indicated that patients with IBS and MDD exhibited both shared and disorder-specific frontal-striatal circuit impairments, potentially explaining both comorbidity and distinct phenotypes.
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Affiliation(s)
- Qiqing Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nana Xiong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Yuwei Wang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhiwei Xia
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Jie Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chaogan Yan
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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He Y, Wang J, Zhao P, Wang R, Li M. Correlations of The Central Sensitization Inventory, conditioned pain modulation, cognitions and psychological factors in individuals with chronic neck pain: A cross-sectional study. Pain Ther 2024; 13:843-856. [PMID: 38789828 PMCID: PMC11254877 DOI: 10.1007/s40122-024-00601-w] [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: 11/15/2023] [Accepted: 04/02/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Chronic neck pain (CNP) is a global public health problem, with high prevalence and absenteeism rates. Central sensitization (CS) as a basis for chronic pain may play an essential role in its development and progression. It is often comorbid with low conditioned pain modulation (CPM) effects, cognitions, and psychological problems. OBJECTIVES The purposes of this study were to (1) explore the relationship between pain-related cognitions and psychological factors, CPM effects, and the central sensitization inventory (CSI) scores; and (2) determine whether cognitions and psychological factors can predict CSI scores and CPM effects in individuals with CNP. METHODS Fifty-four individuals with CNP were recruited for this cross-sectional study. The following outcome measures were evaluated: The CSI (screening tool) was compared with the cold pressor test (CPT), which was the psychophysical test used to assess the CPM; neck pain intensity using the visual analogue scale (VAS), as well as pain-related cognitions (including kinesiophobia and pain catastrophization) and psychological states (including anxiety and depression) using self-report questionnaires. RESULTS CSI score was not associated with the CPM effect (r = 0.257, p > 0.05), and no cognitions or psychological factors were associated with CPM (p > 0.05), but CSI score was moderately positively correlated with kinesiophobia (r = 0.554, p < 0.01), lowly positively correlated with pain catastrophization (r = 0.332, p = 0.017) and anxiety (r = 0.492, p < 0.01), but not depression (r = 0.207, p = 0.132). Multiple linear regression analysis showed that kinesiophobia (B = 1.308, p < 0.01) and anxiety (B = 1.806, p = 0.02) were significant positive predictors of CSI score. CONCLUSIONS The findings confirm some of our hypotheses. Accordingly, the findings inferred that the CSI does not seem to respond to CPM effect in patients with CNP effectively. In addition, CSI score was associated with cognitions and psychological factors, of which kinesiophobia and anxiety were effective predictors. In clinical practice, pain-related cognitions and psychological factors should be fully considered to manage neck pain efficiently.
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Affiliation(s)
- Yuwei He
- College of Sports Medicine and Rehabilitation, Beijing Sport University, 48 Information Road, Haidian District, Beijing, 100084, China
| | - Jialin Wang
- China Institute of Sports Science, General Administration of Sport, 11 Gymnasium Road, Dongcheng District, Beijing, 100061, China
| | - Peng Zhao
- China Institute of Sports Science, General Administration of Sport, 11 Gymnasium Road, Dongcheng District, Beijing, 100061, China.
| | - Ruirui Wang
- College of Sports Medicine and Rehabilitation, Beijing Sport University, 48 Information Road, Haidian District, Beijing, 100084, China
| | - Meng Li
- College of Sports Medicine and Rehabilitation, Beijing Sport University, 48 Information Road, Haidian District, Beijing, 100084, China
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In A, Strohman A, Payne B, Legon W. Low-intensity focused ultrasound to the posterior insula reduces temporal summation of pain. Brain Stimul 2024; 17:911-924. [PMID: 39089647 DOI: 10.1016/j.brs.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The insula and dorsal anterior cingulate cortex (dACC) are core brain regions involved in pain processing and central sensitization, a shared mechanism across various chronic pain conditions. Methods to modulate these regions may serve to reduce central sensitization, though it is unclear which target may be most efficacious for different measures of central sensitization. OBJECTIVE/HYPOTHESIS Investigate the effect of low-intensity focused ultrasound (LIFU) to the anterior insula (AI), posterior insula (PI), or dACC on conditioned pain modulation (CPM) and temporal summation of pain (TSP). METHODS N = 16 volunteers underwent TSP and CPM pain tasks pre/post a 10 min LIFU intervention to either the AI, PI, dACC or Sham stimulation. Pain ratings were collected pre/post LIFU. RESULTS Only LIFU to the PI significantly attenuated pain ratings during the TSP protocol. No effects were found for the CPM task for any of the LIFU targets. LIFU pressure modulated group means but did not affect overall group differences. CONCLUSIONS LIFU to the PI reduced temporal summation of pain. This may, in part, be due to dosing (pressure) of LIFU. Inhibition of the PI with LIFU may be a future potential therapy in chronic pain populations demonstrating central sensitization. The minimal effective dose of LIFU for efficacious neuromodulation will help to translate LIFU for therapeutic options.
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Affiliation(s)
- Alexander In
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
| | - Andrew Strohman
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA
| | - Brighton Payne
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - Wynn Legon
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA; Center for Human Neuroscience Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24016, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, VA, 24016, USA.
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Mathew J, Adhia DB, Hall M, De Ridder D, Mani R. EEG-Based Cortical Alterations in Individuals With Chronic Knee Pain Secondary to Osteoarthritis: A Cross-sectional Investigation. THE JOURNAL OF PAIN 2024; 25:104429. [PMID: 37989404 DOI: 10.1016/j.jpain.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Chronic painful knee osteoarthritis (OA) is a disabling physical health condition. Alterations in brain responses to arthritic changes in the knee may explain persistent pain. This study investigated source localized, resting-state electroencephalography activity and functional connectivity in people with knee OA, compared to healthy controls. Adults aged 44 to 85 years with knee OA (n = 37) and healthy control (n = 39) were recruited. Resting-state electroencephalography was collected for 10 minutes and decomposed into infraslow frequency (ISF) to gamma frequency bands. Standard low-resolution electromagnetic brain tomography statistical nonparametric maps were conducted, current densities of regions of interest were compared between groups and correlation analyses were performed between electroencephalography (EEG) measures and clinical pain and functional outcomes in the knee OA group. Standard low-resolution electromagnetic brain tomography nonparametric maps revealed higher (P = .006) gamma band activity over the right insula (RIns) in the knee OA group. A significant (P < .0001) reduction in ISF band activity at the pregenual anterior cingulate cortex, whereas higher theta, alpha, beta, and gamma band activity at the dorsal anterior cingulate cortex, pregenual anterior cingulate cortex, the somatosensory cortex, and RIns in the knee OA group were identified. ISF activity of the dorsal anterior cingulate cortex was positively correlated with pain measures and psychological distress scores. Theta and alpha activity of RIns were negatively correlated with pain interference. In conclusion, aberrations in infraslow and faster frequency EEG oscillations at sensory discriminative, motivational-affective, and descending inhibitory cortical regions were demonstrated in people with chronic painful knee OA. Moreover, EEG oscillations were correlated with pain and functional outcome measures. PERSPECTIVE: This study confirms alterations in the rsEEG oscillations and its relationship with pain experience in people with knee OA. The study provides potential cortical targets and the EEG frequency bands for neuromodulatory interventions for managing chronic pain experience in knee OA.
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Affiliation(s)
- Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
| | - Divya B Adhia
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Matthew Hall
- Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Dirk De Ridder
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
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Horn-Hofmann C, Jablonowski L, Madden M, Kunz M, Lautenbacher S. Is conditioned pain modulation (CPM) affected by negative emotional state? Eur J Pain 2024; 28:421-433. [PMID: 37837611 DOI: 10.1002/ejp.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Conditioned pain modulation (CPM) is an experimental paradigm, which describes the inhibition of responses to a noxious or strong-innocuous stimulus, the test stimulus (TS), by the additional application of a second noxious or strong-innocuous stimulus, the conditioning stimulus (CS). As inadequate CPM efficiency has been assumed to be predisposing for clinical pain, the search for moderating factors explaining inter-individual variations in CPM is ongoing. Psychological factors have received credits in this context. However, research concerning associations between CPM and trait factors relating to negative emotions has yielded disappointing results. Yet, the influence of anxious or fearful states on CPM has not attracted much interest despite ample evidence that negative affective states enhance pain. Our study aimed at investigating the effect of fear induction by symbolic threat on CPM. METHODS Thirty-seven healthy participants completed two experimental blocks: one presenting aversive pictures showing burn wounds (high-threat block) and one presenting neutral pictures (low-threat block). Both blocks contained a CPM paradigm with contact heat as TS and hot water as CS; subjective numerical ratings as well as contact-heat evoked potentials (CHEPs) were assessed. RESULTS We detected an overall inhibitory CPM effect for CHEPs amplitudes but not for pain ratings. However, we found no evidence for a modulation of CPM by threat despite threat ratings indicating that our manipulation was successful. DISCUSSION These results suggest that heat/thermal CPM is resistant to this specific type of symbolic threat induction and further research is necessary to examine whether it is resistant to fearful states in general. SIGNIFICANCE The attempt of modulating heat conditioned pain modulation (CPM) by emotional threat (fear/anxiety state) failed. Thus, heat CPM inhibition again appeared resistant to emotional influences. Pain-related brain potentials proved to be more sensitive for CPM effects than subjective ratings.
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Affiliation(s)
| | - Lena Jablonowski
- Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Melanie Madden
- Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Miriam Kunz
- Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Stefan Lautenbacher
- Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
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Noseda R, Villanueva L. Central generators of migraine and autonomic cephalalgias as targets for personalized pain management: Translational links. Eur J Pain 2023; 27:1126-1138. [PMID: 37421221 PMCID: PMC10979820 DOI: 10.1002/ejp.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Migraine oscillates between different states in association with internal homeostatic functions and biological rhythms that become more easily dysregulated in genetically susceptible individuals. Clinical and pre-clinical data on migraine pathophysiology support a primary role of the central nervous system (CNS) through 'dysexcitability' of certain brain networks, and a critical contribution of the peripheral sensory and autonomic signalling from the intracranial meningeal innervation. This review focuses on the most relevant back and forward translational studies devoted to the assessment of CNS dysfunctions involved in primary headaches and discusses the role they play in rendering the brain susceptible to headache states. METHODS AND RESULTS We collected a body of scientific literature from human and animal investigations that provide a compelling perspective on the anatomical and functional underpinnings of the CNS in migraine and trigeminal autonomic cephalalgias. We focus on medullary, hypothalamic and corticofugal modulation mechanisms that represent strategic neural substrates for elucidating the links between trigeminovascular maladaptive states, migraine triggering and the temporal phenotype of the disease. CONCLUSION It is argued that a better understanding of homeostatic dysfunctional states appears fundamental and may benefit the development of personalized therapeutic approaches for improving clinical outcomes in primary headache disorders. SIGNIFICANCE This review focuses on the most relevant back and forward translational studies showing the crucial role of top-down brain modulation in triggering and maintaining primary headache states and how these central dysfunctions may interact with personalized pain management strategies.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis Villanueva
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris-Cité, Team Imaging Biomarkers of Brain Disorders (IMA-Brain), INSERM U1266, Paris, France
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7
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Argaman Y, Granovsky Y, Sprecher E, Sinai A, Yarnitsky D, Weissman-Fogel I. Resting-state functional connectivity predicts motor cortex stimulation-dependent pain relief in fibromyalgia syndrome patients. Sci Rep 2022; 12:17135. [PMID: 36224244 PMCID: PMC9556524 DOI: 10.1038/s41598-022-21557-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
MRI-based resting-state functional connectivity (rsFC) has been shown to predict response to pharmacological and non-pharmacological treatments for chronic pain, but not yet for motor cortex transcranial magnetic stimulation (M1-rTMS). Twenty-seven fibromyalgia syndrome (FMS) patients participated in this double-blind, crossover, and sham-controlled study. Ten daily treatments of 10 Hz M1-rTMS were given over 2 weeks. Before treatment series, patients underwent resting-state fMRI and clinical pain evaluation. Significant pain reduction occurred following active, but not sham, M1-rTMS. The following rsFC patterns predicted reductions in clinical pain intensity after the active treatment: weaker rsFC of the default-mode network with the middle frontal gyrus (r = 0.76, p < 0.001), the executive control network with the rostro-medial prefrontal cortex (r = 0.80, p < 0.001), the thalamus with the middle frontal gyrus (r = 0.82, p < 0.001), and the pregenual anterior cingulate cortex with the inferior parietal lobule (r = 0.79, p < 0.001); and stronger rsFC of the anterior insula with the angular gyrus (r = - 0.81, p < 0.001). The above regions process the attentional and emotional aspects of pain intensity; serve as components of the resting-state networks; are modulated by rTMS; and are altered in FMS. Therefore, we suggest that in FMS, the weaker pre-existing interplay between pain-related brain regions and networks, the larger the pain relief resulting from M1-rTMS.
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Affiliation(s)
- Yuval Argaman
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Yelena Granovsky
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel ,grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Alon Sinai
- grid.413731.30000 0000 9950 8111Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - David Yarnitsky
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel ,grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weissman-Fogel
- grid.18098.380000 0004 1937 0562Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Deng EZ, Weikel DP, Martucci KT. Evaluation by Survival Analysis of Cold Pain Tolerance in Patients with Fibromyalgia and Opioid Use. J Pain Res 2022; 15:2783-2799. [PMID: 36111289 PMCID: PMC9470281 DOI: 10.2147/jpr.s368805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The cold pressor test (CPT) is a clinical pain research method used to measure cold pain tolerance. During this test, participants immerse an extremity (ie, hand or foot) into cold water for as long as tolerable. The duration of the test (traditionally up to an experimentally imposed cut-off at 2 minutes) indicates the amount of cold pain tolerance by the participant. Prior research studies have investigated cold pain tolerance in patients with chronic pain. However, few of these studies have used survival analysis, which allows for proper handling of data censoring and is therefore, an optimal statistical method for CPT data analysis. The goal of the present study was to use survival analysis to evaluate cold pain tolerance in patients with fibromyalgia. Furthermore, we aimed to model relationships between psychological and clinical variables as well as opioid medication use and cold pain tolerance. Patients and Methods A total of 85 patients with fibromyalgia (42 who were taking opioids) and 47 healthy pain-free controls provided CPT and questionnaire data (collected across 2 study sites) for a case-control study. We used survival analysis using Cox regression to evaluate group differences (patients vs controls) in cold pain tolerance and to evaluate cold pain tolerance relationships with psychological, clinical, and medication use. Results As compared to healthy controls, patients with fibromyalgia exhibited significantly lower CPT survival (HR = 2.17, 95% CI: [1.42, 3.31], p = 0.00035). As indicated by Cox regression models, the significant group difference in CPT survival did not relate to our selected psychological and clinical measures (p > 0.05). The groups of non-opioid-taking patients and healthy controls showed consistent CPT survival across study sites. However, patients taking opioid pain medications showed differences in CPT survival across study sites. Conclusion By using survival analysis, an optimal method for time-to-event pain measures such as the CPT, we confirmed previously identified reductions in cold pain tolerance in patients with fibromyalgia. While our selected psychological and clinical measures were not significantly associated with cold pain tolerance, our data suggest that opioid medication use may impart greater cold pain tolerance in some patients.
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Affiliation(s)
- Eden Z Deng
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Daniel P Weikel
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Katherine T Martucci
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
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Becker L, Keck A, Rohleder N, Müller-Voggel N. Higher Peripheral Inflammation Is Associated With Lower Orbitofrontal Gamma Power in Chronic Tinnitus. Front Behav Neurosci 2022; 16:883926. [PMID: 35493955 PMCID: PMC9039358 DOI: 10.3389/fnbeh.2022.883926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic tinnitus, the continuous perception of a phantom sound, is a highly prevalent audiological symptom, for which the underlying pathology has not yet been fully understood. It is associated with neurophysiological alterations in the central nervous system and chronic stress, which can be related with a disinhibition of the inflammatory system. We here investigated the association between resting-state oscillatory activity assessed with Magnetoencephalography (MEG), and peripheral inflammation assessed by C-reactive protein (CRP) in a group of patients with chronic tinnitus (N = 21, nine males, mean age: 40.6 ± 14.6 years). Additionally, CRP was assessed in an age- and sex-matched healthy control group (N = 21, nine males, mean age: 40.9 ± 15.2 years). No MEG data was available for the control group. We found a significant negative correlation between CRP and gamma power in the orbitofrontal cortex in tinnitus patients (p < 0.001), pointing to a deactivation of the orbitofrontal cortex when CRP was high. No significant clusters were found for other frequency bands. Moreover, CRP levels were significantly higher in the tinnitus group than in the healthy controls (p = 0.045). Our results can be interpreted based on findings from previous studies having disclosed the orbitofrontal cortex as part of the tinnitus distress network. We suggest that higher CRP levels and the associated deactivation of the orbitofrontal cortex in chronic tinnitus patients is maintaining the tinnitus percept through disinhibition of the auditory cortex and attentional or emotional top-down processes. Although the direction of the association (i.e., causation) between CRP levels and orbitofrontal gamma power in chronic tinnitus is not yet known, inflammation reducing interventions are promising candidates when developing treatments for tinnitus patients. Overall, our study highlights the importance of considering immune-brain communication in tinnitus research.
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Affiliation(s)
- Linda Becker
- Department of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Linda Becker
| | - Antonia Keck
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Müller-Voggel
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
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Argaman Y, Granovsky Y, Sprecher E, Sinai A, Yarnitsky D, Weissman-Fogel I. Clinical Effects of Repetitive Transcranial Magnetic Stimulation of the Motor Cortex Are Associated With Changes in Resting-State Functional Connectivity in Patients With Fibromyalgia Syndrome. THE JOURNAL OF PAIN 2022; 23:595-615. [PMID: 34785365 DOI: 10.1016/j.jpain.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
In this double-blinded, sham-controlled, counterbalanced, and crossover study, we investigated the potential neuroplasticity underlying pain relief and daily function improvements following repetitive transcranial magnetic stimulation of the motor cortex (M1-rTMS) in fibromyalgia syndrome (FMS) patients. Specifically, we used magnetic resonance imaging (MRI) to examine changes in brain structural and resting-state functional connectivity (rsFC) that correlated with improvements in FMS symptomology following M1-rTMS. Twenty-seven women with FMS underwent real and sham treatment series, each consisting of 10 daily treatments of 10Hz M1-rTMS over 2 weeks, with a washout period in between. Before and after each series, participants underwent anatomical and resting-state functional MRI scans and questionnaire assessments of FMS-related clinical pain and functional and psychological burdens. The expected reductions in FMS-related symptomology following M1-rTMS occurred with the real treatment only and correlated with rsFC changes in brain areas associated with pain processing and modulation. Specifically, between the ventromedial prefrontal cortex and the M1 (t = -5.54, corrected P = .002), the amygdala and the posterior insula (t = 5.81, corrected P = .044), and the anterior and posterior insula (t = 6.01, corrected P = .029). Neither treatment significantly changed brain structure. Therefore, we provide the first evidence of an association between the acute clinical effects of M1-rTMS in FMS and functional alterations of brain areas that have a significant role in the experience of chronic pain. Structural changes could potentially occur over a more extended treatment period. PERSPECTIVE: We show that the neurophysiological mechanism of the improvement in fibromyalgia symptoms following active, but not sham, rTMS applied to M1 involves changes in resting-state functional connectivity in sensory, affective and cognitive pain processing brain areas, thus substantiating the essence of fibromyalgia syndrome as a treatable brain-based disorder.
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Affiliation(s)
- Yuval Argaman
- Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yelena Granovsky
- Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - David Yarnitsky
- Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weissman-Fogel
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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11
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Makovac E, Venezia A, Hohenschurz-Schmidt D, Dipasquale O, Jackson JB, Medina S, O'Daly O, Williams SCR, McMahon SB, Howard MA. The association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey. J Physiol 2021; 599:5243-5260. [PMID: 34647321 DOI: 10.1113/jp282013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored. Here, we sought to determine brain regions mediating ANS and descending pain control associations. Thirty participants underwent conditioned pain modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between 'pressure-only' and 'pressure + cold' stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain were acquired. Heart rate variability (HRV) was simultaneously recorded. Normalised low-frequency HRV (LF-HRVnu) and the CPM score were negatively correlated; individuals with higher LF-HRVnu during pain reported reductions in pain during CPM. PAG-ventro-medial prefrontal cortex (vmPFC) and PAG-rostral ventromedial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-vmPFC functional connectivity mediated the strength of the LF-HRVnu-CPM association. CPM response magnitude was also negatively correlated with vmPFC GM volume. Our multi-modal approach, using behavioural, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments. KEY POINTS: Heart rate variability (HRV) is associated with descending pain modulation as measured by the conditioned pain modulation protocol (CPM). There is an association between CPM scores and the functional connectivity between the periaqueductal grey (PAG) and ventro-medial prefrontal cortex (vmPFC). CPM scores are also associated with vmPFC grey matter volume. The strength of functional connectivity between the PAG and vmPFC mediates the association between HRV and CPM. Our data provide new evidence of interactions between the autonomic nervous system and descending pain mechanisms.
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Affiliation(s)
- Elena Makovac
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | | - David Hohenschurz-Schmidt
- Department of Neuroimaging, King's College London, London, UK.,Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | | | - Jade B Jackson
- Department of Neuroimaging, King's College London, London, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sonia Medina
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, UK
| | | | - Stephen B McMahon
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
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12
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Teixeira PEP, Pacheco-Barrios K, Uygur-Kucukseymen E, Machado RM, Balbuena-Pareja A, Giannoni-Luza S, Luna-Cuadros MA, Cardenas-Rojas A, Gonzalez-Mego P, Mejia-Pando PF, Wagner T, Dipietro L, Fregni F. Electroencephalography Signatures for Conditioned Pain Modulation and Pain Perception in Non-Specific Chronic Low Back Pain-an Exploratory Study. PAIN MEDICINE 2021; 23:558-570. [PMID: 34633449 DOI: 10.1093/pm/pnab293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/24/2022]
Abstract
Conditioned pain modulation (CPM) can discriminate between healthy and chronic pain patients. However, its relationship with neurophysiological pain mechanisms is poorly understood. Brain oscillations measured by electroencephalography (EEG) might help gain insight into this complex relationship. OBJECTIVE To investigate the relationship between CPM response and self-reported pain intensity in non-specific chronic low back pain (NSCLBP) and explore respective EEG signatures associated to these mechanisms. DESIGN Cross-sectional analysis. Participants: Thirty NSCLBP patients participated. METHODS Self-reported low back pain, questionnaires, mood scales, CPM (static and dynamic quantitative sensory tests), and resting surface EEG data were collected and analyzed. Linear regression models were used for statistical analysis. RESULTS CPM was not significantly correlated with self-reported pain intensity scores. Relative power of EEG in the beta and high beta bands as recorded from the frontal, central, and parietal cortical areas were significantly associated with CPM. EEG relative power at delta and theta bands as recorded from the central area were significantly correlated with self-reported pain intensity scores while controlling for self-reported depression. CONCLUSIONS Faster EEG frequencies recorded from pain perception areas may provide a signature of a potential cortical compensation caused by chronic pain states. Slower EEG frequencies may have a critical role in abnormal pain processing.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Instituto Wilson Mello, Campinas, SP, Brazil
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, . Lima, Peru
| | - Elif Uygur-Kucukseymen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Roberto Mathias Machado
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ana Balbuena-Pareja
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maria Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Piero F Mejia-Pando
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Timothy Wagner
- Division of Health Sciences and Technology, Harvard Medical School/Massachusetts Institute of Technology, Boston, MA.,Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Laura Dipietro
- Division of Health Sciences and Technology, Harvard Medical School/Massachusetts Institute of Technology, Boston, MA
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Highland Instruments, Inc., Cambridge, MA, USA
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13
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Chen XF, Guo Y, Lu XQ, Qi L, Xu KH, Chen Y, Li GX, Ding JP, Li J. Aberrant Intraregional Brain Activity and Functional Connectivity in Patients With Diarrhea-Predominant Irritable Bowel Syndrome. Front Neurosci 2021; 15:721822. [PMID: 34539337 PMCID: PMC8446353 DOI: 10.3389/fnins.2021.721822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose The appearance and aggravation of diarrhea-predominant irritable bowel syndrome (IBS-D) have proven to be closely related to psychosocial factors. We aimed to measure altered spontaneous brain activity and functional connectivity (FC) in patients with IBS-D using resting-state functional magnetic resonance imaging (RS-fMRI) and to analyze the relationship between these parameters and emotional symptoms. Methods Thirty-six adult IBS-D patients and thirty-six demographic-matched healthy controls (HCs) underwent RS-fMRI scans. After processing RS-fMRI data, the values of the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) of the two groups were compared. The abnormal regions were selected as the regions of interest to compare whole-brain seed-based FC between the groups. The relationships between RS-fMRI data and mood and gastrointestinal symptoms were analyzed using correlation and mediation analyses. Results Compared with HCs, IBS-D patients showed increased ALFF in the right cerebellum posterior lobe, the right lingual gyrus/calcarine, the right postcentral gyrus, the right superior frontal gyrus (SFG), and middle frontal gyrus (MFG), with decreased ALFF in the right inferior parietal lobule, the right striatum, the right anterior cingulated cortex, the right insula, the right hippocampus, the right thalamus, the right midbrain, and the left precuneus. IBS-D patients showed increased ReHo in the bilateral lingual gyrus/calcarine, the bilateral SFG, the right MFG, and the right postcentral gyrus, with decreased ReHo in the orbital part of the left inferior frontal gyrus and the right supplementary motor area. Patients showed enhanced FC between the left precuneus and the bilateral orbitofrontal cortex (OFC). There was a positive correlation between increased ALFF values in the right midbrain and anxiety-depression symptoms in IBS-D patients, and the mediating effect of gastrointestinal symptoms indirectly caused this correlation. Conclusion IBS-D patients had dysregulated spontaneous activity and FC in regions related to pain regulation and emotional arousal involved in prefrontal–limbic–midbrain circuit and somatosensory processing. The development of mood disorders in IBS-D patients may be partly related to the dysfunction of components in the dopamine pathway (especially the midbrain, OFC) due to visceral pain.
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Affiliation(s)
- Xiao-Fei Chen
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yun Guo
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xing-Qi Lu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Le Qi
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Medical College, Hangzhou Normal University, Hangzhou, China
| | - Kuang-Hui Xu
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Yong Chen
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Guo-Xiong Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jian-Ping Ding
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Medical College, Hangzhou Normal University, Hangzhou, China
| | - Jie Li
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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14
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Medina S, Bakar NA, O'Daly O, Miller S, Makovac E, Renton T, Williams SCR, Matharu M, Howard MA. Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache. J Headache Pain 2021; 22:91. [PMID: 34384347 PMCID: PMC8359299 DOI: 10.1186/s10194-021-01304-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023] Open
Abstract
Background Cluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls. Methods 21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient. Results Following treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus. Conclusions We provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.
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Affiliation(s)
- Sonia Medina
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK. .,Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | | | - Owen O'Daly
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Miller
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Elena Makovac
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Tara Renton
- Department of Oral Surgery, King's College London, London, UK
| | - Steve C R Williams
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Matthew A Howard
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
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15
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Tan LL, Kuner R. Neocortical circuits in pain and pain relief. Nat Rev Neurosci 2021; 22:458-471. [PMID: 34127843 DOI: 10.1038/s41583-021-00468-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
The sensory, associative and limbic neocortical structures play a critical role in shaping incoming noxious inputs to generate variable pain perceptions. Technological advances in tracing circuitry and interrogation of pathways and complex behaviours are now yielding critical knowledge of neocortical circuits, cellular contributions and causal relationships between pain perception and its abnormalities in chronic pain. Emerging insights into neocortical pain processing suggest the existence of neocortical causality and specificity for pain at the level of subdomains, circuits and cellular entities and the activity patterns they encode. These mechanisms provide opportunities for therapeutic intervention for improved pain management.
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Affiliation(s)
- Linette Liqi Tan
- Institute of Pharmacology, Heidelberg University, Heidelberg, Germany.
| | - Rohini Kuner
- Institute of Pharmacology, Heidelberg University, Heidelberg, Germany.
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16
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Bannister K, Kucharczyk MW, Graven-Nielsen T, Porreca F. Introducing descending control of nociception: a measure of diffuse noxious inhibitory controls in conscious animals. Pain 2021; 162:1957-1959. [PMID: 33470750 PMCID: PMC8205930 DOI: 10.1097/j.pain.0000000000002203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/10/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE1 1UL. UK
| | - Mateusz W. Kucharczyk
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE1 1UL. UK
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Frank Porreca
- Department of Pharmacology, University of Arizona, Tucson, Arizona, AZ 85721. USA
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17
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Bunk S, Zuidema S, Koch K, Lautenbacher S, De Deyn PP, Kunz M. Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration. Neurobiol Aging 2021; 106:139-152. [PMID: 34274699 DOI: 10.1016/j.neurobiolaging.2021.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
Experimental pain research has shown that pain processing seems to be heightened in dementia. It is unclear which neuropathological changes underlie these alterations. This study examined whether differences in pressure pain sensitivity and endogenous pain inhibition (conditioned pain modulation (CPM)) between individuals with a dementia-related cognitive impairment (N=23) and healthy controls (N=35) are linked to dementia-related neurodegeneration. Pain was assessed via self-report ratings and by analyzing the facial expression of pain using the Facial Action Coding System. We found that cognitively impaired individuals show decreased CPM inhibition as assessed by facial responses compared to healthy controls, which was mediated by decreased gray matter volume in the medial orbitofrontal and anterior cingulate cortex in the patient group. This study confirms previous findings of intensified pain processing in dementia when pain is assessed using non-verbal responses. Our findings suggest that a loss of pain inhibitory functioning caused by structural changes in prefrontal areas might be one of the underlying mechanisms responsible for amplified pain responses in individuals with a dementia-related cognitive impairment.
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Affiliation(s)
- Steffie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | | | - Peter P De Deyn
- Alzheimer Center Groningen, Department Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
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18
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The dynamics of pain reappraisal: the joint contribution of cognitive change and mental load. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 20:276-293. [PMID: 31950439 PMCID: PMC7105446 DOI: 10.3758/s13415-020-00768-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study was designed to investigate the neural mechanism of cognitive modulation of pain via a reappraisal strategy with high temporal resolution. The EEG signal was recorded from 29 participants who were instructed to down-regulate, up-regulate, or maintain their pain experience. The L2 minimum norm source reconstruction method was used to localize areas in which a significant effect of the instruction was present. Down-regulating pain by reappraisal exerted a robust effect on pain processing from as early as ~100 ms that diminished the activity of limbic brain regions: the anterior cingulate cortex, right orbitofrontal cortex, left anterior temporal region, and left insula. However, compared with the no-regulation condition, the neural activity was similarly attenuated in the up- and down-regulation conditions. We suggest that this effect could be ascribed to the cognitive load that was associated with the execution of a cognitively demanding reappraisal task that could have produced a general attenuation of pain-related areas regardless of the aim of the reappraisal task (i.e., up- or down-regulation attempts). These findings indicate that reappraisal effects reflect the joint influence of both reappraisal-specific (cognitive change) and unspecific (cognitive demand) factors, thus pointing to the importance of cautiously selected control conditions that allow the modulating impact of both processes to be distinguished.
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19
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García-Barajas G, Serrano-Muñoz D, Gómez-Soriano Pt J, Avendaño-Coy J, Fernández-Carnero J, García AM, Segura-Fragosa A, Taylor J. Efficacy of anodal suboccipital direct current stimulation for endogenous pain modulation and tonic thermal pain control in healthy participants: a randomised controlled clinical trial. PAIN MEDICINE 2021; 22:2908-2917. [PMID: 33822227 DOI: 10.1093/pm/pnab125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether anodal DCS applied to the suboccipital (SO) target area could potentiate antinociception assessed primarily with conditioned pain modulation of tonic thermal test stimuli. DESIGN Randomised double-blinded control trial. SETTING Rehabilitation hospital. SUBJECTS Healthy participants. METHODS Forty healthy participants were randomized to receive either SO-DCS or M1-DCS. The 20-minute 1.5mA anodal or sham DCS intervention were applied to each participant in randomised order during two test sessions. The primary outcome measure included heterotopic cold-pressor conditioned pain modulation (CPM) of tonic heat pain. Secondary measures included pressure pain threshold and tonic thermal pain intensity. RESULTS Heterotopic CPM of tonic heat pain intensity was unaffected by either SO-DCS or active M1, including the secondary measures of pressure pain threshold and tonic thermal pain intensity. Although low-power non-significant interactions were identified for DCS intervention (active versus sham) and time (before and after), a significant within-group inhibition of tonic cold pain was identified following SO-DCS (p = 0.011, mean [SD]: -0.76±0.88 points) and M1-DCS (p < 0.002: -0.84±0.82 points), without a significant change following sham DCS. CONCLUSIONS Although heterotopic CPM was not facilitated with either SO-DCS or M1-DCS, a general significant inhibition of tonic cold pain intensity was demonstrated following both interventions. The general effects of active DCS compared to sham on tonic cold pain-irrespective of the M1 or SO target-need to be confirmed using standard quantitative sensory testing.
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Affiliation(s)
- Guillermo García-Barajas
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Diego Serrano-Muñoz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Julio Gómez-Soriano Pt
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Josue Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain.,La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, Universidad Rey Juan Carlos-Banco de Santander, Madrid, Spain
| | - Alvaro Megía García
- Biomechanical and Technical Aids Unit, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Harris Manchester College, University of Oxford, Oxford, United Kingdom
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20
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Völker JM, Arguissain FG, Andersen OK, Biurrun Manresa J. Variability and effect sizes of intracranial current source density estimations during pain: Systematic review, experimental findings, and future perspectives. Hum Brain Mapp 2021; 42:2461-2476. [PMID: 33605512 PMCID: PMC8090781 DOI: 10.1002/hbm.25380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Pain arises from the integration of sensory and cognitive processes in the brain, resulting in specific patterns of neural oscillations that can be characterized by measuring electrical brain activity. Current source density (CSD) estimation from low-resolution brain electromagnetic tomography (LORETA) and its standardized (sLORETA) and exact (eLORETA) variants, is a common approach to identify the spatiotemporal dynamics of the brain sources in physiological and pathological pain-related conditions. However, there is no consensus on the magnitude and variability of clinically or experimentally relevant effects for CSD estimations. Here, we systematically examined reports of sample size calculations and effect size estimations in all studies that included the keywords pain, and LORETA, sLORETA, or eLORETA in Scopus and PubMed. We also assessed the reliability of LORETA CSD estimations during non-painful and painful conditions to estimate hypothetical sample sizes for future experiments using CSD estimations. We found that none of the studies included in the systematic review reported sample size calculations, and less than 20% reported measures of central tendency and dispersion, which are necessary to estimate effect sizes. Based on these data and our experimental results, we determined that sample sizes commonly used in pain studies using CSD estimations are suitable to detect medium and large effect sizes in crossover designs and only large effects in parallel designs. These results provide a comprehensive summary of the effect sizes observed using LORETA in pain research, and this information can be used by clinicians and researchers to improve settings and designs of future pain studies.
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Affiliation(s)
- Juan Manuel Völker
- Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Federico Gabriel Arguissain
- Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ole Kaeseler Andersen
- Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - José Biurrun Manresa
- Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Institute for Research and Development in Bioengineering and Bioinformatics (IBB), National Scientific and Technical Research Council (CONICET) and National University of Entre Ríos (UNER), Oro Verde, Argentina
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21
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Selective modulation of tonic aversive qualities of neuropathic pain by morphine in the central nucleus of the amygdala requires endogenous opioid signaling in the anterior cingulate cortex. Pain 2021; 161:609-618. [PMID: 31725062 DOI: 10.1097/j.pain.0000000000001748] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The amygdala is a key subcortical region believed to contribute to emotional components of pain. As opioid receptors are found in both the central (CeA) and basolateral (BLA) nuclei of the amygdala, we investigated the effects of morphine microinjection on evoked pain responses, pain-motivated behaviors, dopamine release in the nucleus accumbens (NAc), and descending modulation in rats with left-side spinal nerve ligation (SNL). Morphine administered into the right or left CeA had no effect on nerve injury-induced tactile allodynia or mechanical hyperalgesia. Right, but not left, CeA morphine produced conditioned place preference (CPP) and increased extracellular dopamine in the NAc selectively in SNL rats, suggesting relief of aversive qualities of ongoing pain. In SNL rats, CPP and NAc dopamine release following right CeA morphine was abolished by blocking mu opioid receptor signaling in the rostral anterior cingulate cortex (rACC). Right CeA morphine also significantly restored SNL-induced loss of the diffuse noxious inhibitory controls, a spino-bulbo-spinal pain modulatory mechanism, termed conditioned pain modulation in humans. Microinjection of morphine into the BLA had no effects on evoked behaviors and did not produce CPP in nerve-injured rats. These findings demonstrate that the amygdalar action of morphine is specific to the right CeA contralateral to the side of injury and results in enhancement of net descending inhibition. In addition, engagement of mu opioid receptors in the right CeA modulates affective qualities of ongoing pain through endogenous opioid neurotransmission within the rACC, revealing opioid-dependent functional connections from the CeA to the rACC.
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Lötsch J, Oertel BG, Felden L, Nöth U, Deichmann R, Hummel T, Walter C. Central encoding of the strength of intranasal chemosensory trigeminal stimuli in a human experimental pain setting. Hum Brain Mapp 2020; 41:5240-5254. [PMID: 32870583 PMCID: PMC7670645 DOI: 10.1002/hbm.25190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
An important measure in pain research is the intensity of nociceptive stimuli and their cortical representation. However, there is evidence of different cerebral representations of nociceptive stimuli, including the fact that cortical areas recruited during processing of intranasal nociceptive chemical stimuli included those outside the traditional trigeminal areas. Therefore, the aim of this study was to investigate the major cerebral representations of stimulus intensity associated with intranasal chemical trigeminal stimulation. Trigeminal stimulation was achieved with carbon dioxide presented to the nasal mucosa. Using a single-blinded, randomized crossover design, 24 subjects received nociceptive stimuli with two different stimulation paradigms, depending on the just noticeable differences in the stimulus strengths applied. Stimulus-related brain activations were recorded using functional magnetic resonance imaging with event-related design. Brain activations increased significantly with increasing stimulus intensity, with the largest cluster at the right Rolandic operculum and a global maximum in a smaller cluster at the left lower frontal orbital lobe. Region of interest analyses additionally supported an activation pattern correlated with the stimulus intensity at the piriform cortex as an area of special interest with the trigeminal input. The results support the piriform cortex, in addition to the secondary somatosensory cortex, as a major area of interest for stimulus strength-related brain activation in pain models using trigeminal stimuli. This makes both areas a primary objective to be observed in human experimental pain settings where trigeminal input is used to study effects of analgesics.
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Affiliation(s)
- Jörn Lötsch
- Institute of Clinical PharmacologyGoethe – UniversityFrankfurt am MainGermany
- Fraunhofer Institute for Molecular Biology and Applied Ecology IMEBranch for Translational Medicine and Pharmacology TMPFrankfurt am MainGermany
| | - Bruno G. Oertel
- Institute of Clinical PharmacologyGoethe – UniversityFrankfurt am MainGermany
| | - Lisa Felden
- Institute of Clinical PharmacologyGoethe – UniversityFrankfurt am MainGermany
| | - Ulrike Nöth
- Brain Imaging CenterGoethe – UniversityFrankfurt am MainGermany
| | - Ralf Deichmann
- Brain Imaging CenterGoethe – UniversityFrankfurt am MainGermany
| | - Thomas Hummel
- Smell & Taste Clinic, Department of OtorhinolaryngologyTU DresdenDresdenGermany
| | - Carmen Walter
- Institute of Clinical PharmacologyGoethe – UniversityFrankfurt am MainGermany
- Fraunhofer Institute for Molecular Biology and Applied Ecology IMEBranch for Translational Medicine and Pharmacology TMPFrankfurt am MainGermany
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Do ATL, Enax-Krumova EK, Özgül Ö, Eitner LB, Heba S, Tegenthoff M, Maier C, Höffken O. Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation. BMC Neurosci 2020; 21:53. [PMID: 33287715 PMCID: PMC7720448 DOI: 10.1186/s12868-020-00604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0–100) on one hand. In a crossover design healthy subjects (included: n = 38, analyzed: n = 23) immersed the contralateral hand into 10 °C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6 ± 12.0 μV to 20.2 ± 9.5 μV, cognitive distraction: 30.3 ± 14.2 µV to 13.6 ± 5.2 μV, p < 0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58 ± 4 to 41.1 ± 12.3, cognitive distraction: 58.3 ± 4.4 to 38.0 ± 13.0, p < 0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p = 0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.
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Affiliation(s)
- A T L Do
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - E K Enax-Krumova
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Ö Özgül
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - L B Eitner
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Neuropaediatrics, University Children's Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - S Heba
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | | | - C Maier
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - O Höffken
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Squintani G, Rasera A, Segatti A, Concon E, Bonetti B, Valeriani M, Tinazzi M. Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser-evoked potentials. Eur J Pain 2020; 25:550-557. [PMID: 33170987 DOI: 10.1002/ejp.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 'pain-inhibits-pain' effect stems from neurophysiological mechanisms involving endogenous modulatory systems termed diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). Laser-evoked potentials (LEPs) components, the N2/P2 complex, and the N1 wave, reflect the medial and lateral pain pathway, respectively: anatomically, the lateral thalamic nuclei (LT) project mainly to the somatosensory cortex (N1 generator), while the medial thalamic nuclei (MT) are bound to the limbic cortices (N2/P2 generators). METHODS We applied a CPM protocol in which the test stimulus was laser stimulation and the conditioning stimulus was a cold pressor test. LEPs recordings were obtained from 15 healthy subjects in three different conditions: baseline, during heterotopic noxious conditioning stimulation (HNCS) and post-HNCS. RESULTS We observed a significant reduction in N2/P2 amplitude during HNCS and a return to pre-test amplitude post-HNCS, whereas the N1 wave remained unchanged during and post-HNCS. CONCLUSIONS Our results indicate that CPM affects only the medial pain system. The spinothalamic tract (STT) transmits to both the LT and the MT, while the spinoreticulothalamic (SRT) projects only to the MT. The reduction in the amplitude of the N2/P2 complex and the absence of change in the N1 wave suggest that DNIC inhibition on the dorsal horn neurons affects only pain transmission via the SRT, while the neurons that give rise to the STT are not involved. The N1 wave can be a reliable neurophysiological parameter for assessment of STT function in clinical practice, as it does not seem to be influenced by CPM. SIGNIFICANCE No reports have described the effect of DNIC on lateral and medial pain pathways. We studied the N1 wave and the N2/P2 complex to detect changes during a CPM protocol. We found a reduction in the amplitude of the N2/P2 complex and no change in the N1 wave. This suggests that the DNIC inhibitory effect on dorsal horns neurons affects only pain transmission via the SRT, whereas the neurons that give rise to the STT are not involved.
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Affiliation(s)
- Giovanna Squintani
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Rasera
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - Alessia Segatti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Concon
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Bruno Bonetti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michele Tinazzi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
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25
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Rustamov N, Wagenaar-Tison A, Doyer E, Piché M. Electrophysiological investigation of the contribution of attention to altered pain inhibition processes in patients with irritable bowel syndrome. J Physiol Sci 2020; 70:46. [PMID: 33023474 PMCID: PMC10717774 DOI: 10.1186/s12576-020-00774-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with chronic abdominal pain and altered pain processing. The aim of this study was to examine whether attentional processes contribute to altered pain inhibition processes in patients with IBS. Nine female patients with IBS and nine age-/sex-matched controls were included in a pain inhibition paradigm using counter-stimulation and distraction with electroencephalography. Patients with IBS showed no inhibition of pain-related brain activity by heterotopic noxious counter-stimulation (HNCS) or selective attention. In the control group, HNCS and selective attention decreased the N100, P260 and high-gamma oscillation power. In addition, pain-related high-gamma power in sensorimotor, anterior cingulate and left dorsolateral prefrontal cortex was decreased by HNCS and selective attention in the control group, but not in patients with IBS. These results indicate that the central pain inhibition deficit in IBS reflects interactions between several brain processes related to pain and attention.
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Affiliation(s)
- Nabi Rustamov
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Alice Wagenaar-Tison
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Elysa Doyer
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
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Bunk S, Emch M, Koch K, Lautenbacher S, Zuidema S, Kunz M. Pain Processing in Older Adults and Its Association with Prefrontal Characteristics. Brain Sci 2020; 10:brainsci10080477. [PMID: 32722197 PMCID: PMC7465457 DOI: 10.3390/brainsci10080477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open
Abstract
Aging is known to affect nociceptive processing, e.g., the ability to inhibit pain. This study aims to investigate whether pain responses in older individuals are associated with prefrontal characteristics, namely (i) executive functioning performance and (ii) structural brain variations in the prefrontal cortex. Heat and pressure stimuli were applied to assess pressure pain sensitivity and endogenous pain inhibition in 46 healthy older individuals. Executive functioning performance was assessed in three domains (i.e., cognitive inhibition, shifting, and updating) and structural brain variations were assessed in both gray and white matter. Overall pain responses were significantly associated with the executive functioning domains cognitive inhibition and shifting. However, no specific type of pain response showed an especially strong association. Endogenous pain inhibition specifically showed a significant association with gray matter volume in the prefrontal cortex and with variations in white matter structure of tracts connecting the prefrontal cortex with the periaqueductal gray. Hierarchical regression analyses showed that these variations in the prefrontal cortex can explain variance in pain inhibition beyond what can be explained by executive functioning. This might indicate that known deficits in pain inhibition in older individuals are associated with structural variations in prefrontal areas.
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Affiliation(s)
- Steffie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
- Correspondence: ; Tel.: +31-503616686
| | - Mónica Emch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; (M.E.); (K.K.)
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | - Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; (M.E.); (K.K.)
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | | | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
- Department of Medical Psychology and Sociology, University of Augsburg, 86159 Augsburg, Germany
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27
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Gentile E, Ricci K, Vecchio E, Libro G, Delussi M, Casas-Barragàn A, de Tommaso M. A Simple Pattern of Movement is not Able to Inhibit Experimental Pain in FM Patients and Controls: an sLORETA Study. Brain Sci 2020; 10:E190. [PMID: 32214053 PMCID: PMC7139913 DOI: 10.3390/brainsci10030190] [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: 02/14/2020] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Motor cortex activation seems to induce an analgesic effect on pain that would be different between patients with fibromyalgia (FM) and control subjects. This study was conducted to analyze the changes of the laser-evoked potentials (LEPs) induced during a finger tapping task in the FM patients and the controls employing a multi-dipolar analysis according to Standardized low resolution brain electromagnetic tomography (sLORETA) method. The LEPs from 38 FM patients and 21 controls were analyzed. The LEPs were recorded while subjects performed a slow and a fast finger tapping task. We confirmed that the difference between N1, N2 and P2 wave amplitudes between conditions and groups was not significant. In control subjects, the fast finger tapping task induced a modification of cortical source activation in the main areas processing laser stimulation from the moving hand independently from the movement speed. In summary, a simple and repetitive movement is not able to induce consistent inhibition of experimental pain evoked by the moving and the not moving hand in each group. It could interfere with LEP sources within the limbic area at least in control subjects, without inhibit cortical responses or explain the different pattern of motor and pain interaction in FM patients.
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Affiliation(s)
- Eleonora Gentile
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
| | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
| | | | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, 70121 Bari, Italy; (K.R.); (E.V.); (G.L.); (M.D.); (M.d.T.)
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Bunk S, Preis L, Zuidema S, Lautenbacher S, Kunz M. Executive Functions and Pain. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2019. [DOI: 10.1024/1016-264x/a000264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. A growing body of literature suggests that chronic-pain patients suffer from problems in various neuropsychological domains, including executive functioning. In order to better understand which components of executive functioning (inhibition, shifting and/or updating) might be especially affected by pain and which mechanisms might underlie this association, we conducted a systematic review, including both chronic-pain studies as well as experimental-pain studies. The chronic-pain studies (N = 57) show that pain is associated with poorer executive functioning. The findings of experimental-pain studies (N = 28) suggest that this might be a bidirectional relationship: Pain can disrupt executive functioning, but poorer executive functioning might also be a risk factor for higher vulnerability to pain.
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Affiliation(s)
- Stefanie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | - Lukas Preis
- Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | | | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
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30
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Grashorn W, Fründt O, Buhmann C, Wrobel N, Schmidt K, Bingel U. Conditioned pain modulation in drug-naïve patients with de novo Parkinson's disease. Neurol Res Pract 2019; 1:27. [PMID: 33324893 PMCID: PMC7650066 DOI: 10.1186/s42466-019-0029-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but underlying pathophysiological mechanisms are largely unclear. In many chronic pain syndromes deficits in endogenous pain inhibition have been detected that can be assessed using conditioned pain modulation paradigms. Previous studies employing this approach in medicated PD patients did not find abnormal pain inhibition. However, these results might have been confounded by residual dopaminergic medication. Methods An established conditioned pain modulation paradigm was used in 17 drug-naïve de novo PD patients and 17 healthy age and gender-matched controls. We tested i) whether conditioned pain modulation responses differed between the patient and control group and ii) whether pain inhibition differed between PD subtypes. Results PD patients and healthy controls did not differ in their conditioned pain modulation responses. Furthermore, there were no significant differences in CPM responses depending on the PD subtype. However, at a descriptive level, tremor-dominant patients showed a tendency for better descending pain inhibition compared to akinetic-rigid and mixed type patients. Conclusions In this first study investigating conditioned pain modulation in de novo PD patients, we found no additional impairment in descending pain modulation besides the known age-related decline. Our findings indicate that mechanisms other than an impaired descending inhibition contribute to high pain prevalence rates in PD and suggest that mechanisms underlying pain may differ between PD subtypes. Electronic supplementary material The online version of this article (10.1186/s42466-019-0029-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wiebke Grashorn
- Department of Neurology, University Medical Center Hamburg - Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Odette Fründt
- Department of Neurology, University Medical Center Hamburg - Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg - Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | | | - Katharina Schmidt
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.,Erwin L. Hahn Institute for magnetic resonance imaging, Essen, Germany
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Hellman N, Sturycz CA, Lannon EW, Kuhn BL, Güereca YM, Toledo TA, Payne MF, Huber FA, Demuth M, Palit S, Shadlow JO, Rhudy JL. Conditioned Pain Modulation in Sexual Assault Survivors. THE JOURNAL OF PAIN 2019; 20:1027-1039. [PMID: 30825639 DOI: 10.1016/j.jpain.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 12/20/2022]
Abstract
Sexual assault (SA) is associated with an increased risk of chronic pain, but the mechanisms for this relationship are poorly understood. To explore whether disrupted descending inhibition is involved, this study used a conditioned pain modulation task to study the inhibition of pain and the nociceptive flexion reflex (NFR; a correlate of spinal nociception) in 32 pain-free SA survivors. This group was compared with 32 pain-free, trauma-exposed persons without SA and a group of 40 pain-free persons who reported no trauma exposure. Conditioned pain modulation was assessed from painful electric stimulations (test stimulus) delivered to the ankle before, during, and after participants submerged their hand in painful 10°C water (conditioning stimulus). Pain ratings and NFR were assessed in response to test stimuli. All groups demonstrated significant inhibition of pain during conditioned pain modulation. However, only the no trauma exposure group demonstrated significant inhibition of NFR. The persons without SA group showed no inhibition of NFR, whereas the SA group showed significant facilitation of the NFR. These findings suggest that trauma exposure may impair inhibitory cerebrospinal circuits, but that SA may specifically promote facilitation of spinal nociception. Perspective: This study suggests that trauma exposure disrupts the cerebrospinal inhibition of spinal nociception, but that exposure to SA further promotes chronic pain risk by facilitating spinal nociception. This finding help may help to elucidate the pain risk mechanisms in trauma survivors.
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Affiliation(s)
| | | | | | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa OK
| | | | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa OK
| | | | | | - Mara Demuth
- Department of Psychology, The University of Tulsa, Tulsa OK
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa OK
| | | | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa OK.
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García-Muntión A, Godefroy L, Robert H, Muñoz-García D, Calvo-Lobo C, López-de-Uralde-Villanueva I. Study of the mechanisms of action of the hypoalgesic effect of pressure under shock waves application: A randomised controlled trial. Complement Ther Med 2018; 42:332-339. [PMID: 30670263 DOI: 10.1016/j.ctim.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine if the perceived pain intensity during the application of shock waves (SWs) is a determinant mechanism in producing hypoalgesic changes in pressure pain thresholds (PPTs) in asymptomatic individuals. DESIGN A randomised, single-blind controlled trial [NCT03455933]. SETTING University. PARTICIPANTS Sixty-three asymptomatic individuals. INTERVENTIONS Participants were randomised into three groups: 1-SWs causing mild pain (SW-DP); 2-SWs generating moderate pain (SW-MP); and 3-cold pressor test (CPT). MAIN OUTCOME MEASUREMENTS Before and after the intervention, the PPT was evaluated bilaterally at the following points: lateral epicondyle, median nerve in the flexure of the elbow, and tibia. RESULTS The results showed differences between various groups over time for all PPTs assessments, due to the existence of statistically significant differences in the interaction group x times (dominant arm lateral epicondyle [P < 0.001; η2p = 0.255]; dominant arm median nerve [P = 0.001; η2p = 0.212]; nondominant arm lateral epicondyle [P < 0.001; η2p = 0.275]; nondominant arm median nerve [P < 0.001; η2p = 0.268]; tibia [P = 0.012, η2p = 0.138]). The SW-MP group obtained a significant increase in all the PPT evaluations compared with the SW-DP group (d > 0.80). The CPT group only showed significantly higher results, and of high magnitude (d > 0.80), regarding the SW-DP group for the PPT evaluation in the dominant member. The SW-MP group showed differences compared with the CPT only for the PPT obtained in the nondominant arm. CONCLUSIONS The findings show that SW treatment generates a hypoalgesic effect on the application point, with moderate pain. Further studies are necessary in order to link these hypoalgesic changes to the activation of the descending inhibitory systems.
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Affiliation(s)
- Alberto García-Muntión
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Loris Godefroy
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hugo Robert
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Muñoz-García
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Av. Astorga, s/n, Ponferrada, 24401, León, Spain.
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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Nees F, Usai K, Löffler M, Flor H. The evaluation and brain representation of pleasant touch in chronic and subacute back pain. NEUROBIOLOGY OF PAIN 2018; 5:100025. [PMID: 31194113 PMCID: PMC6550103 DOI: 10.1016/j.ynpai.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 12/26/2022]
Abstract
Chronic back pain (CBP) showed less positive evaluations of touch. Highest response to pleasant touch in SI and SII and insula in chronic back pain. Highest response to pleasant touch in ventral striatum in subacute back pain (SABP). Correlations of brain responses with pain interference in CBP and distress in SABP. Brain-behavior changes in pleasant touch processing may be a marker of pain chronicity.
If touch is perceived as pleasant, it can counteract the experience of pain. However, its pain-inhibitory function might be disturbed in chronic pain and this could contribute to pain-related interference. We investigated the perception of pleasant touch and its brain correlates in chronic back pain patients (CBP) compared to subacute back pain patients (SABP) and healthy controls (HC) using soft brush strokes. CBP showed less positive evaluations of touch. We found the highest activation in somatosensory and insular cortices in CBP, ventral striatum (VS) in SABP, and the orbitofrontal cortex in HC. Brain responses were significantly positively correlated with pleasantness ratings in HC and SABP, but not CBP. Further, the insula responses in CBP were positively correlated with pain-related interference and the VS activation in SABP correlated negatively with affective distress. Brain and behavioral changes in the processing of touch and its pleasantness may be a marker of pain chronicity and raise questions about the therapeutic value of pleasant touch in pain prevention and treatment.
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Affiliation(s)
- F Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K Usai
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Löffler
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - H Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Damien J, Colloca L, Bellei-Rodriguez CÉ, Marchand S. Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:255-296. [PMID: 30146050 DOI: 10.1016/bs.irn.2018.07.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.
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Affiliation(s)
- Janie Damien
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Psychiatry and Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Carmen-Édith Bellei-Rodriguez
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Serge Marchand
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Fonds de Recherche du Québec-Santé (FRQS), Montréal, QC, Canada.
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Nation KM, DeFelice M, Hernandez PI, Dodick DW, Neugebauer V, Navratilova E, Porreca F. Lateralized kappa opioid receptor signaling from the amygdala central nucleus promotes stress-induced functional pain. Pain 2018; 159:919-928. [PMID: 29369967 PMCID: PMC5916844 DOI: 10.1097/j.pain.0000000000001167] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The response of diffuse noxious inhibitory controls (DNIC) is often decreased, or lost, in stress-related functional pain syndromes. Because the dynorphin/kappa opioid receptor (KOR) pathway is activated by stress, we determined its role in DNIC using a model of stress-induced functional pain. Male, Sprague-Dawley rats were primed for 7 days with systemic morphine resulting in opioid-induced hyperalgesia. Fourteen days after priming, when hyperalgesia was resolved, rats were exposed to environmental stress and DNIC was evaluated by measuring hind paw response threshold to noxious pressure (test stimulus) after capsaicin injection in the forepaw (conditioning stimulus). Morphine priming without stress did not alter DNIC. However, stress produced a loss of DNIC in morphine-primed rats in both hind paws that was abolished by systemic administration of the KOR antagonist, nor-binaltorphimine (nor-BNI). Microinjection of nor-BNI into the right, but not left, central nucleus of the amygdala (CeA) prevented the loss of DNIC in morphine-primed rats. Diffuse noxious inhibitory controls were not modulated by bilateral nor-BNI in the rostral ventromedial medulla. Stress increased dynorphin content in both the left and right CeA of primed rats, reaching significance only in the right CeA; no change was observed in the rostral ventromedial medulla or hypothalamus. Although morphine priming alone is not sufficient to influence DNIC, it establishes a state of latent sensitization that amplifies the consequences of stress. After priming, stress-induced dynorphin/KOR signaling from the right CeA inhibits DNIC in both hind paws, likely reflecting enhanced descending facilitation that masks descending inhibition. Kappa opioid receptor antagonists may provide a new therapeutic strategy for stress-related functional pain disorders.
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Affiliation(s)
| | - Milena DeFelice
- Department of Pharmacology, University of Arizona, Tucson, AZ
| | | | | | - Volker Neugebauer
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Edita Navratilova
- Department of Pharmacology, University of Arizona, Tucson, AZ
- Mayo Clinic, Scottsdale, AZ
| | - Frank Porreca
- GIDP in Neuroscience, University of Arizona, Tucson, AZ
- Department of Pharmacology, University of Arizona, Tucson, AZ
- Mayo Clinic, Scottsdale, AZ
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Rice DA, Parker RS, Lewis GN, Kluger MT, McNair PJ. Pain Catastrophizing is Not Associated With Spinal Nociceptive Processing in People With Chronic Widespread Pain. Clin J Pain 2018; 33:804-810. [PMID: 27930392 PMCID: PMC5638430 DOI: 10.1097/ajp.0000000000000464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: Pain catastrophizing has been associated with higher pain intensity, increased risk of developing chronic pain and poorer outcomes after treatment. Despite this, the mechanisms by which pain catastrophizing influences pain remain poorly understood. It has been hypothesized that pain catastrophizing may impair descending inhibition of spinal level nociception. The aims of this study were to compare spinal nociceptive processing in people with chronic widespread pain and pain-free controls and examine potential relationships between measures of pain catastrophizing and spinal nociception. Materials and Methods: Twenty-six patients with chronic widespread pain and 22 pain-free individuals participated in this study. Spinal nociception was measured using the nociceptive flexion reflex (NFR) threshold and NFR inhibition, measured as the change in NFR area during exposure to a second, painful conditioning stimulus (cold water immersion). Pain catastrophizing was assessed using the Pain Catastrophizing Scale and a situational pain catastrophizing scale. Results: Compared with pain-free controls, patients with chronic widespread pain had higher pain catastrophizing scores and lower NFR thresholds. Although NFR area was reduced by a painful conditioning stimulus in controls, this was not apparent in individuals with chronic widespread pain. No significant correlations were observed between measures of pain catastrophizing and spinal nociception. Discussion: Despite increased excitability and decreased inhibition of spinal nociception in patients with chronic widespread pain, we could find no evidence of a significant relationship between pain catastrophizing and measures of spinal nociceptive processing.
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Affiliation(s)
- David A Rice
- *Health and Rehabilitation Research Institute, Auckland University of Technology Departments of †Anaesthesiology and Perioperative Medicine, Waitemata Pain Services ‡Physiotherapy, Waitemata District Health Board, Auckland, New Zealand
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Kisler LB, Gurion I, Granovsky Y, Sinai A, Sprecher E, Shamay-Tsoory S, Weissman-Fogel I. Can a single pulse transcranial magnetic stimulation targeted to the motor cortex interrupt pain processing? PLoS One 2018; 13:e0195739. [PMID: 29630681 PMCID: PMC5891059 DOI: 10.1371/journal.pone.0195739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/28/2018] [Indexed: 01/06/2023] Open
Abstract
The modulatory role of the primary motor cortex (M1), reflected by an inhibitory effect of M1-stimulation on clinical pain, motivated us to deepen our understanding of M1’s role in pain modulation. We used Transcranial Magnetic Stimulation (TMS)-induced virtual lesion (VL) to interrupt with M1 activity during noxious heat pain. We hypothesized that TMS-VL will effect experimental pain ratings. Three VL protocols were applied consisting of single-pulse TMS to transiently interfere with right M1 activity: (1) VLM1- TMS applied to 11 subjects, 20 msec before the individual’s first pain-related M1 peak activation, as determined by source analysis (sLORETA), (2) VL-50 (N = 16; TMS applied 50 ms prior to noxious stimulus onset), and (3) VL+150 (N = 16; TMS applied 150 ms after noxious stimulus onset). Each protocol included 3 conditions ('pain-alone', ' TMS-VL', and ‘SHAM-VL’), each consisted of 30 noxious heat stimuli. Pain ratings were compared, in each protocol, for TMS-VL vs. SHAM-VL and vs. pain-alone conditions. Repeated measures analysis of variance, corrected for multiple comparisons revealed no significant differences in the pain ratings between the different conditions within each protocol. Therefore, our results from this exploratory study suggest that a single pulse TMS-induced VL that is targeted to M1 failed to interrupt experimental pain processing in the specific three stimulation timing examined here.
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Affiliation(s)
- Lee-Bareket Kisler
- Department of Psychology, University of Haifa, Haifa, Israel
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Ilan Gurion
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Alon Sinai
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Irit Weissman-Fogel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- * E-mail:
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Gajsar H, Nahrwold K, Titze C, Hasenbring MI, Vaegter HB. Exercise does not produce hypoalgesia when performed immediately after a painful stimulus. Scand J Pain 2018; 18:311-320. [DOI: 10.1515/sjpain-2018-0024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims:
Exercise-induced hypoalgesia (EIH) and conditioned pain modulation (CPM) are assumed to reflect descending pain inhibition. Potential interactions between EIH and CPM may be important in the therapy of chronic pain, as reduced CPM and increased pain after exercise are frequently observed. This study compared the EIH response after CPM was activated using a cold pressor task with the EIH response after a control condition.
Methods:
Thirty-one participants (age: 27.7±9.8; 15 female) completed two sessions: a cold pressor task (CPT) session, i.e. testing EIH with preceding CPM activation induced using a 2 min CPT at approximately 2°C, and a control session, i.e. testing EIH after a control condition (2 min of quiet rest). EIH was induced using a 15 min bicycling exercise at a target heart rate corresponding to 75% VO2 max. Repeated measures ANOVAs on pressure pain thresholds (PPTs) at the hand, back and leg were used to determine the effects of exercise after the cold pressor test and control condition. Furthermore, correlations between CPM and EIH, in the CPT session as well as control session, were calculated at each assessment site.
Results:
A significant time x condition interaction (F(1, 30)=43.61, p<0.001, partial η2=0.59), with Bonferroni-corrected post-hoc t-tests showed that PPTs increased after exercise in the control session (p<0.001), but not in the CPT session (p=0.125). Furthermore, there was a small positive correlation of EIH in the control session and CPM at the hand (r=0.37, p=0.043). There was a moderate negative correlation of EIH in the CPT session and CPM at the hand (r=−0.50, p=0.004), and smaller negative correlations at the back (r=−0.37, p=0.036) and at the leg (r=−0.35, p=0.054).
Conclusions:
Attenuated EIH after the CPM activation in comparison to a control condition suggests that EIH and CPM may share underlying pain inhibitory mechanisms on a systemic level. This assumption is further supported by the finding of small to moderate significant correlations between EIH and CPM at the hand. The attenuated EIH response furthermore suggests that these mechanisms are exhaustible, i.e. that its effects decline after a certain amount of inhibition.
Implications:
In patients with chronic pain, assessing the current capacity of the descending pain inhibitory system – as indicated by the CPM response – may aid to make better predictions about how patients will respond to exercise with respect to acute pain reduction.
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Affiliation(s)
- Hannah Gajsar
- Mind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology , Ruhr-University of Bochum , Bochum , Germany
| | - Katharina Nahrwold
- Mind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology , Ruhr-University of Bochum , Bochum , Germany
| | - Christina Titze
- Mind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology , Ruhr-University of Bochum , Bochum , Germany
| | - Monika I. Hasenbring
- Mind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology , Ruhr-University of Bochum , Bochum , Germany
| | - Henrik B. Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital , Odense , Denmark
- Department of Clinical Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
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Kashi Y, Ratmansky M, Defrin R. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain. Pain Pract 2018; 18:716-728. [DOI: 10.1111/papr.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/14/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Yafit Kashi
- Department of Physical Therapy; Loewenstein Rehabilitation Hospital; Raanana Israel
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Motti Ratmansky
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Pain Rehabilitation Unit; Loewenstein Rehabilitation Hospital; Raanana Israel
| | - Ruth Defrin
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Sagol School of Neuroscience; Tel-Aviv University; Tel-Aviv Israel
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Che X, Cash R, Fitzgerald P, Fitzgibbon BM. The Social Regulation of Pain: Autonomic and Neurophysiological Changes Associated With Perceived Threat. THE JOURNAL OF PAIN 2017; 19:496-505. [PMID: 29274393 DOI: 10.1016/j.jpain.2017.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 12/28/2022]
Abstract
The analgesic effect of social support is proposed as a function of social support modulating perceived threat of painful stimuli. In the current study, we directly examined the social buffering effect in the context of the threat of pain. Eighteen healthy participants were subjected to the threat of pain while they held the hand of a close other, a stranger, or not at all. Neural and autonomic responses were recorded using electroencephalogram and heart rate, respectively. Close other hand-holding reduced pain perception. This was accompanied by decreased heart rate and frontal theta oscillation (4-8 Hz) during the threat phase preceding painful stimulation. Interestingly, decreased heart rate and frontal theta in the close other hand-holding condition were uniquely associated with greater pain reduction during subsequent nociceptive stimulation. Neural changes were source-localized to the insular cortex and the rostral-ventral portions of anterior cingulate cortex, regions involved in the processing of threat and pain. Together, our data build upon work to date linking social support to pain by showing autonomic and neurophysiological changes associated with pain reduction. PERSPECTIVE Social support may reduce pain through buffering the autonomic and neurophysiological response to the threatening quality of noxious stimuli. Results implicate that in clinical settings the caregiver could help people with chronic pain reappraise pain and related conditions as less stressful.
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Affiliation(s)
- Xianwei Che
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Melbourne, Australia.
| | - Robin Cash
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - Paul Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Melbourne, Australia; Epworth Clinic, Epworth Healthcare, Camberwell, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
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Goudman L, Laton J, Brouns R, Nagels G, Huysmans E, Buyl R, Ickmans K, Nijs J, Moens M. Cortical mapping of painful electrical stimulation by quantitative electroencephalography: unraveling the time-frequency-channel domain. J Pain Res 2017; 10:2675-2685. [PMID: 29180894 PMCID: PMC5697445 DOI: 10.2147/jpr.s145783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The goal of this study was to capture the electroencephalographic signature of experimentally induced pain and pain-modulating mechanisms after painful peripheral electrical stimulation to determine one or a selected group of electrodes at a specific time point with a specific frequency range. In the first experiment, ten healthy participants were exposed to stimulation of the right median nerve while registering brain activity using 32-channel electroencephalography. Electrical stimulations were organized in four blocks of 20 stimuli with four intensities – 100%, 120%, 140%, and 160% – of the electrical pain threshold. In the second experiment, 15 healthy participants received electrical stimulation on the dominant median nerve before and during the application of a second painful stimulus. Raw data were converted into the time–frequency domain by applying a continuous wavelet transform. Separated domain information was extracted by calculating Parafac models. The results demonstrated that it is possible to capture a reproducible cortical neural response after painful electrical stimulation, more specifically at 250 milliseconds poststimulus, at the midline electrodes Cz and FCz with predominant δ-oscillations. The signature of the top-down nociceptive inhibitory mechanisms is δ-activity at 235 ms poststimulus at the prefrontal electrodes. This study presents a methodology to overcome the a priori determination of the regions of interest to analyze the brain response after painful electrical stimulation.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy
| | - Jorne Laton
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB)
| | - Raf Brouns
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB).,Department of Neurology, Universitair Ziekenhuis Brussel
| | - Guy Nagels
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB).,Department of Neurology, Universitair Ziekenhuis Brussel.,National MS Center
| | - Eva Huysmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel.,Interuniversity Centre for Health Economics Research (I-CHER)
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel.,Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy.,Department of Physical Medicine and Physiotherapy
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy.,Department of Physical Medicine and Physiotherapy
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel.,Pain in Motion International Research Group.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB).,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Psychophysical and Electrophysiological Evidence for Enhanced Pain Facilitation and Unaltered Pain Inhibition in Acute Low Back Pain Patients. THE JOURNAL OF PAIN 2017. [DOI: 10.1016/j.jpain.2017.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Castillo D, Ernst T, Cunningham E, Chang L. Altered Associations between Pain Symptoms and Brain Morphometry in the Pain Matrix of HIV-Seropositive Individuals. J Neuroimmune Pharmacol 2017; 13:77-89. [PMID: 28866752 DOI: 10.1007/s11481-017-9762-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p < 0.001), suggest adequate pain treatment would lead to better quality of life in all participants.
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Affiliation(s)
- Deborrah Castillo
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Thomas Ernst
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Eric Cunningham
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA
| | - Linda Chang
- John A. Burns School of Medicine, Neuroscience and MR Research Program, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA.
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 225, Baltimore, MD, 21201, USA.
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Vecchio E, Gentile E, Franco G, Ricci K, de Tommaso M. Effects of external trigeminal nerve stimulation (eTNS) on laser evoked cortical potentials (LEP): A pilot study in migraine patients and controls. Cephalalgia 2017; 38:1245-1256. [DOI: 10.1177/0333102417728748] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcutaneous external supraorbital nerve stimulation has emerged as a treatment option for primary headache disorders, though its action mechanism is still unclear. Study aim In this randomized, sham-controlled pilot study we aimed to test the effects of a single external transcutaneous nerve stimulation session on pain perception and cortical responses induced by painful laser stimuli delivered to the right forehead and the right hand in a cohort of migraine without aura patients and healthy controls. Methods Seventeen migraine without aura patients and 21 age- and sex-matched controls were selected and randomly assigned to a real or sham external transcutaneous nerve stimulation single stimulation session. The external transcutaneous nerve stimulation was delivered with a self-adhesive electrode placed on the forehead and generating a 60 Hz pulse at 16 mA intensity for 20 minutes. For sham stimulation, we used 2 mA intensity. Laser evoked responses were recorded from 21 scalp electrodes in basal condition (T0), during external transcutaneous nerve stimulation and sham stimulation (T1), and immediately after these (T2). The laser evoked responses were analyzed by LORETA software. Results The real external transcutaneous nerve stimulation reduced the trigeminal N2P2 amplitude in migraine and control groups significantly in respect to placebo. The real stimulation was associated with lower activity in the anterior cingulate cortex under trigeminal laser stimuli. The pattern of LEP-reduced habituation was reverted by real and sham transcutaneous stimulation in migraine patients. Conclusions The present results could suggest that the external transcutaneous nerve stimulation may interfere with the threshold and the extent of trigeminal system activation, with a mechanism of potential utility in the resolution and prevention of migraine attacks.
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Affiliation(s)
- Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Giovanni Franco
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
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Höffken O, Özgül ÖS, Enax-Krumova EK, Tegenthoff M, Maier C. Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation. BMC Neurol 2017; 17:167. [PMID: 28851323 PMCID: PMC5575837 DOI: 10.1186/s12883-017-0946-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conditioned pain modulation (CPM) evaluates the pain modulating effect of a noxious conditioning stimulus (CS) on another noxious test stimulus (TS), mostly based solely on subjective pain ratings. We used painful cutaneous electrical stimulation (PCES) to induce TS in a novel CPM-model. Additionally, to evaluate a more objective parameter, we recorded the corresponding changes of cortical evoked potentials (PCES-EP). METHODS We examined the CPM-effect in 17 healthy subjects in a randomized controlled cross-over design during immersion of the non-dominant hand into 10 °C or 24 °C cold water (CS). Using three custom-built concentric surface electrodes, electrical stimuli were applied on the dominant hand, inducing pain of 40-60 on NRS 0-100 (TS). At baseline, during and after CS we assessed the electrically induced pain intensity and electrically evoked potentials recorded over the central electrode (Cz). RESULTS Only in the 10 °C-condition, both pain (52.6 ± 4.4 (baseline) vs. 30.3 ± 12.5 (during CS)) and amplitudes of PCES-EP (42.1 ± 13.4 μV (baseline) vs. 28.7 ± 10.5 μV (during CS)) attenuated during CS and recovered there after (all p < 0.001). In the 10 °C-condition changes of subjective pain ratings during electrical stimulation and amplitudes of PCES-EP correlated significantly with each other (r = 0.5) and with CS pain intensity (r = 0.5). CONCLUSIONS PCES-EPs are a quantitative measure of pain relief, as changes in the electrophysiological response are paralleled by a consistent decrease in subjective pain ratings. This novel CPM paradigm is a feasible method, which could help to evaluate the function of the endogenous pain modulation processes. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: DRKS00012779 , retrospectively registered on 24 July 2017.
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Affiliation(s)
- Oliver Höffken
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Özüm S Özgül
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Christoph Maier
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome. Eur J Pain 2017; 21:855-865. [DOI: 10.1002/ejp.988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 12/26/2022]
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Polli A, Weis L, Biundo R, Thacker M, Turolla A, Koutsikos K, Chaudhuri KR, Antonini A. Anatomical and functional correlates of persistent pain in Parkinson's disease. Mov Disord 2016; 31:1854-1864. [DOI: 10.1002/mds.26826] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023] Open
Affiliation(s)
- Andrea Polli
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
- Laboratory of Robotics and Kinematics, Neurorehabilitation Department, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Hospital Foundation; Venice Italy
| | - Luca Weis
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - Roberta Biundo
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - Michael Thacker
- Centre for Human and Aerospace Physiological Sciences, Pain Section, Neuroimaging, Institute of Psychiatry, Kings College London; London United Kingdom
| | - Andrea Turolla
- Laboratory of Robotics and Kinematics, Neurorehabilitation Department, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Hospital Foundation; Venice Italy
- Department of Neuroscience; The University of Sheffield; Sheffield United Kingdom
| | - Kostantinos Koutsikos
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - K. Ray Chaudhuri
- Neuroscience Research and Development, Denmark Hill Campus, King's College Hospital, King's College London; London United Kingdom
| | - Angelo Antonini
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
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48
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Flood A, Waddington G, Thompson K, Cathcart S. Increased conditioned pain modulation in athletes. J Sports Sci 2016; 35:1066-1072. [DOI: 10.1080/02640414.2016.1210196] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bastuji H, Frot M, Perchet C, Magnin M, Garcia-Larrea L. Pain networks from the inside: Spatiotemporal analysis of brain responses leading from nociception to conscious perception. Hum Brain Mapp 2016; 37:4301-4315. [PMID: 27391083 DOI: 10.1002/hbm.23310] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022] Open
Abstract
Conscious perception of painful stimuli needs the contribution of an extensive cortico-subcortical network, and is completed in less than one second. While initial activities in operculo-insular and mid-cingulate cortices have been extensively assessed, the activation timing of most areas supporting conscious pain has barely been studied. Here we used intracranial EEG to investigate the dynamics of 16 brain regions (insular, parietal, prefrontal, cingulate, hippocampal and limbic) during the first second following nociceptive-specific laser pulses. Three waves of activation could be defined according to their temporal relation with conscious perception, ascertained by voluntary motor responses. Pre-conscious activities were recorded in the posterior insula, operculum, mid-cingulate and amygdala. Antero-insular, prefrontal and posterior parietal activities started later and developed during time-frames consistent with conscious voluntary reactions. Responses from hippocampus, perigenual and perisplenial cingulate developed latest and persisted well after conscious perception occurred. Nociceptive inputs reach simultaneously sensory and limbic networks, probably through parallel spino-thalamic and spino-parabrachial pathways, and the initial limbic activation precedes conscious perception of pain. Access of sensory information to consciousness develops concomitant to fronto-parietal activity, while late-occurring responses in the hippocampal region, perigenual and posterior cingulate cortices likely underlie processes linked to memory encoding, self-awareness and pain modulation. Hum Brain Mapp 37:4301-4315, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hélène Bastuji
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France.,Unité D'Hypnologie, Service De Neurologie Fonctionnelle Et D'Épileptologie, Hôpital Neurologique, Hospices Civils De Lyon, Bron, F-69677, France
| | - Maud Frot
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Caroline Perchet
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Michel Magnin
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France.,Centre D'évaluation Et De Traitement De La Douleur, Hôpital Neurologique, Lyon, France
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Rustamov N, Tessier J, Provencher B, Lehmann A, Piché M. Inhibitory effects of heterotopic noxious counter-stimulation on perception and brain activity related to Aβ-fibre activation. Eur J Neurosci 2016; 44:1771-8. [PMID: 27086672 DOI: 10.1111/ejn.13258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/08/2016] [Indexed: 12/21/2022]
Abstract
Heterotopic noxious counter-stimulation (HNCS) inhibits pain and pain processes through cerebral and cerebrospinal mechanisms. However, it is unclear whether HNCS inhibits non-nociceptive processes, which needs to be clarified for a better understanding of HNCS analgesia. The aim of this study was to examine the effects of HNCS on perception and scalp somatosensory evoked potentials (SEPs). Seventeen healthy volunteers participated in two counter-balanced sessions, including non-nociceptive (selective Aβ-fibre activation) or nociceptive electrical stimulation, combined with HNCS. HNCS was produced by a 20-min cold pressor test (left hand) adjusted individually to produce moderate pain (mean ± SEM: 42.5 ± 5.3 on a 0-100 scale, where 0 is no pain and 100 the worst pain imaginable). Non-nociceptive electrical stimulation was adjusted individually at 80% of pain threshold and produced a tactile sensation in every subject. Nociceptive electrical stimulation was adjusted individually at 120% of RIII-reflex threshold and produced moderate pain (45.3 ± 4.5). Shock sensation was significantly decreased by HNCS compared with baseline for non-nociceptive (P < 0.001) and nociceptive (P < 0.001) stimulation. SEP peak-to-peak amplitude at Cz was significantly decreased by HNCS for non-nociceptive (P < 0.01) and nociceptive (P < 0.05) stimulation. These results indicate that perception and brain activity related to Aβ-fibre activation are inhibited by HNCS. The mechanisms of this effect remain to be investigated to clarify whether it involves inhibition of spinal wide-dynamic-range neurons by diffuse noxious inhibitory controls, supraspinal processes or both.
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Affiliation(s)
- Nabi Rustamov
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.,Groupe de Recherche en Cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jessica Tessier
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.,Groupe de Recherche en Cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Benjamin Provencher
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.,Groupe de Recherche en Cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Alexandre Lehmann
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.,International Laboratory for Brain, Music and Sound Research & Center for Research on Brain, Language and Music, Montreal, QC, Canada
| | - Mathieu Piché
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.,Groupe de Recherche en Cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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