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Wei X, Lai Y, Lan X, Tan Y, Zhang J, Liu J, Chen J, Wang C, Zhou X, Tang Y, Liu D, Zhang J. Uncovering brain functional connectivity disruption patterns of lung cancer-related pain. Brain Imaging Behav 2024; 18:576-587. [PMID: 38316730 DOI: 10.1007/s11682-023-00836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
Pain is a pervasive symptom in lung cancer patients during the onset of the disease. This study aims to investigate the connectivity disruption patterns of the whole-brain functional network in lung cancer patients with cancer pain (CP+). We constructed individual whole-brain, region of interest (ROI)-level functional connectivity (FC) networks for 50 CP+ patients, 34 lung cancer patients without pain-related complaints (CP-), and 31 matched healthy controls (HC). Then, a ROI-based FC analysis was used to determine the disruptions of FC among the three groups. The relationships between aberrant FCs and clinical parameters were also characterized. The ROI-based FC analysis demonstrated that hypo-connectivity was present both in CP+ and CP- patients compared to HC, which were particularly clustered in the somatomotor and ventral attention, frontoparietal control, and default mode modules. Notably, compared to CP- patients, CP+ patients had hyper-connectivity in several brain regions mainly distributed in the somatomotor and visual modules, suggesting these abnormal FC patterns may be significant for cancer pain. Moreover, CP+ patients also showed increased intramodular and intermodular connectivity strength of the functional network, which could be replicated in cancer stage IV and lung adenocarcinoma. Finally, abnormal FCs within the prefrontal cortex and somatomotor cortex were positively correlated with pain intensity and pain duration, respectively. These findings suggested that lung cancer patients with cancer pain had disrupted connectivity in the intrinsic brain functional network, which may be the underlying neuroimaging mechanisms.
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Affiliation(s)
- Xiaotong Wei
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yong Lai
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jiang Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Chengfang Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Xiaoyu Zhou
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yu Tang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
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Del Mauro G, Sevel LS, Boissoneault J, Wang Z. Divergent association between pain intensity and resting-state fMRI-based brain entropy in different age groups. J Neurosci Res 2024; 102:e25341. [PMID: 38751218 PMCID: PMC11154588 DOI: 10.1002/jnr.25341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 06/11/2024]
Abstract
Pain is a multidimensional subjective experience sustained by multiple brain regions involved in different aspects of pain experience. We used brain entropy (BEN) estimated from resting-state fMRI (rsfMRI) data to investigate the neural correlates of pain experience. BEN was estimated from rs-fMRI data provided by two datasets with different age range: the Human Connectome Project-Young Adult (HCP-YA) and the Human Connectome project-Aging (HCP-A) datasets. Retrospective assessment of experienced pain intensity was retrieved from both datasets. No main effect of pain intensity was observed. The interaction between pain and age, however, was related to increased BEN in several pain-related brain regions, reflecting greater variability of spontaneous brain activity. Dividing the sample into a young adult group (YG) and a middle age-aging group (MAG) resulted in two divergent patterns of pain-BEN association: In the YG, pain intensity was related to reduced BEN in brain regions involved in the sensory processing of pain; in the MAG, pain was associated with increased BEN in areas related to both sensory and cognitive aspects of pain experience.
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Affiliation(s)
- Gianpaolo Del Mauro
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Landrew Samuel Sevel
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeff Boissoneault
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ze Wang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Zhu K, Chang J, Zhang S, Li Y, Zuo J, Ni H, Xie B, Yao J, Xu Z, Bian S, Yan T, Wu X, Chen S, Jin W, Wang Y, Xu P, Song P, Wu Y, Shen C, Zhu J, Yu Y, Dong F. The enhanced connectivity between the frontoparietal, somatomotor network and thalamus as the most significant network changes of chronic low back pain. Neuroimage 2024; 290:120558. [PMID: 38437909 DOI: 10.1016/j.neuroimage.2024.120558] [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: 10/28/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
The prolonged duration of chronic low back pain (cLBP) inevitably leads to changes in the cognitive, attentional, sensory and emotional processing brain regions. Currently, it remains unclear how these alterations are manifested in the interplay between brain functional and structural networks. This study aimed to predict the Oswestry Disability Index (ODI) in cLBP patients using multimodal brain magnetic resonance imaging (MRI) data and identified the most significant features within the multimodal networks to aid in distinguishing patients from healthy controls (HCs). We constructed dynamic functional connectivity (dFC) and structural connectivity (SC) networks for all participants (n = 112) and employed the Connectome-based Predictive Modeling (CPM) approach to predict ODI scores, utilizing various feature selection thresholds to identify the most significant network change features in dFC and SC outcomes. Subsequently, we utilized these significant features for optimal classifier selection and the integration of multimodal features. The results revealed enhanced connectivity among the frontoparietal network (FPN), somatomotor network (SMN) and thalamus in cLBP patients compared to HCs. The thalamus transmits pain-related sensations and emotions to the cortical areas through the dorsolateral prefrontal cortex (dlPFC) and primary somatosensory cortex (SI), leading to alterations in whole-brain network functionality and structure. Regarding the model selection for the classifier, we found that Support Vector Machine (SVM) best fit these significant network features. The combined model based on dFC and SC features significantly improved classification performance between cLBP patients and HCs (AUC=0.9772). Finally, the results from an external validation set support our hypotheses and provide insights into the potential applicability of the model in real-world scenarios. Our discovery of enhanced connectivity between the thalamus and both the dlPFC (FPN) and SI (SMN) provides a valuable supplement to prior research on cLBP.
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Affiliation(s)
- Kun Zhu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Jianchao Chang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Siya Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; School of Basic Medical Sciences, Anhui Medical University, Hefei, PR China
| | - Yan Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Junxun Zuo
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Haoyu Ni
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Bingyong Xie
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Jiyuan Yao
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Zhibin Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Sicheng Bian
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Tingfei Yan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Xianyong Wu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Orthopedics, Anqing First People's Hospital of Anhui Medical University, Anqing, PR China
| | - Senlin Chen
- Department of Orthopedics, Dongcheng branch of The First Affiliated Hospital of Anhui Medical University (Feidong People's Hospital), Hefei, PR China
| | - Weiming Jin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Ying Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Peng Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Peiwen Song
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yuanyuan Wu
- Department of Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Fulong Dong
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China; School of Basic Medical Sciences, Anhui Medical University, Hefei, PR China.
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Lee J, Lazaridou A, Paschali M, Loggia ML, Berry MP, Dan-Mikael E, Isenburg K, Anzolin A, Grahl A, Wasan AD, Napadow V, Edwards RR. A Randomized Controlled Neuroimaging Trial of Cognitive Behavioral Therapy for Fibromyalgia Pain. Arthritis Rheumatol 2024; 76:130-140. [PMID: 37727908 PMCID: PMC10842345 DOI: 10.1002/art.42672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Fibromyalgia (FM) is characterized by pervasive pain-related symptomatology and high levels of negative affect. Mind-body treatments such as cognitive behavioral therapy (CBT) appear to foster improvement in FM via reductions in pain-related catastrophizing, a set of negative, pain-amplifying cognitive and emotional processes. However, the neural underpinnings of CBT's catastrophizing-reducing effects remain uncertain. This randomized controlled mechanistic trial was designed to assess CBT's effects on pain catastrophizing and its underlying brain circuitry. METHODS Of 114 enrolled participants, 98 underwent a baseline neuroimaging assessment and were randomized to 8 weeks of individual CBT or a matched FM education control (EDU) condition. RESULTS Compared with EDU, CBT produced larger decreases in pain catastrophizing post treatment (P < 0.05) and larger reductions in pain interference and symptom impact. Decreases in pain catastrophizing played a significant role in mediating those functional improvements in the CBT group. At baseline, brain functional connectivity between the ventral posterior cingulate cortex (vPCC), a key node of the default mode network (DMN), and somatomotor and salience network regions was increased during catastrophizing thoughts. Following CBT, vPCC connectivity to somatomotor and salience network areas was reduced. CONCLUSION Our results suggest clinically important and CBT-specific associations between somatosensory/motor- and salience-processing brain regions and the DMN in chronic pain. These patterns of connectivity may contribute to individual differences (and treatment-related changes) in somatic self-awareness. CBT appears to provide clinical benefits at least partially by reducing pain-related catastrophizing and producing adaptive alterations in DMN functional connectivity.
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Affiliation(s)
- Jeungchan Lee
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Discovery Center for Recovery from Chronic Pain, Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marco L. Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Michael P. Berry
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Ellingsen Dan-Mikael
- Department of School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kylie Isenburg
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Alessandra Anzolin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Discovery Center for Recovery from Chronic Pain, Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Arvina Grahl
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Discovery Center for Recovery from Chronic Pain, Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and Perioperative Medicine, Center for Innovation in Pain Care, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Vitaly Napadow
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Discovery Center for Recovery from Chronic Pain, Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Hotta J, Saari J, Harno H, Kalso E, Forss N, Hari R. Somatotopic disruption of the functional connectivity of the primary sensorimotor cortex in complex regional pain syndrome type 1. Hum Brain Mapp 2023; 44:6258-6274. [PMID: 37837646 PMCID: PMC10619416 DOI: 10.1002/hbm.26513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023] Open
Abstract
In complex regional pain syndrome (CRPS), the representation area of the affected limb in the primary sensorimotor cortex (SM1) reacts abnormally during sensory stimulation and motor actions. We recorded 3T functional magnetic resonance imaging resting-state data from 17 upper-limb CRPS type 1 patients and 19 healthy control subjects to identify alterations of patients' SM1 function during spontaneous pain and to find out how the spatial distribution of these alterations were related to peripheral symptoms. Seed-based correlations and independent component analyses indicated that patients' upper-limb SM1 representation areas display (i) reduced interhemispheric connectivity, associated with the combined effect of intensity and spatial extent of limb pain, (ii) increased connectivity with the right anterior insula that positively correlated with the duration of CRPS, (iii) increased connectivity with periaqueductal gray matter, and (iv) disengagement from the other parts of the SM1 network. These findings, now reported for the first time in CRPS, parallel the alterations found in patients suffering from other chronic pain conditions or from limb denervation; they also agree with findings in healthy persons who are exposed to experimental pain or have used their limbs asymmetrically. Our results suggest that CRPS is associated with a sustained and somatotopically specific alteration of SM1 function, that has correspondence to the spatial distribution of the peripheral manifestations and to the duration of the syndrome.
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Affiliation(s)
- Jaakko Hotta
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Aalto NeuroImagingAalto UniversityEspooFinland
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
| | - Jukka Saari
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Aalto NeuroImagingAalto UniversityEspooFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Hanna Harno
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
- Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Nina Forss
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
| | - Riitta Hari
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Department of Art and MediaAalto University School of Arts, Design and ArchitectureHelsinkiFinland
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Tangella AV. Imaging Modalities and Their Findings in Patients With Complex Regional Pain Syndrome: A Review. Cureus 2023; 15:e41747. [PMID: 37575802 PMCID: PMC10415629 DOI: 10.7759/cureus.41747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Complex regional pain syndrome (CRPS) is a systemic or regional pain pathology associated with the nondermatomal or dermatomal distribution of excruciating intolerable pain, which might be triggered by an insignificant or weak stimulus or sometimes without any. Its symptoms encompass neurological, musculoskeletal, dermatological, and vascular realms. It is usually preceded by an episode of nerve injury or intervention set in numerous circumstances ranging from trauma to surgeries to chronic diseases. CRPS has been shrouded in a veil of mystery and was called a psychological phenomenon without any proper organic basis when it was described by Ambroise Pare initially. This led to disproportionately fewer research investments into this disease. Given the great advancement of diagnostic modalities since its inception, researchers and physicians have been trying to identify the physiological basis for it and have succeeded. Numerous pathophysiological pathways have been involved in this disease, but all of them point toward the possibility of improper pain processing at various levels of the pain pathway along with brain plasticity leading to aberrant neuronal circuitry between different segments of the sensory cortex, basal ganglia, prefrontal cortex, and insula. This paper explores the various studies done to evaluate the role of different imaging modalities, ranging from three-phase bone scintigraphy (TPBS) to diffusion traction imaging (DTI).
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Wank I, Niedermair T, Kronenberg D, Stange R, Brochhausen C, Hess A, Grässel S. Influence of the Peripheral Nervous System on Murine Osteoporotic Fracture Healing and Fracture-Induced Hyperalgesia. Int J Mol Sci 2022; 24:ijms24010510. [PMID: 36613952 PMCID: PMC9820334 DOI: 10.3390/ijms24010510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Osteoporotic fractures are often linked to persisting chronic pain and poor healing outcomes. Substance P (SP), α-calcitonin gene-related peptide (α-CGRP) and sympathetic neurotransmitters are involved in bone remodeling after trauma and nociceptive processes, e.g., fracture-induced hyperalgesia. We aimed to link sensory and sympathetic signaling to fracture healing and fracture-induced hyperalgesia under osteoporotic conditions. Externally stabilized femoral fractures were set 28 days after OVX in wild type (WT), α-CGRP- deficient (α-CGRP -/-), SP-deficient (Tac1-/-) and sympathectomized (SYX) mice. Functional MRI (fMRI) was performed two days before and five and 21 days post fracture, followed by µCT and biomechanical tests. Sympathectomy affected structural bone properties in the fracture callus whereas loss of sensory neurotransmitters affected trabecular structures in contralateral, non-fractured bones. Biomechanical properties were mostly similar in all groups. Both nociceptive and resting-state (RS) fMRI revealed significant baseline differences in functional connectivity (FC) between WT and neurotransmitter-deficient mice. The fracture-induced hyperalgesia modulated central nociception and had robust impact on RS FC in all groups. The changes demonstrated in RS FC in fMRI might potentially be used as a bone traumata-induced biomarker regarding fracture healing under pathophysiological musculoskeletal conditions. The findings are of clinical importance and relevance as they advance our understanding of pain during osteoporotic fracture healing and provide a potential imaging biomarker for fracture-related hyperalgesia and its temporal development. Overall, this may help to reduce the development of chronic pain after fracture thereby improving the treatment of osteoporotic fractures.
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Affiliation(s)
- Isabel Wank
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Tanja Niedermair
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany
| | - Daniel Kronenberg
- Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine (IMM), University Hospital Münster, 48149 Münster, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine (IMM), University Hospital Münster, 48149 Münster, Germany
| | | | - Andreas Hess
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Susanne Grässel
- Centre for Medical Biotechnology (ZMB), Department of Orthopedic Surgery, Experimental Orthopedics, University of Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-943-5065
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Wei X, Wang L, Yu F, Lee C, Liu N, Ren M, Tu J, Zhou H, Shi G, Wang X, Liu CZ. Identifying the neural marker of chronic sciatica using multimodal neuroimaging and machine learning analyses. Front Neurosci 2022; 16:1036487. [PMID: 36532276 PMCID: PMC9748090 DOI: 10.3389/fnins.2022.1036487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/14/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots. Neuroimaging studies have identified functional abnormalities in patients with chronic sciatica (CS). However, few studies have investigated the neural marker of CS using brain structure and the classification value of multidimensional neuroimaging features in CS patients is unclear. METHODS Here, structural and resting-state functional magnetic resonance imaging (fMRI) was acquired for 34 CS patients and 36 matched healthy controls (HCs). We analyzed cortical surface area, cortical thickness, amplitude of low-frequency fluctuation (ALFF), regional homogeneity (REHO), between-regions functional connectivity (FC), and assessed the correlation between neuroimaging measures and clinical scores. Finally, the multimodal neuroimaging features were used to differentiate the CS patients and HC individuals by support vector machine (SVM) algorithm. RESULTS Compared to HC, CS patients had a larger cortical surface area in the right banks of the superior temporal sulcus and rostral anterior cingulate; higher ALFF value in the left inferior frontal gyrus; enhanced FCs between somatomotor and ventral attention network. Three FCs values were associated with clinical pain scores. Furthermore, the three multimodal neuroimaging features with significant differences between groups and the SVM algorithm could classify CS patients and HC with an accuracy of 90.00%. DISCUSSION Together, our findings revealed extensive reorganization of local functional properties, surface area, and network metrics in CS patients. The success of patient identification highlights the potential of using artificial intelligence and multimodal neuroimaging markers in chronic pain research.
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Affiliation(s)
- Xiaoya Wei
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Liqiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fangting Yu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chihkai Lee
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ni Liu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Mengmeng Ren
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Jianfeng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hang Zhou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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9
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Sun R, Zhang SY, Cheng X, Zhang P, Qiao PG, Li GJ. Changes in sensory-related brain networks of patients with moyamoya disease with limb paresthesia: A resting-state fMRI-based functional connectivity analysis. Neuroimage Clin 2022; 36:103267. [PMID: 36510412 PMCID: PMC9668639 DOI: 10.1016/j.nicl.2022.103267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
This study's aim was to investigate functional brain connectivity changes among patients with moyamoya disease (MMD) with limb paresthesia, using functional connectivity analysis based on resting-state functional magnetic resonance imaging (rs-fMRI). A total of 181 patients with MMD were enrolled, including 57 with left limb paresthesia (MLP group), 61 with right limb paresthesia (MRP group), and 63 without paresthesia (MWP group). Encephaloduroarteriosynangiosis (EDAS) was performed in 20 of the 57 patients with left limb paresthesia and 15 of the 61 patients with right limb paresthesia. Twenty-nine age- and sex-matched healthy controls (HC group) were recruited during the same period. All participants underwent rs-fMRI examination, and the patients treated with EDAS were re-examined 3-4 months after the surgery. After data preprocessing, we selected Brodmann area 3 on each side of the brain as the seed region to construct a functional connectivity network of the whole brain, and then we analyzed the differences in functional connectivity between the HC group, MWP group, MLP group, and MRP group. The functional connectivity of Brodmann area 3 (on either side) with the ipsilateral frontal (superior frontal gyrus, middle frontal gyrus, and inferior frontal gyrus) and parietal (supramarginal gyrus, angular gyrus, and superior parietal lobule) cortices was increased among patients with MMD. The functional connectivity enhancement in these brain regions was broader and greater in patients with contralateral limb paresthesia than in patients without paresthesia, and the regions with functional connectivity changes were roughly distributed symmetrically among the MLP group and the MRP group. There were no changes 3-4 months after EDAS in the increased functional connectivity between the frontal and parietal cortices and Brodmann area 3. Limb paresthesia in patients with MMD may be driven by abnormal functional connectivity in the frontal and parietal cortices. Functional changes in associated brain regions may be a target for evaluating the severity of MMD and its response to treatment.
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Affiliation(s)
- Rujing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shi-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xu Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng-Gang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China,Corresponding authors at: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing 100050, China, (P.-G. Qiao). Department of Radiology, Affiliated hospital of Academy of Military Medical Sciences, #8 Fengtai dong street, Fengtai district, Beijing 100071, China, (G.-J. Li).
| | - Gong-Jie Li
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China,Corresponding authors at: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing 100050, China, (P.-G. Qiao). Department of Radiology, Affiliated hospital of Academy of Military Medical Sciences, #8 Fengtai dong street, Fengtai district, Beijing 100071, China, (G.-J. Li).
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10
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Lee JJ, Lee S, Lee DH, Woo CW. Functional brain reconfiguration during sustained pain. eLife 2022; 11:74463. [PMID: 36173388 PMCID: PMC9522250 DOI: 10.7554/elife.74463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is constructed through complex interactions among multiple brain systems, but it remains unclear how functional brain networks are reconfigured over time while experiencing pain. Here, we investigated the time-varying changes in the functional brain networks during 20 min capsaicin-induced sustained orofacial pain. In the early stage, the orofacial areas of the primary somatomotor cortex were separated from other areas of the somatosensory cortex and integrated with subcortical and frontoparietal regions, constituting an extended brain network of sustained pain. As pain decreased over time, the subcortical and frontoparietal regions were separated from this brain network and connected to multiple cerebellar regions. Machine-learning models based on these network features showed significant predictions of changes in pain experience across two independent datasets (n = 48 and 74). This study provides new insights into how multiple brain systems dynamically interact to construct and modulate pain experience, advancing our mechanistic understanding of sustained pain.
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Affiliation(s)
- Jae-Joong Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Sungwoo Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea.,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Dong Hee Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea.,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea.,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
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11
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Dehghan Nayyeri M, Missler M, Ritterbach R, Sundermann B, Wulms N, Süer A, Dugas M, Pereira MP, Ständer S, Schmelz M, Pfleiderer B. Altered resting-state functional connectivity of default mode network in brachioradial pruritus. J Eur Acad Dermatol Venereol 2022; 36:2214-2223. [PMID: 35796634 DOI: 10.1111/jdv.18411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic pruritus (CP) have a low quality of life, thus it is important to gain a better understanding of the underlying processes. Previous functional magnetic resonance imaging studies at rest (rs-fMRI) have shown that mainly areas associated with the default mode network (DMN), sensorimotor (SMN), frontoparietal (FPN) and salience networks (SN) are involved in the processing of itch in patients with chronic pruritus (CP), as well as the cortico-striatal circuit, which is involved in the motoric preparation of scratching. rs-fMRI studies on functional connectivity (FC) patterns of resting-state networks (RSNs) in patients with inflammatory atopic dermatitis (AD) or with neuropathic brachioradial pruritus (BRP) compared to healthy controls (HC) are lacking. OBJECTIVES The main goals of this study were to investigate whether functional connectivity within networks and areas associated with itch detection and processing are altered in patients with AD and BRP compared to matched healthy controls by rsfMRI, respectively. METHODS Patients with AD (n = 28) and with BRP (n = 28) were compared to corresponding matched healthy controls by rsfMRI. Group specific RSNs were identified by independent component analysis (ICA) and between-group differences in the RSNs were analyzed by dual regression technique. Seed-based functional connectivity was analyzed in several itch-related brain regions belonging to the DMN, SN and FPN, respectively. RESULTS ICA and seed-based analyses revealed decreased functional connectivity in BRP compared to HC specially within the DMN including the precuneus and cingulate cortex. For AD patients in comparison to HC, as well as when BRP and AD patients when compared directly, no significant FC differences at rest were seen. CONCLUSIONS Our findings point towards decreased FC particularly in the DMN at rest in patients with BRP. These results seem to indicate that central connectivity patterns at rest differentially encode itch in BRP and AD.
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Affiliation(s)
- Mahboobeh Dehghan Nayyeri
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Miriam Missler
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Rebecca Ritterbach
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel P Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, Medical Faculty Mannheim, Heidelberg of University, Mannheim, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Otto Creutzfeld Center for Cognitive and Behavioral Neuroscience, Muenster, Germany
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12
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Tonic pain alters functional connectivity of the descending pain modulatory network involving amygdala, periaqueductal gray, parabrachial nucleus and anterior cingulate cortex. Neuroimage 2022; 256:119278. [PMID: 35523367 PMCID: PMC9250649 DOI: 10.1016/j.neuroimage.2022.119278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC accompanying tonic pain in pain-free persons are rare. A network we term the Descending Pain Modulatory Network (DPMN) is implicated in healthy and pathologic pain modulation. Here, we evaluate the effect of tonic pain on FC of specific nodes of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN). METHODS In 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. functional MRI measured resting BOLD signal during pain-free rest with a 32°C thermode and then tonic pain where participants experienced a previously warm temperature combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity during both states. We hypothesized tonic pain would diminish FC dyads within the DPMN. RESULTS Of all hypothesized FC dyads, only PAG and subgenual ACC was weakly altered during pain (F=3.34; p=0.074; pain-free>pain d=0.25). After pain induction sACC-PAG FC became positively correlated with pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During pain, this connection's FC was diminished (paired t=-3.17; p=0.0026). In whole-brain analyses, during pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During pain, FC between left AMYG and right inferior temporal gyrus negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC with right claustrum; right primary visual cortex and right temporo-occipitoparietal junction Conclusion: We demonstrate sACC-PAG tonic pain FC positively correlates with experienced pain and resting right PBN-PAG FC correlates with subsequent pain and is diminished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which correlate with subsequently experienced pain intensity. Our findings suggest specific connectivity patterns within the DPMN at rest are associated with subsequently experienced pain and modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation or biomarkers to guide interventions.
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Fisher H, Sclocco R, Maeda Y, Kim J, Malatesta C, Gerber J, Audette J, Kettner N, Napadow V. S1 Brain Connectivity in Carpal Tunnel Syndrome Underlies Median Nerve and Functional Improvement Following Electro-Acupuncture. Front Neurol 2021; 12:754670. [PMID: 34777225 PMCID: PMC8578723 DOI: 10.3389/fneur.2021.754670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Carpal Tunnel Syndrome (CTS) is a median nerve entrapment neuropathy that alters primary somatosensory cortex (S1) organization. While electro-acupuncture (EA), a form of peripheral neuromodulation, has been shown to improve clinical and neurophysiological CTS outcomes, the role of EA-evoked brain response during therapy (within and beyond S1) for improved outcomes is unknown. We investigated S1-associated whole brain fMRI connectivity during both a resting and sustained EA stimulation state in age-matched healthy controls (N = 28) and CTS patients (N = 64), at baseline and after 8 weeks of acupuncture therapy (local, distal, or sham EA). Compared to healthy controls, CTS patients at baseline showed decreased resting state functional connectivity between S1 and thalamic pulvinar nucleus. Increases in S1/pulvinar connectivity strength following verum EA therapy (combined local and distal) were correlated with improvements in median nerve velocity (r = 0.38, p = 0.035). During sustained local EA, compared to healthy controls, CTS patients demonstrated increased functional connectivity between S1 and anterior hippocampus (aHipp). Following 8 weeks of local EA therapy, S1/aHipp connectivity significantly decreased and greater decrease was associated with improvement in patients' functional status (r = 0.64, p = 0.01) and increased median nerve velocity (r = -0.62, p = 0.013). Thus, connectivity between S1 and other brain areas is also disrupted in CTS patients and may be improved following EA therapy. Furthermore, stimulus-evoked fMRI connectivity adds therapy-specific, mechanistic insight to more common resting state connectivity approaches. Specifically, local EA modulates S1 connectivity to sensory and affective processing regions, linked to patient function and median nerve health.
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Affiliation(s)
- Harrison Fisher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Roberta Sclocco
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Yumi Maeda
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Jieun Kim
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Cristina Malatesta
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Jessica Gerber
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Joseph Audette
- Department of Pain Medicine, Harvard Vanguard Medical Associates, Atrium Health, Boston, MA, United States
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Vitaly Napadow
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
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14
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Allen Demers F, Zangrandi A, Schneider C. Theta-Burst Stimulation of Forearm Muscles in Patients With Complex Regional Pain Syndrome: Influence on Brain and Clinical Outcomes. FRONTIERS IN PAIN RESEARCH 2021; 2:736806. [PMID: 35295471 PMCID: PMC8915654 DOI: 10.3389/fpain.2021.736806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Complex regional pain syndrome (CRPS) is a common pain condition characterized by the changes in the brain that are not yet addressed by conventional treatment regimens. Repetitive peripheral magnetic stimulation (rPMS) of muscles is painless and non-invasive and can influence these changes (the induction of brain plasticity) to reduce pain and improve motricity. In patients with CRPS, this open-label pilot study tested rPMS after-effects on the pain intensity and sensorimotor control of the upper limb along with the excitability changes of the primary motor cortex (M1). Methods: Eight patients with CRPS were enrolled in a single-session program. Patients were tested at pre- and post-rPMS over the flexor digitorum superficialis (FDS) muscle. The clinical outcomes were pain intensity, proprioception, active range of motion (ROM), and grip strength. M1 excitability was tested using the single- and paired-pulse transcranial magnetic stimulation (TMS) of M1. Results: In our small sample study, rPMS reduced instant and week pain, improved proprioception and ROM, and reduced the hemispheric imbalance of several TMS outcomes. The more M1 contralateral to the CRPS side was hyperactivated at baseline, the more pain was reduced. Discussion: This open-label pilot study provided promising findings for the use of rPMS in CRPS with a focus on M1 plastic changes. Future randomized, placebo-controlled clinical trials should confirm the existence of a causal relationship between the TMS outcomes and post-rPMS decrease of pain. This will favor the development of personalized treatments of peripheral non-invasive neurostimulation in CRPS.
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Affiliation(s)
- Fannie Allen Demers
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Andrea Zangrandi
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- *Correspondence: Cyril Schneider
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15
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Berry MP, Lutz J, Schuman-Olivier Z, Germer C, Pollak S, Edwards RR, Gardiner P, Desbordes G, Napadow V. Brief Self-Compassion Training Alters Neural Responses to Evoked Pain for Chronic Low Back Pain: A Pilot Study. PAIN MEDICINE 2021; 21:2172-2185. [PMID: 32783054 DOI: 10.1093/pm/pnaa178] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Self-compassion meditation, which involves compassion toward the self in moments of suffering, shows promise for improving pain-related functioning, but its underlying mechanisms are unknown. This longitudinal, exploratory pilot study investigated the effects of a brief (eight contact hours, two weeks of home practice) self-compassion training on pain-related brain processing in chronic low back pain (cLBP). METHODS We evaluated functional magnetic resonance imaging (fMRI) response to evoked pressure pain and its anticipation during a self-compassionate state and compared altered brain responses following training with changes on self-reported measures of self-compassion (Self-Compassion Scale [SCS]), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness [MAIA]), and clinical pain intensity. RESULTS In a sample of participants with cLBP (N = 20 total, N = 14 with complete longitudinal data) who underwent self-compassion training, we observed reduced clinical pain intensity and disability (P < 0.01) and increased trait self-compassion and interoceptive awareness (all P < 0.05) following training. Evoked pressure pain response in the right temporo-parietal junction (TPJ) was reduced following training, and decreases were associated with reduced clinical pain intensity. Further, increased fMRI responses to pain anticipation were observed in the right dorsolateral prefrontal cortex (dlPFC) and ventral posterior cingulate cortex (vPCC), and these increases were associated with mean post-training changes in SCS scores and scores from the body listening subscale of the MAIA. DISCUSSION These findings, though exploratory and lacking comparison with a control condition, suggest that self-compassion training supports regulation of pain through the involvement of self-referential (vPCC), salience-processing (TPJ), and emotion regulatory (dlPFC) brain areas. The results also suggest that self-compassion could be an important target in the psychotherapeutic treatment of cLBP, although further studies using controlled experimental designs are needed to determine the specificity of these effects.
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Affiliation(s)
- Michael P Berry
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Jacqueline Lutz
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.,Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Christopher Germer
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Susan Pollak
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paula Gardiner
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gaelle Desbordes
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Vitaly Napadow
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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16
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Abstract
Complex regional pain syndrome (CRPS) develops after-limb injury, with persistent pain and deficits in movement frequently co-occurring. The striatum is critical for mediating multiple mechanisms that are often aberrant in CRPS, which includes sensory and pain processing, motor function, and goal-directed behaviors associated with movement. Yet, much remains unknown with regards to the morphological and functional properties of the striatum and its subregions in this disease. Thus, we investigated 20 patients (15 female, age 58 ± 9 years, right-handed) diagnosed with chronic (6+ months of pain duration) CRPS in the right hand and 20 matched, healthy controls with anatomical and resting-state, functional magnetic resonance imaging. In addition, a comprehensive clinical and behavioral evaluation was performed, where each participant's pain, motor function, and medical history were assessed. Complex regional pain syndrome patients harbored significant abnormalities in hand coordination, dexterity, and strength. These clinical pain- and movement-related findings in CRPS patients were concomitant with bilateral decreases in gray matter density in the putamen as well as functional connectivity increases and decreases among the putamen and pre-/postcentral gyri and cerebellum, respectively. Importantly, higher levels of clinical pain and motor impairment were associated with increased putamen-pre-/postcentral gyri functional connectivity strengths. Collectively, these findings suggest that putaminal alterations, specifically the functional interactions with sensorimotor structures, may underpin clinical pain and motor impairment in chronic CRPS patients.
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17
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Völker JM, Arguissain FG, Manresa JB, Andersen OK. Characterization of Source-Localized EEG Activity During Sustained Deep-Tissue Pain. Brain Topogr 2021; 34:192-206. [PMID: 33403561 DOI: 10.1007/s10548-020-00815-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
Musculoskeletal pain is a clinical condition that is characterized by ongoing pain and discomfort in the deep tissues such as muscle, bones, ligaments, nerves, and tendons. In the last decades, it was subject to extensive research due to its high prevalence. Still, a quantitative description of the electrical brain activity during musculoskeletal pain is lacking. This study aimed to characterize intracranial current source density (CSD) estimations during sustained deep-tissue experimental pain. Twenty-three healthy volunteers received three types of tonic stimuli for three minutes each: computer-controlled cuff pressure (1) below pain threshold (sustained deep-tissue no-pain, SDTnP), (2) above pain threshold (sustained deep-tissue pain, SDTP) and (3) vibrotactile stimulation (VT). The CSD in response to these stimuli was calculated in seven regions of interest (ROIs) likely involved in pain processing: contralateral anterior cingulate cortex, contralateral primary somatosensory cortex, bilateral anterior insula, contralateral dorsolateral prefrontal cortex, posterior parietal cortex and contralateral premotor cortex. Results showed that participants exhibited an overall increase in spectral power during SDTP in all seven ROIs compared to both SDTnP and VT, likely reflecting the differences in the salience of these stimuli. Moreover, we observed a difference is CSD due to the type of stimulus, likely reflecting somatosensory discrimination of stimulus intensity. These results describe the different contributions of neural oscillations within these brain regions in the processing of sustained deep-tissue pain.
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Affiliation(s)
- Juan Manuel Völker
- Department of Health Science and Technology, Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark.
| | - Federico Gabriel Arguissain
- Department of Health Science and Technology, Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - José Biurrun Manresa
- Department of Health Science and Technology, Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark.,Institute for Research and Development in Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
| | - Ole Kæseler Andersen
- Department of Health Science and Technology, Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
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18
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Mawla I, Schrepf A, Ichesco E, Harte SE, Klumpp DJ, Griffith JW, Strachan E, Yang CC, Lai H, Andriole G, Magnotta VA, Kreder K, Clauw DJ, Harris RE, Clemens JQ, Landis JR, Mullins C, Rodriguez LV, Mayer EA, Kutch JJ. Natural bladder filling alters resting brain function at multiple spatial scales: a proof-of-concept MAPP Network Neuroimaging Study. Sci Rep 2020; 10:19901. [PMID: 33199816 PMCID: PMC7669903 DOI: 10.1038/s41598-020-76857-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/29/2020] [Indexed: 01/23/2023] Open
Abstract
Neural circuitry regulating urine storage in humans has been largely inferred from fMRI during urodynamic studies driven by catheter infusion of fluid into the bladder. However, urodynamic testing may be confounded by artificially filling the bladder repeatedly at a high rate and examining associated time-locked changes in fMRI signals. Here we describe and test a more ecologically-valid paradigm to study the brain response to bladder filling by (1) filling the bladder naturally with oral water ingestion, (2) examining resting state fMRI (rs-fMRI) which is more natural since it is not linked with a specific stimulus, and (3) relating rs-fMRI measures to self-report (urinary urge) and physiologic measures (voided volume). To establish appropriate controls and analyses for future clinical studies, here we analyze data collected from healthy individuals (N = 62) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Participants orally ingested approximately 350 mL of water, and had a 10 min “fuller bladder” rs-fMRI scan approximately 1 h later. A second 10 min “empty bladder” rs-fMRI scan was conducted immediately following micturition. We examined multiple spatial scales of brain function, including local activity, circuits, and networks. We found changes in brain function distributed across micturition loci (e.g., subregions of the salience, sensorimotor, and default networks) that were significantly related to the stimulus (volume) and response (urinary urge). Based on our results, this paradigm can be applied in the future to study the neurobiological underpinnings of urologic conditions.
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Affiliation(s)
- Ishtiaq Mawla
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Eric Ichesco
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David J Klumpp
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Strachan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Henry Lai
- Department of Anesthesiology, Washington University, St. Louis, MO, USA.,Division of Urologic Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Gerald Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | | | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | | | - J Richard Landis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA, 90033, USA.
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19
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Physiological Measures of Acute and Chronic Pain within Different Subject Groups: A Systematic Review. Pain Res Manag 2020; 2020:9249465. [PMID: 32952747 PMCID: PMC7487119 DOI: 10.1155/2020/9249465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Results The methods' heart rate variability and electroencephalogram show clear and consistent results as acute pain assessment. Magnetic resonance imaging can measure chronic pain. Ordered by invasiveness and vulnerability, a trend shows that the invasive methods are used more with less vulnerable subjects. Only instruments used for skin conductance and automatic facial recognition have a lower-than-average technological maturity. Conclusions Some pain assessment methods show good and consistent results and have high technological maturity; however, using them as pain assessment for persons with ID is uncommon. Since this addition can ameliorate caregiving, more research of assessment methods should occur.
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20
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Pei Y, Zhang Y, Zhu Y, Zhao Y, Zhou F, Huang M, Wu L, Gong H. Hyperconnectivity and High Temporal Variability of the Primary Somatosensory Cortex in Low-Back-Related Leg Pain: An fMRI Study of Static and Dynamic Functional Connectivity. J Pain Res 2020; 13:1665-1675. [PMID: 32753942 PMCID: PMC7351631 DOI: 10.2147/jpr.s242807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/23/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate the functional connectivity (FC) and its variability in the primary somatosensory cortex (S1) of patients with low-back-related leg pain (LBLP) in the context of the persistent stimuli of pain and numbness. Patients and Methods We performed functional magnetic resonance imaging on LBLP patients (n = 26) and healthy controls (HCs; n = 34) at rest. We quantified and compared static FC (sFC) using a seed-based analysis strategy, with 6 predefined bilateral paired spherical regions of interest (ROIs) in the S1 cortex. Then, we captured the dynamic FC using sliding window correlation of ROIs in both the LBLP patients and HCs. Furthermore, we performed a correlational analysis between altered static and dynamic FC and clinical measures in LBLP patients. Results Compared with controls, the LBLP patients had 1) significantly increased static FC between the left S1back (the representation of the back in the S1) and right superior and middle frontal gyrus (SFG/MFG), between the left S1chest and right SFG/MFG, between right S1chest and right SFG/MFG, between the left S1face and right MFG, and between the right S1face and right inferior parietal lobule (P < 0.001, Gaussian random field theory correction); 2) increased dynamic FC only between the right S1finger and the left precentral and postcentral gyrus and between the right S1hand and the right precentral and postcentral gyrus (P < 0.01, Gaussian random field theory correction); and 3) a negative correlation between the Barthel index and the increased static FC between the left S1face and right inferior parietal lobule (P = 0.048). Conclusion The present study demonstrated the hyperconnectivity of the S1 cortex to the default mode and executive control network in a spatial pattern and an increase in the tendency for signal variability in the internal network connections of the S1 cortex in patients with LBLP.
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Affiliation(s)
- Yixiu Pei
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Yong Zhang
- Department of Pain Clinic, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China
| | - Yanyan Zhu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Yanlin Zhao
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
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21
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Hubbard CS, Lazaridou A, Cahalan CM, Kim J, Edwards RR, Napadow V, Loggia ML. Aberrant Salience? Brain Hyperactivation in Response to Pain Onset and Offset in Fibromyalgia. Arthritis Rheumatol 2020; 72:1203-1213. [PMID: 32017421 DOI: 10.1002/art.41220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While much brain research on fibromyalgia (FM) focuses on the study of hyperresponsiveness to painful stimuli, some studies suggest that the increased pain-related brain activity often reported in FM studies may be partially explained by stronger responses to salient aspects of the stimulation rather than, or in addition to, the stimulation's painfulness. Therefore, this study was undertaken to test our hypothesis that FM patients would demonstrate elevated brain responses to both pain onset and offset-2 salient sensory events of opposing valences. METHODS Thirty-eight FM patients (mean ± SD age 46.1 ± 13.4 years; 33 women) and 15 healthy controls (mean ± SD age 45.5 ± 12.4; 10 women) received a moderately painful pressure stimulus to the leg during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Stimulus onset and offset transients were analyzed using a general linear model as stick functions. RESULTS During pain onset, higher BOLD signal response was observed in FM patients compared to healthy controls in dorsolateral and ventrolateral prefrontal cortices (DLPFC and VLPFC, respectively), orbitofrontal cortex (OFC), frontal pole, and precentral gyrus (PrCG). During pain offset, higher and more widespread BOLD signal response was demonstrated in FM patients compared to controls in frontal regions significantly hyperactivated in response to onset. In FM patients, some of these responses were positively correlated with pain unpleasantness ratings (VLPFC, onset; r = 0.35, P = 0.03), pain catastrophizing scores (DLPFC, offset; r = 0.33, P = 0.04), or negatively correlated with stimulus intensity (OFC, offset; r = -0.35, P = 0.03) (PrCG, offset; r = -0.39, P = 0.02). CONCLUSION Our results suggest that the increased sensitivity exhibited by FM patients in response to the onset and offset of painful stimuli may reflect a more generalized hypersensitivity to salient sensory events, and that brain hyperactivation may be a mechanism potentially involved in the generalized hypervigilance to salient stimuli in FM.
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Affiliation(s)
- Catherine S Hubbard
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jieun Kim
- Massachusetts General Hospital, Charlestown
| | - Robert R Edwards
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco L Loggia
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
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22
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Somatotopically specific primary somatosensory connectivity to salience and default mode networks encodes clinical pain. Pain 2020; 160:1594-1605. [PMID: 30839429 DOI: 10.1097/j.pain.0000000000001541] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although several studies have found that chronic pain is characterized by increased cross-network connectivity between salience network, sensorimotor network, and default mode network (DMN), a large sample-size investigation allowing for a more reliable evaluation of somatotopic specificity and subgroup analyses with linkage to clinical pain intensity has been lacking. We enrolled healthy adults and a large cohort of patients (N = 181) suffering from chronic low back pain (cLBP). To specifically link brain connectivity with clinical pain intensity, patients were scanned at baseline and after performing physical maneuvers that exacerbated pain. Compared with healthy adults, patients with cLBP demonstrated increased connectivity between the functionally localized back representation in the primary somatosensory cortex (S1back) and both salience network and DMN. Pain exacerbation maneuvers increased S1back connectivity to salience network regions, but decreased connectivity to DMN, with greater pain intensity increase associated with greater shifts in these connectivity patterns. Furthermore, only in patients with cLBP reporting high pain catastrophizing, DMN connectivity was increased to a cardinal node of the salience network, anterior insula cortex, which was correlated with increased postmaneuver pain in this cLBP subgroup. Hence, increased information transfer between salience processing regions, particularly anterior insula, and DMN may be strongly influenced by pain catastrophizing. Increased information transfer between the salience network and S1 likely plays an important role in shifting nociceptive afference away from self-referential processing, reallocating attentional focus, and affective coding of nociceptive afference from specific body areas. These results demonstrate S1 somatotopic specificity for cross-network connectivity in encoding clinical back pain and moderating influence of catastrophizing for DMN/insula connectivity.
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23
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Lee J, Eun S, Kim J, Lee JH, Park K. Differential Influence of Acupuncture Somatosensory and Cognitive/Affective Components on Functional Brain Connectivity and Pain Reduction During Low Back Pain State. Front Neurosci 2019; 13:1062. [PMID: 31636536 PMCID: PMC6788296 DOI: 10.3389/fnins.2019.01062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
The underlying mechanism of pain reduction by acupuncture is still unclear, because acupuncture treatment involves multidimensional factors. In this study, we investigated the differential influence of acupuncture components on brain functional connectivity and on pain reduction. We used a specific form of sham acupuncture (phantom acupuncture; PHNT), which only has a needling-credibility (a belief that they were treated with real acupuncture needles), while real acupuncture (REAL) has a somatosensory needling stimulation, as well as a needling-credibility. Forty-three patients with low back pain were randomized into the REAL group (n = 25) and the PHNT group (n = 18). They underwent two pain steady-state fMRI runs implemented by a low back extension (LBE) pain model (lifting the low back using air-cuff inflation) before and after REAL or PHNT stimulation. Subjective pain ratings, perceived throughout the LBE runs due to the posture, were reported (LBEpain). The regions of interest (ROI) were (1) the main nodes of the default mode network (DMN) – the medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), (2) the main nodes of the salience network (SN) – the anterior/posterior insular cortices (a/pINS), and (3) the low back-specific region of sensorimotor network (SMN), S1back. Significant reductions in LBEpain were observed in both groups (REAL = −1.02 ± 1.53, PHNT = −1.26 ± 2.20). In REAL group, decreased LBEpain was positively correlated with decreased functional connectivity between the mPFC and pINS (r = 0.58, P < 0.05). Reduced LBEpain in PHNT was negatively correlated with increased PCC–aINS connectivity (r = −0.48, P < 0.05) and tended toward positive correlation with decreased S1back–pINS connectivity (r = 0.44, P = 0.07). Our findings might suggest different brain mechanisms of observed pain reduction; REAL seems to involve detachment of the self from the sensory aspect of pain, while PHNT does to shift attention to self and disengages physical pain processing hubs. This exploratory study proposes a sham methodology to dissociate the influence of different acupuncture components in acupuncture research. Further studies need to be followed with more elaborated hypothesis, study design, and analysis considering various cognitive/affective factors for better understanding of brain mechanisms of pain reduction regarding the different acupuncture aspects.
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Affiliation(s)
- Jeungchan Lee
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Seulgi Eun
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Jieun Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Kyungmo Park
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
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24
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Palsson TS, Boudreau SA, Krebs HJ, Graven-Nielsen T. Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study. THE JOURNAL OF PAIN 2018; 19:1189-1200. [DOI: 10.1016/j.jpain.2018.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
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25
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Matsubayashi K, Nagoshi N, Komaki Y, Kojima K, Shinozaki M, Tsuji O, Iwanami A, Ishihara R, Takata N, Matsumoto M, Mimura M, Okano H, Nakamura M. Assessing cortical plasticity after spinal cord injury by using resting-state functional magnetic resonance imaging in awake adult mice. Sci Rep 2018; 8:14406. [PMID: 30258091 PMCID: PMC6158265 DOI: 10.1038/s41598-018-32766-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/26/2018] [Indexed: 12/30/2022] Open
Abstract
Neural connectivity has recently been shown to be altered after spinal cord injury (SCI) not only in the spinal cord but also in the brain. However, to date, no studies have analyzed the functional alterations after SCI in various areas of the cerebral cortex over time. To examine the plasticity of the neural connectivity in the brain after SCI, we performed resting-state functional magnetic resonance imaging (rs-fMRI) in awake adult mice pre- and post-SCI. After a complete thoracic SCI, the functional connectivity between the primary motor (MOp) and primary sensory (SSp) areas was significantly decreased during the chronic phase. In contrast, the connectivity between the MOp and motivation area was increased. Thus, impairments in sensory and motor connections after SCI led to a time-dependent compensatory upregulation of “motor functional motivation”. Moreover, the functional connectivity between the SSp and pain-related areas, such as the caudoputamen (CP) and the anterior cingulate area (ACA), was strengthened during the chronic phase, thus suggesting that rs-fMRI can indicate the presence of neuropathic pain after SCI. Therefore, rs-fMRI is a useful tool for revealing the pathological changes that occur in the brain after SCI.
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Affiliation(s)
- Kohei Matsubayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Physiology, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Komaki
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan.,Central Institute for Experimental Animals, Kawasaki, Japan
| | - Kota Kojima
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Munehisa Shinozaki
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akio Iwanami
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryosuke Ishihara
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Norio Takata
- Central Institute for Experimental Animals, Kawasaki, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan. .,Laboratory for Marmoset Neural Architecture, RIKEN Center for Brain Science, Wako-shi, Saitama, 351-0198, Japan.
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
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26
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Makary MM, Seulgi E. Self-regulation of primary motor cortex activity with motor imagery induces functional connectivity modulation: A real-time fMRI neurofeedback study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:4147-4150. [PMID: 29060810 DOI: 10.1109/embc.2017.8037769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent developments in data acquisition of functional magnetic resonance imaging (fMRI) have led to rapid preprocessing and analysis of brain activity in a quasireal-time basis, what so called real-time fMRI neurofeedback (rtfMRI-NFB). This information is fed back to subjects allowing them to gain a voluntary control over their own region-specific brain activity. Forty-one healthy participants were randomized into an experimental (NFB) group, who received a feedback directly proportional to their brain activity from the primary motor cortex (M1), and a control (CTRL) group who received a sham feedback. The M1 ROI was functionally localized during motor execution and imagery tasks. A resting-state functional run was performed before and after the neurofeedback training to investigate the default mode network (DMN) modulation after training. The NFB group revealed increased DMN functional connectivity after training to the cortical and subcortical sensory/motor areas (M1/S1 and caudate nucleus, respectively), which may be associated with sensorimotor processing of learning in the resting state. These results show that motor imagery training through rtfMRI-NFB could modulate the DMN functional connectivity to motor-related areas, suggesting that this modulation potentially subserved the establishment of motor learning in the NFB group.
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27
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Ellingsen DM, Garcia RG, Lee J, Lin RL, Kim J, Thurler AH, Castel S, Dimisko L, Rosen BR, Hadjikhani N, Kuo B, Napadow V. Cyclic Vomiting Syndrome is characterized by altered functional brain connectivity of the insular cortex: A cross-comparison with migraine and healthy adults. Neurogastroenterol Motil 2017; 29:10.1111/nmo.13004. [PMID: 27910222 PMCID: PMC5423835 DOI: 10.1111/nmo.13004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/07/2016] [Indexed: 02/03/2023]
Abstract
Cyclic Vomiting Syndrome (CVS) has been linked to episodic migraine, yet little is known about the precise brain-based mechanisms underpinning CVS, and whether these associated conditions share similar pathophysiology. We investigated the functional integrity of salience (SLN) and sensorimotor (SMN) intrinsic connectivity networks in CVS, migraine and healthy controls using brain functional Magnetic Resonance Imaging. CVS, relative to both migraine and controls, showed increased SLN connectivity to middle/posterior insula, a key brain region for nausea and viscerosensory processing. In contrast, this same region showed diminished SMN connectivity in both CVS and migraine. These results highlight both unique and potentially shared pathophysiology between these conditions, and suggest a potential target for therapeutics in future studies.
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Affiliation(s)
- Dan-Mikael Ellingsen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ronald G. Garcia
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuroscience Group, School of Medicine, Universidad de Santander (UDES), Bucaramanga, Colombia
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeungchan Lee
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard L. Lin
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Korean Institute for Oriental Medicine, Daejeon, Korea
| | - Andrea H Thurler
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahar Castel
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laurie Dimisko
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce R. Rosen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nouchine Hadjikhani
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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28
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Vogt KM, Becker CJ, Wasan AD, Ibinson JW. Human Posterior Insula Functional Connectivity Differs Between Electrical Pain and the Resting State. Brain Connect 2016; 6:786-794. [PMID: 27527402 DOI: 10.1089/brain.2016.0436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective in this study was to directly compare MRI-based functional connectivity between conditions of rest and painful electrical nerve stimulation for key regions involved in pain processing: the anterior and posterior insula and the anterior cingulate cortex. Electric nerve stimulation, rated 7/10 for pain, was delivered to the right index finger of 14 healthy pain-free adult volunteers in four 30-sec blocks and continuously for 2 min. Functional connectivity maps obtained at rest and during both pain tasks were compared using seed time courses from the left anterior and posterior insula and anterior cingulate. Significant Pain versus Rest connectivity differences were consistently shown for the posterior insula, notably to the posterior cingulate and precuneus, while minimal and inconsistent differences were observed for the anterior insula and anterior cingulate. This study reinforces the known differences that can occur with changes in seed region selection in functional connectivity analysis. It also presents preliminary evidence that functional connectivity for the left posterior insula can potentially differentiate the presence of acute right-sided electrical pain from the nonpainful resting state.
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Affiliation(s)
- Keith M Vogt
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Christopher J Becker
- 2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ajay D Wasan
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - James W Ibinson
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
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29
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Motion sickness increases functional connectivity between visual motion and nausea-associated brain regions. Auton Neurosci 2016; 202:108-113. [PMID: 28245927 DOI: 10.1016/j.autneu.2016.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/25/2016] [Accepted: 10/15/2016] [Indexed: 11/21/2022]
Abstract
The brain networks supporting nausea not yet understood. We previously found that while visual stimulation activated primary (V1) and extrastriate visual cortices (MT+/V5, coding for visual motion), increasing nausea was associated with increasing sustained activation in several brain areas, with significant co-activation for anterior insula (aIns) and mid-cingulate (MCC) cortices. Here, we hypothesized that motion sickness also alters functional connectivity between visual motion and previously identified nausea-processing brain regions. Subjects prone to motion sickness and controls completed a motion sickness provocation task during fMRI/ECG acquisition. We studied changes in connectivity between visual processing areas activated by the stimulus (MT+/V5, V1), right aIns and MCC when comparing rest (BASELINE) to peak nausea state (NAUSEA). Compared to BASELINE, NAUSEA reduced connectivity between right and left V1 and increased connectivity between right MT+/V5 and aIns and between left MT+/V5 and MCC. Additionally, the change in MT+/V5 to insula connectivity was significantly associated with a change in sympathovagal balance, assessed by heart rate variability analysis. No state-related connectivity changes were noted for the control group. Increased connectivity between a visual motion processing region and nausea/salience brain regions may reflect increased transfer of visual/vestibular mismatch information to brain regions supporting nausea perception and autonomic processing. We conclude that vection-induced nausea increases connectivity between nausea-processing regions and those activated by the nauseogenic stimulus. This enhanced low-frequency coupling may support continual, slowly evolving nausea perception and shifts toward sympathetic dominance. Disengaging this coupling may be a target for biobehavioral interventions aimed at reducing motion sickness severity.
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30
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Effects of chronic neck–shoulder pain on normalized mutual information analysis of surface electromyography during functional tasks. Clin Neurophysiol 2016; 127:3110-3117. [DOI: 10.1016/j.clinph.2016.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/14/2016] [Accepted: 06/18/2016] [Indexed: 11/22/2022]
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Michels L, Christidi F, Steiger VR, Sándor PS, Gantenbein AR, Landmann G, Schreglmann SR, Kollias S, Riederer F. Pain modulation is affected differently in medication-overuse headache and chronic myofascial pain - A multimodal MRI study. Cephalalgia 2016; 37:764-779. [PMID: 27250235 DOI: 10.1177/0333102416652625] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Neuroimaging studies revealed structural and functional changes in medication-overuse headache (MOH), but it remains unclear whether similar changes could be observed in other chronic pain disorders. Methods In this cross-sectional study, we investigated functional connectivity (FC) with resting-state functional magnetic resonance imaging (fMRI) and white matter integrity using diffusion tensor imaging (DTI) to measure fractional anisotropy (FA) and mean diffusivity (MD) in patients with MOH ( N = 12) relative to two control groups: patients with chronic myofascial pain (MYO; N = 11) and healthy controls (CN; N = 16). Results In a data-driven approach we found hypoconnectivity in the fronto-parietal attention network in both pain groups relative to CN (i.e. MOH < CN and MYO < CN). In contrast, hyperconnectivity in the saliency network (SN) was detected only in MOH, which correlated with FA in the insula. In a seed-based analysis we investigated FC between the periaqueductal grey (PAG) and all other brain regions. In addition to overlapping hyperconnectivity seen in patient groups (relative to CN), MOH had a distinct connectivity pattern with lower FC to parieto-occipital regions and higher FC to orbitofrontal regions compared to controls. FA and MD abnormalities were mostly observed in MOH, involving the insula. Conclusions Hyperconnectivity within the SN along with associated white matter changes therein suggest a particular role of this network in MOH. In addition, abnormal connectivity between the PAG and other pain modulatory (frontal) regions in MOH are consistent with dysfunctional central pain control.
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Affiliation(s)
- Lars Michels
- 1 Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Foteini Christidi
- 1 Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Vivian R Steiger
- 2 Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Peter S Sándor
- 3 RehaClinic, Bad Zurzach and Baden, Switzerland.,4 University of Zurich, Zürich, Switzerland
| | - Andreas R Gantenbein
- 3 RehaClinic, Bad Zurzach and Baden, Switzerland.,4 University of Zurich, Zürich, Switzerland
| | - Gunther Landmann
- 5 Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | | | - Spyros Kollias
- 1 Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Franz Riederer
- 4 University of Zurich, Zürich, Switzerland.,7 Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
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Ko SJ, Park K, Kim J, Kim M, Kim JH, Lee J, Mohamed AZ, Yeo I, Kim J, Choi SM, Kim H, Park JW, Lee JH. Effect of acupuncture and its influence on cerebral activity in functional dyspepsia patients: study protocol for a randomized controlled trial. Trials 2016; 17:183. [PMID: 27039086 PMCID: PMC4818864 DOI: 10.1186/s13063-016-1296-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/17/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a prevalent gastric disorder that is difficult to manage due to lack of satisfactory treatments. Acupuncture has been studied with regard to the rising need for treating FD, but the mechanism verifying its efficacy has not yet been fully revealed. The aim of this study is to explore the efficacy and mechanism of acupuncture for FD compared with a sham group. METHODS/DESIGN We describe a proposal for a randomized, assessor-blind, sham-controlled trial with 70 eligible participants who will be randomly allocated either into an acupuncture or a sham group. Participants in the acupuncture group will receive 10 sessions of real acupuncture treatment and those in the sham group will be treated with identical sessions using a Streitberger needle. Functional magnetic resonance imaging (fMRI) and metabolomics studies will be implemented before and after 4 weeks of treatment to investigate the mechanism of acupuncture. The primary outcome is a proportion of responders with adequate symptom relief and the secondary outcomes include the Nepean Dyspepsia Index - Korean version, Functional Dyspepsia-Related Quality of Life questionnaire, Ways of Coping Questionnaire, Coping Strategies Questionnaire, perception of bodily sensation questionnaire, State-Trait Anxiety Inventory, and the Center for Epidemiological Studies - Depression Scale. The outcomes will be evaluated before and after the treatment. DISCUSSION This is the first large-scale trial evaluating the efficacy and mechanism of acupuncture with fMRI and metabolomic methods. We will compare real acupuncture with the Streitberger sham needle to verify the specific effect of acupuncture. The results of this trial are expected to be relevant evidences affecting policy and decision-makers associated with routine healthcare. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358486 . Date of Registration: 21 January 2015.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyungmo Park
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Jieun Kim
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Minji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joo-Hee Kim
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeungchan Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA
| | - Abdalla Z Mohamed
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Inkwon Yeo
- Department of Statistics, Sookmyung Women's University, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sun-Mi Choi
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Honggeol Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Jun-Hwan Lee
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea. .,Korean Medicine Life Science, University of Science & Technology, Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
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Sikandar S, Aasvang EK, Dickenson AH. Scratching the surface: the processing of pain from deep tissues. Pain Manag 2016; 6:95-102. [PMID: 26974398 DOI: 10.2217/pmt.15.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although most pain research focuses on skin, muscles, joints and viscerae are major sources of pain. We discuss the mechanisms of deep pains arising from somatic and visceral structures and how this can lead to widespread manifestations and chronification. We include how both altered peripheral and central sensory neurotransmission lead to deep pain states and comment on key areas such as top-down modulation where little is known. It is vital that the clinical characterization of deep pain in patients is improved to allow for back translation to preclinical models so that the missing links can be ascertained. The contribution of deeper somatic and visceral tissues to various chronic pain syndromes is common but there is much we need to know.
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Affiliation(s)
- Shafaq Sikandar
- Department of Neuroscience, Physiology & Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Eske Kvanner Aasvang
- Section for Surgical Pathophysiology, Julianne Marie Centre, Rigshospitalet, Copenhagen University, Copenhagen 2100 KBH Ø, Denmark
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology & Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
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Amin FM, Hougaard A, Magon S, Asghar MS, Ahmad NN, Rostrup E, Sprenger T, Ashina M. Change in brain network connectivity during PACAP38-induced migraine attacks: A resting-state functional MRI study. Neurology 2015; 86:180-7. [PMID: 26674334 DOI: 10.1212/wnl.0000000000002261] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate resting-state functional connectivity in the salience network (SN), the sensorimotor network (SMN), and the default mode network (DMN) during migraine attacks induced by pituitary adenylate cyclase-activating polypeptide-38 (PACAP38). METHODS In a double-blind, randomized study, 24 female migraine patients without aura received IV PACAP38 or vasoactive intestinal polypeptide (VIP) over 20 minutes. Both peptides are closely related and cause vasodilation, but only PACAP38 induces migraine attacks. VIP was therefore used as active placebo. Resting-state functional MRI was recorded before and during PACAP38-induced migraine attacks and before and after VIP infusion. We analyzed data by Statistical Parametric Mapping 8 and the Resting-State fMRI Data Analysis Toolkit for Matlab in a seed-based fashion. RESULTS PACAP38 (n = 16) induced migraine attacks and increased connectivity with the bilateral opercular part of the inferior frontal gyrus in the SN. In SMN, there was increased connectivity with the right premotor cortex and decreased connectivity with the left visual cortex. Several areas showed increased (left primary auditory, secondary somatosensory, premotor, and visual cortices) and decreased (right cerebellum and left frontal lobe) connectivity with DMN. We found no resting-state network changes after VIP (n = 15). CONCLUSIONS PACAP38-induced migraine attack is associated with altered connectivity of several large-scale functional networks of the brain.
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Affiliation(s)
- Faisal Mohammad Amin
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Anders Hougaard
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Stefano Magon
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Mohammad Sohail Asghar
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Nur Nabil Ahmad
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Egill Rostrup
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Till Sprenger
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Messoud Ashina
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany.
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Ibinson JW, Vogt KM, Taylor KB, Dua SB, Becker CJ, Loggia M, Wasan AD. Optimizing and Interpreting Insular Functional Connectivity Maps Obtained During Acute Experimental Pain: The Effects of Global Signal and Task Paradigm Regression. Brain Connect 2015; 5:649-57. [PMID: 26061382 DOI: 10.1089/brain.2015.0354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The insula is uniquely located between the temporal and parietal cortices, making it anatomically well-positioned to act as an integrating center between the sensory and affective domains for the processing of painful stimulation. This can be studied through resting-state functional connectivity (fcMRI) imaging; however, the lack of a clear methodology for the analysis of fcMRI complicates the interpretation of these data during acute pain. Detected connectivity changes may reflect actual alterations in low-frequency synchronous neuronal activity related to pain, may be due to changes in global cerebral blood flow or the superimposed task-induced neuronal activity. The primary goal of this study was to investigate the effects of global signal regression (GSR) and task paradigm regression (TPR) on the changes in functional connectivity of the left (contralateral) insula in healthy subjects at rest and during acute painful electric nerve stimulation of the right hand. The use of GSR reduced the size and statistical significance of connectivity clusters and created negative correlation coefficients for some connectivity clusters. TPR with cyclic stimulation gave task versus rest connectivity differences similar to those with a constant task, suggesting that analysis which includes TPR is more accurately reflective of low-frequency neuronal activity. Both GSR and TPR have been inconsistently applied to fcMRI analysis. Based on these results, investigators need to consider the impact GSR and TPR have on connectivity during task performance when attempting to synthesize the literature.
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Affiliation(s)
- James W Ibinson
- 1 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Keith M Vogt
- 2 Department of Anesthesiology, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Kevin B Taylor
- 3 University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Shiv B Dua
- 4 George Washington University School of Medicine and Health Sciences , Washington, District of Columbia
| | | | - Marco Loggia
- 5 Department of Radiology, Massachusetts General Hospital, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Ajay D Wasan
- 1 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
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36
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Loggia ML, Berna C, Kim J, Cahalan CM, Martel MO, Gollub RL, Wasan AD, Napadow V, Edwards RR. The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients. THE JOURNAL OF PAIN 2015; 16:692-9. [PMID: 25937162 PMCID: PMC4522376 DOI: 10.1016/j.jpain.2015.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/01/2015] [Accepted: 04/11/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Although high levels of negative affect and cognitions have been associated with greater pain sensitivity in chronic pain conditions, the neural mechanisms mediating the hyperalgesic effect of psychological factors in patients with pain disorders are largely unknown. In this cross-sectional study, we hypothesized that 1) catastrophizing modulates brain responses to pain anticipation and 2) anticipatory brain activity mediates the hyperalgesic effect of different levels of catastrophizing in fibromyalgia (FM) patients. Using functional magnetic resonance imaging, we scanned the brains of 31 FM patients exposed to visual cues anticipating the onset of moderately intense deep-tissue pain stimuli. Our results indicated the existence of a negative association between catastrophizing and pain-anticipatory brain activity, including in the right lateral prefrontal cortex. A bootstrapped mediation analysis revealed that pain-anticipatory activity in the lateral prefrontal cortex mediates the association between catastrophizing and pain sensitivity. These findings highlight the role of the lateral prefrontal cortex in the pathophysiology of FM-related hyperalgesia and suggest that deficits in the recruitment of pain-inhibitory brain circuitry during pain-anticipatory periods may play an important contributory role in the association between various degrees of widespread hyperalgesia in FM and levels of catastrophizing, a well-validated measure of negative cognitions and psychological distress. PERSPECTIVE This article highlights the presence of alterations in pain-anticipatory brain activity in FM. These findings provide the rationale for the development of psychological or neurofeedback-based techniques aimed at modifying patients' negative affect and cognitions toward pain.
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Affiliation(s)
- Marco L Loggia
- Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts.
| | - Chantal Berna
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jieun Kim
- Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Christine M Cahalan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marc-Olivier Martel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Randy L Gollub
- Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Ajay D Wasan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vitaly Napadow
- Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts; Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
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Kim J, Loggia ML, Cahalan CM, Harris RE, Beissner F, Garcia RG, Kim H, Wasan AD, Edwards RR, Napadow V. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol 2015; 67:1395-1405. [PMID: 25622796 DOI: 10.1002/art.39043] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/15/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is a chronic functional pain syndrome characterized by widespread pain, significant pain catastrophizing, sympathovagal dysfunction, and amplified temporal summation for evoked pain. While several studies have demonstrated altered resting brain connectivity in FM, studies have not specifically probed the somatosensory system and its role in both somatic and nonsomatic FM symptoms. Our objective was to evaluate resting primary somatosensory cortex (S1) connectivity and to explore how sustained, evoked deep tissue pain modulates this connectivity. METHODS We acquired functional magnetic resonance imaging and electrocardiography data on FM patients and healthy controls during rest (the rest phase) and during sustained mechanical pressure-induced pain over the lower leg (the pain phase). Functional connectivity associated with different S1 subregions was calculated, while S1(leg) connectivity (representation of the leg in the primary somatosensory cortex) was contrasted between the rest phase and the pain phase and was correlated with clinically relevant measures in FM. RESULTS During the rest phase, FM patients showed decreased connectivity between multiple ipsilateral and cross-hemispheric S1 subregions, which was correlated with clinical pain severity. Compared to the rest phase, the pain phase produced increased S1(leg) connectivity to the bilateral anterior insula in FM patients, but not in healthy controls. Moreover, in FM patients, sustained pain-altered S1(leg) connectivity to the anterior insula was correlated with clinical/behavioral pain measures and autonomic responses. CONCLUSION Our study demonstrates that both somatic and nonsomatic dysfunction in FM, including clinical pain, pain catastrophizing, autonomic dysfunction, and amplified temporal summation, are closely linked with the degree to which evoked deep tissue pain alters S1 connectivity to salience/affective pain-processing regions. Additionally, diminished connectivity between S1 subregions during the rest phase in FM may result from ongoing widespread clinical pain.
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Affiliation(s)
- Jieun Kim
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Division of Medical Research, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School (HMS), Chestnut Hill, MA, USA
| | - Christine M Cahalan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School (HMS), Chestnut Hill, MA, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Florian Beissner
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Ronald G Garcia
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Masira Research Institute, School of Medicine, Universidad de Santander, Bucaramanga, Colombia
| | - Hyungjun Kim
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Division of Medical Research, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Ajay D Wasan
- Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School (HMS), Chestnut Hill, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, HMS, Boston, MA, USA
| | - Vitaly Napadow
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School (HMS), Chestnut Hill, MA, USA.,Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin, Korea
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38
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Fibromyalgia is characterized by altered frontal and cerebellar structural covariance brain networks. NEUROIMAGE-CLINICAL 2015; 7:667-77. [PMID: 25844321 PMCID: PMC4379388 DOI: 10.1016/j.nicl.2015.02.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/24/2015] [Accepted: 02/27/2015] [Indexed: 01/24/2023]
Abstract
Altered brain morphometry has been widely acknowledged in chronic pain, and recent studies have implicated altered network dynamics, as opposed to properties of individual brain regions, in supporting persistent pain. Structural covariance analysis determines the inter-regional association in morphological metrics, such as gray matter volume, and such structural associations may be altered in chronic pain. In this study, voxel-based morphometry structural covariance networks were compared between fibromyalgia patients (N = 42) and age- and sex-matched pain-free adults (N = 63). We investigated network topology using spectral partitioning, which can delineate local network submodules with consistent structural covariance. We also explored white matter connectivity between regions comprising these submodules and evaluated the association between probabilistic white matter tractography and pain-relevant clinical metrics. Our structural covariance network analysis noted more connections within the cerebellum for fibromyalgia patients, and more connections in the frontal lobe for healthy controls. For fibromyalgia patients, spectral partitioning identified a distinct submodule with cerebellar connections to medial prefrontal and temporal and right inferior parietal lobes, whose gray matter volume was associated with the severity of depression in these patients. Volume for a submodule encompassing lateral orbitofrontal, inferior frontal, postcentral, lateral temporal, and insular cortices was correlated with evoked pain sensitivity. Additionally, the number of white matter fibers between specific submodule regions was also associated with measures of evoked pain sensitivity and clinical pain interference. Hence, altered gray and white matter morphometry in cerebellar and frontal cortical regions may contribute to, or result from, pain-relevant dysfunction in chronic pain patients. We conducted structural covariance and tractography analyses in fibromyalgia. In fibromyalgia, higher correlations between cerebellar ROI volumes were found. In controls, higher correlations between frontal ROI volumes were found. Volume of cerebellum, orbitofrontal and inferior parietal areas correlated with BDI. WM fiber numbers connecting the areas associated with hyperalgesia and clinical pain
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Key Words
- AAL, automated anatomical labeling
- BDI, Beck depression inventory
- BPI, brief pain inventory
- Cerebellum
- DTI, diffusion tensor imaging
- FM, fibromyalgia
- FSL, FMRIB software library
- Fibromyalgia
- HC, healthy controls
- MCP, middle cerebellar peduncle
- MNI, Montreal neurological institute
- MRI, magnetic resonance imaging
- Network
- P40, the pressure level (mm Hg) for a pain intensity rating of 40/100
- Pain
- ROI, region of interest
- SCP, superior cerebellar peduncle
- SPM, statistical parametric mapping
- Tractography
- VBM, voxel-based morphometry
- fMRI, functional MRI
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Wright H, Li X, Fallon NB, Giesbrecht T, Thomas A, Harrold JA, Halford JCG, Stancak A. Heightened eating drive and visual food stimuli attenuate central nociceptive processing. J Neurophysiol 2014; 113:1323-33. [PMID: 25475348 PMCID: PMC4346715 DOI: 10.1152/jn.00504.2014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hunger and pain are basic drives that compete for a behavioral response when experienced together. To investigate the cortical processes underlying hunger-pain interactions, we manipulated participants' hunger and presented photographs of appetizing food or inedible objects in combination with painful laser stimuli. Fourteen healthy participants completed two EEG sessions: one after an overnight fast, the other following a large breakfast. Spatio-temporal patterns of cortical activation underlying the hunger-pain competition were explored with 128-channel EEG recordings and source dipole analysis of laser-evoked potentials (LEPs). We found that initial pain ratings were temporarily reduced when participants were hungry compared with fed. Source activity in parahippocampal gyrus was weaker when participants were hungry, and activations of operculo-insular cortex, anterior cingulate cortex, parahippocampal gyrus, and cerebellum were smaller in the context of appetitive food photographs than in that of inedible object photographs. Cortical processing of noxious stimuli in pain-related brain structures is reduced and pain temporarily attenuated when people are hungry or passively viewing food photographs, suggesting a possible interaction between the opposing motivational forces of the eating drive and pain.
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Affiliation(s)
- Hazel Wright
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
| | - Xiaoyun Li
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
| | - Nicholas B Fallon
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
| | | | | | - Joanne A Harrold
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
| | - Jason C G Halford
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
| | - Andrej Stancak
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and
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Desbordes G, Li A, Loggia ML, Kim J, Schalock PC, Lerner E, Tran TN, Ring J, Rosen BR, Kaptchuk TJ, Pfab F, Napadow V. Evoked itch perception is associated with changes in functional brain connectivity. NEUROIMAGE-CLINICAL 2014; 7:213-21. [PMID: 25610783 PMCID: PMC4300003 DOI: 10.1016/j.nicl.2014.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Abstract
Chronic itch, a highly debilitating condition, has received relatively little attention in the neuroimaging literature. Recent studies suggest that brain regions supporting itch in chronic itch patients encompass sensorimotor and salience networks, and corticostriatal circuits involved in motor preparation for scratching. However, how these different brain areas interact with one another in the context of itch is still unknown. We acquired BOLD fMRI scans in 14 atopic dermatitis patients to investigate resting-state functional connectivity before and after allergen-induced itch exacerbated the clinical itch perception in these patients. A seed-based analysis revealed decreased functional connectivity from baseline resting state to the evoked-itch state between several itch-related brain regions, particularly the insular and cingulate cortices and basal ganglia, where decreased connectivity was significantly correlated with increased levels of perceived itch. In contrast, evoked itch increased connectivity between key nodes of the frontoparietal control network (superior parietal lobule and dorsolateral prefrontal cortex), where higher increase in connectivity was correlated with a lesser increase in perceived itch, suggesting that greater interaction between nodes of this executive attention network serves to limit itch sensation via enhanced top-down regulation. Overall, our results provide the first evidence of itch-dependent changes in functional connectivity across multiple brain regions. Atopic dermatitis patients were subjected to allergen-induced itch. Evoked itch reduced functional connectivity between itch-related brain regions. Evoked itch increased functional connectivity within frontoparietal control network. The above changes in functional connectivity correlated with perceived itch level. Itch sensation may be top-down regulated by frontoparietal control network.
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Key Words
- AD, atopic dermatitis
- ASL, arterial spin labeling
- Atopic dermatitis
- BA, Brodmann area
- BOLD, blood-oxygen-level dependent
- DMN, default mode network
- ECG, electrocardiography
- Eczema
- GLM, general linear model
- ITCH, evoked itch resting-state scan
- Insula
- L, left
- MNI, Montreal Neurological Institute
- MR, magnetic resonance
- PCC, posterior cingulate cortex
- PET, positron emission tomography
- PMC, premotor cortex
- Pruritus
- Putamen
- R, right
- REST, baseline resting-state scan
- S1/M1, primary sensorimotor cortex
- SCORAD, SCORing atopic dermatitis scale
- SPL, Superior parietal lobule
- VAS, visual analog scale
- aMCC, anterior mid-cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fcMRI, functional connectivity magnetic resonance imaging
- pMCC, posterior mid-cingulate cortex
- vlPFC, ventrolateral prefrontal cortex.
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Affiliation(s)
- Gaëlle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter C Schalock
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan Lerner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thanh N Tran
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ted J Kaptchuk
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Florian Pfab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Radiology, Logan College of Chiropractic, Chesterfield, MO, USA ; Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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41
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Akeju O, Loggia ML, Catana C, Pavone KJ, Vazquez R, Rhee J, Contreras Ramirez V, Chonde DB, Izquierdo-Garcia D, Arabasz G, Hsu S, Habeeb K, Hooker JM, Napadow V, Brown EN, Purdon PL. Disruption of thalamic functional connectivity is a neural correlate of dexmedetomidine-induced unconsciousness. eLife 2014; 3:e04499. [PMID: 25432022 PMCID: PMC4280551 DOI: 10.7554/elife.04499] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/26/2014] [Indexed: 12/17/2022] Open
Abstract
Understanding the neural basis of consciousness is fundamental to neuroscience research. Disruptions in cortico-cortical connectivity have been suggested as a primary mechanism of unconsciousness. By using a novel combination of positron emission tomography and functional magnetic resonance imaging, we studied anesthesia-induced unconsciousness and recovery using the α2-agonist dexmedetomidine. During unconsciousness, cerebral metabolic rate of glucose and cerebral blood flow were preferentially decreased in the thalamus, the Default Mode Network (DMN), and the bilateral Frontoparietal Networks (FPNs). Cortico-cortical functional connectivity within the DMN and FPNs was preserved. However, DMN thalamo-cortical functional connectivity was disrupted. Recovery from this state was associated with sustained reduction in cerebral blood flow and restored DMN thalamo-cortical functional connectivity. We report that loss of thalamo-cortical functional connectivity is sufficient to produce unconsciousness. DOI:http://dx.doi.org/10.7554/eLife.04499.001 Although we are all familiar with the experience of being conscious, explaining precisely what consciousness is and how it arises from activity in the brain remains extremely challenging. Indeed, explaining consciousness is so challenging that it is sometimes referred to as ‘the hard question’ of neuroscience. One way to obtain insights into the neural basis of consciousness is to compare patterns of activity in the brains of conscious subjects with patterns of brain activity in the same subjects under anesthesia. The results of some experiments of this kind suggest that loss of consciousness occurs when the communication between specific regions within the outer layer of the brain, the cortex, is disrupted. However, other studies seem to contradict these findings by showing that this communication can sometimes remain intact in unconscious subjects. Akeju, Loggia et al. have now resolved this issue by using brain imaging to examine the changes that occur as healthy volunteers enter and emerge from a light form of anesthesia roughly equivalent to non-REM sleep. An imaging technique called PET revealed that the loss of consciousness in the subjects was accompanied by reduced activity in a structure deep within the brain called the thalamus. Reduced activity was also seen in areas of cortex at the front and back of the brain. A technique called fMRI showed in turn that communication between the cortex and the thalamus was disrupted as subjects drifted into unconsciousness, whereas communication between cortical regions was spared. As subjects awakened from the anesthesia, communication between the thalamus and the cortex was restored. These results suggest that changes within distinct brain regions give rise to different depths of unconsciousness. Loss of communication between the thalamus and the cortex generates the unconsciousness of sleep or light anesthesia, while the additional loss of communication between cortical regions generates the unconsciousness of general anesthesia or coma. In addition to explaining the mixed results seen in previous experiments, this distinction could lead to advances in the diagnosis of patients with disorders of consciousness, and even to the development of therapies that target the thalamus and its connections with cortex. DOI:http://dx.doi.org/10.7554/eLife.04499.002
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Ciprian Catana
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Kara J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Violeta Contreras Ramirez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Daniel B Chonde
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - David Izquierdo-Garcia
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Grae Arabasz
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Shirley Hsu
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Kathleen Habeeb
- Clinical Research Center, Massachusetts General Hospital, Boston, United States
| | - Jacob M Hooker
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Vitaly Napadow
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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Lieberman G, Shpaner M, Watts R, Andrews T, Filippi CG, Davis M, Naylor MR. White matter involvement in chronic musculoskeletal pain. THE JOURNAL OF PAIN 2014; 15:1110-1119. [PMID: 25135468 PMCID: PMC4254784 DOI: 10.1016/j.jpain.2014.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 07/07/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED There is emerging evidence that chronic musculoskeletal pain is associated with anatomic and functional abnormalities in gray matter. However, little research has investigated the relationship between chronic musculoskeletal pain and white matter. In this study, we used whole-brain tract-based spatial statistics and region-of-interest analyses of diffusion tensor imaging data to demonstrate that patients with chronic musculoskeletal pain exhibit several abnormal metrics of white matter integrity compared with healthy controls. Chronic musculoskeletal pain was associated with lower fractional anisotropy in the splenium of the corpus callosum and the left cingulum adjacent to the hippocampus. Patients also had higher radial diffusivity in the splenium, right anterior and posterior limbs of the internal capsule, external capsule, superior longitudinal fasciculus, and cerebral peduncle. Patterns of axial diffusivity (AD) varied: patients exhibited lower AD in the left cingulum adjacent to the hippocampus and higher AD in the anterior limbs of the internal capsule and in the right cerebral peduncle. Several correlations between diffusion metrics and clinical variables were also significant at a P < .01 level: fractional anisotropy in the left uncinate fasciculus correlated positively with total pain experience and typical levels of pain severity. AD in the left anterior limb of the internal capsule and left uncinate fasciculus was correlated with total pain experience and typical pain level. Positive correlations were also found between AD in the right uncinate and both total pain experience and pain catastrophizing. These results demonstrate that white matter abnormalities play a role in chronic musculoskeletal pain as a cause, a predisposing factor, a consequence, or a compensatory adaptation. PERSPECTIVE Patients with chronic musculoskeletal pain exhibit altered metrics of diffusion in the brain's white matter compared with healthy volunteers, and some of these differences are directly related to symptom severity.
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Affiliation(s)
- Gregory Lieberman
- MindBody Medicine Clinic at Fletcher Allen Healthcare and Clinical Neuroscience Research Unit, University of Vermont, Burlington, Vermont
| | - Marina Shpaner
- MindBody Medicine Clinic at Fletcher Allen Healthcare and Clinical Neuroscience Research Unit, University of Vermont, Burlington, Vermont
| | - Richard Watts
- Department of Radiology and MRI Center for Biomedical Imaging, University of Vermont, Burlington, Vermont
| | - Trevor Andrews
- Department of Radiology and MRI Center for Biomedical Imaging, University of Vermont, Burlington, Vermont; Philips Healthcare, Best, The Netherlands
| | | | - Marcia Davis
- MindBody Medicine Clinic at Fletcher Allen Healthcare and Clinical Neuroscience Research Unit, University of Vermont, Burlington, Vermont
| | - Magdalena R Naylor
- MindBody Medicine Clinic at Fletcher Allen Healthcare and Clinical Neuroscience Research Unit, University of Vermont, Burlington, Vermont.
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43
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Kim CE, Kim YK, Chung G, Jeong JM, Lee DS, Kim J, Kim SJ. Large-scale plastic changes of the brain network in an animal model of neuropathic pain. Neuroimage 2014; 98:203-15. [DOI: 10.1016/j.neuroimage.2014.04.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/17/2014] [Accepted: 04/23/2014] [Indexed: 11/16/2022] Open
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Unlearning chronic pain: A randomized controlled trial to investigate changes in intrinsic brain connectivity following Cognitive Behavioral Therapy. NEUROIMAGE-CLINICAL 2014; 5:365-76. [PMID: 26958466 PMCID: PMC4749849 DOI: 10.1016/j.nicl.2014.07.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/01/2014] [Accepted: 07/17/2014] [Indexed: 11/25/2022]
Abstract
Chronic pain is a complex physiological and psychological phenomenon. Implicit learning mechanisms contribute to the development of chronic pain and to persistent changes in the central nervous system. We hypothesized that these central abnormalities can be remedied with Cognitive Behavioral Therapy (CBT). Specifically, since regions of the anterior Default Mode Network (DMN) are centrally involved in emotional regulation via connections with limbic regions, such as the amygdala, remediation of maladaptive behavioral and cognitive patterns as a result of CBT for chronic pain would manifest itself as a change in the intrinsic functional connectivity (iFC) between these prefrontal and limbic regions. Resting-state functional neuroimaging was performed in patients with chronic pain before and after 11-week CBT (n = 19), as well as a matched (ages 19–59, both sexes) active control group of patients who received educational materials (n = 19). Participants were randomized prior to the intervention. To investigate the differential impact of treatment on intrinsic functional connectivity (iFC), we compared pre–post differences in iFC between groups. In addition, we performed exploratory whole brain analyses of changes in fractional amplitude of low frequency fluctuations (fALFF). The course of CBT led to significant improvements in clinical measures of pain and self-efficacy for coping with chronic pain. Significant group differences in pre–post changes in both iFC and fALFF were correlated with clinical outcomes. Compared to control patients, iFC between the anterior DMN and the amygdala/periaqueductal gray decreased following CBT, whereas iFC between the basal ganglia network and the right secondary somatosensory cortex increased following CBT. CBT patients also had increased post-therapy fALFF in the bilateral posterior cingulate and the cerebellum. By delineating neuroplasticity associated with CBT-related improvements, these results add to mounting evidence that CBT is a valuable treatment option for chronic pain.
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