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Shillo P, Sloan G, Selvarajah D, Greig M, Gandhi R, Anand P, Edden RA, Wilkinson ID, Tesfaye S. Reduced Thalamic γ-Aminobutyric Acid (GABA) in Painless but Not Painful Diabetic Peripheral Neuropathy. Diabetes 2024; 73:1317-1324. [PMID: 38776434 DOI: 10.2337/db23-0921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Alterations in the structure, function, and microcirculation of the thalamus, a key brain region involved in pain pathways, have previously been demonstrated in patients with painless and painful diabetic peripheral neuropathy (DPN). However, thalamic neurotransmitter levels including γ-aminobutyric acid (GABA) (inhibitory neurotransmitter) and glutamate (excitatory neurotransmitter) in different DPN phenotypes are not known. We performed a magnetic resonance spectroscopy study and quantified GABA and glutamate levels within the thalamus, in a carefully characterized cohort of participants with painless and painful DPN. Participants with DPN (painful and painless combined) had a significantly lower GABA:H2O ratio compared with those without DPN (healthy volunteers [HV] and participants with diabetes without DPN [no DPN]). Participants with painless DPN had the lowest GABA:H2O ratio, which reached significance compared with HV and no DPN, but not painful DPN. There was no difference in GABA:H2O in painful DPN compared with all other groups. A significant correlation with GABA:H2O and neuropathy severity was also seen. This study demonstrates that lower levels of thalamic GABA in participants with painless DPN may reflect neuroplasticity due to reduced afferent pain impulses, whereas partially preserved levels of GABA in painful DPN may indicate that central GABAergic pathways are involved in the mechanisms of neuropathic pain in diabetes. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Pallai Shillo
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
- Division of Clinical Medicine, University of Sheffield, Sheffield, U.K
| | - Dinesh Selvarajah
- Division of Clinical Medicine, University of Sheffield, Sheffield, U.K
| | - Marni Greig
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Rajiv Gandhi
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Praveen Anand
- Peripheral Neuropathy Unit, Imperial College London, London, U.K
| | - Richard A Edden
- Department of Neuroradiology, Johns Hopkins University, Baltimore, MD
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, U.K
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
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Shigemura T, Osone F, Hara A, Miyano K, Okada A, Yokokawa T, Shirayama Y. Alterations in metabolites in the anterior cingulate cortex and thalamus and their associations with pain and empathy in patients with chronic mild pain: a preliminary study. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02791-1. [PMID: 38896135 DOI: 10.1007/s00702-024-02791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) has shown inconsistent alterations in the brain metabolites of individuals with chronic pain. We used 3T 1H-MRS to investigate the brain metabolites in the anterior cingulate cortex and thalamus of 22 patients with chronic mild pain and no gait disturbance and 22 healthy controls. The chronic-pain group included patients with chronic low back pain and/or osteoarthritis but none suffering from hypersensitivity. There were no significant between group-differences in glutamate, glutamate plus glutamine (Glx), N-acetylaspartate, glycerophosphorylcholine (GPC), glutamine, creatine plus phosphocreatine, or myo-inositol in the anterior cingulate cortex, but the patients showed a significant decrease in GPC, but not other metabolites, in the thalamus compared to the controls. The GPC values in the patients' thalamus were significantly correlated with pain components on the Short-Form McGill Pain Questionnaire (SF-MPQ-2) and affective empathy components on the Questionnaire of Cognitive and Affective Empathy (QCAE). The GPC in the patients' anterior cingulate cortex showed significant correlations with cognitive empathy components on the QCAE. Myo-inositol in the controls' anterior cingulate cortex and Glx in the patients' thalamus each showed significant relationships with peripheral responsivity on the QCAE. These significances were not significant after Bonferroni corrections. These preliminary findings indicate important roles of GPC, myo-inositol, and Glx in the brain of patients with chronic mild pain.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopedics, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Fumio Osone
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Akira Hara
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Kanako Miyano
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Okada
- Department of Psychology, Sapporo International University, Sapporo, Japan
| | - Tokuzou Yokokawa
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Yukihiko Shirayama
- Department of Psychiatry, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111, Japan.
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3
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De Stefano G, Truini A. An overview of diagnosis and assessment methods for neuropathic pain. Presse Med 2024; 53:104234. [PMID: 38636786 DOI: 10.1016/j.lpm.2024.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Neuropathic pain, defined as pain arising as a consequence of a lesion or disease affecting the somatosensory nervous system, requires precise diagnostic assessment. Different diagnostic tools have been devised for the diagnosis of neuropathic pain. This review offers insights into the diagnostic accuracy of screening questionnaires and different tests that investigate the somatosensory nervous system, in patients with suspected neuropathic pain. Thus, it illustrates how these tools can aid clinicians in accurately diagnosing neuropathic pain.
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Affiliation(s)
| | - Andrea Truini
- Sapienza University, Department of Human Neuroscience, Rome, Italy.
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Wang W, Yuan M, Xu Y, Yang J, Wang X, Zhou Y, Yu Z, Lu Z, Wang Y, Hu C, Bai Q, Li Z. Prokineticin-2 Participates in Chronic Constriction Injury-Triggered Neuropathic Pain and Anxiety via Regulated by NF-κB in Nucleus Accumbens Shell in Rats. Mol Neurobiol 2024; 61:2764-2783. [PMID: 37934398 DOI: 10.1007/s12035-023-03680-6] [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: 12/05/2022] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
Neuropathic pain (NP) is an intractable pain that results from primary nervous system injury and dysfunction. Herein, we demonstrated in animal models that peripheral nerve injury induced enhanced pain perception and anxiety-like behaviors. According to previous reports, nucleus accumbens (NAc) shell is required for complete expression of neuropathic pain behaviors and mood alternations, we found the elevated mRNA and protein level of Prokineticin-2 (Prok2) in the NAc shell after Chronic Constriction Injury (CCI). Prok2 knockdown in the NAc shell reversed NP and anxiety-like behaviors in rats, indicating that Prok2 might play a fundamental role in NP and anxiety co-morbidity. CCI significantly enhanced Prok2 co-expression with NF-κB P-p65 in comparison with control animals. In addition to reversing the established nociceptive hypersensitivities and anxiety simultaneously, NAc microinjection of NF-κB siRNA or specific inhibitor PDTC reversed Prok2 upregulation. Besides, Prok2 was significantly decreased in vitro when co-transfected with si-NF-κB. Dual-Luciferase assay showed NF-κB directly activated Prok2 gene transcriptional activity. Overall, these findings provide new insights into the neurobiological mechanisms behind NP and comorbid anxiety. The NF-κB/Prok2 pathway could be a potential therapeutic target for NP and anxiety disorders.
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Affiliation(s)
- Wenting Wang
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Meng Yuan
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Yaowei Xu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Neuroscience, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jingjie Yang
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Xiaoling Wang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yifan Zhou
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Zhixiang Yu
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Zhongyuan Lu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Wang
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
| | - Chenge Hu
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China
- Institute of Neuroscience, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Qian Bai
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China.
| | - Zhisong Li
- Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Zhengzhou University, No.2, Jingba Road, Jinshui District, Zhengzhou, Henan, China.
- Institute of Neuroscience, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China.
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Pires MP, McBenedict B, Ahmed IE, Yau RCC, Fong YB, Goh KS, Lim YS, Mohamed SA, Ngu O, Devan JN, Hauwanga WN, Lima Pessôa B. Exploring the Thalamus as a Target for Neuropathic Pain Management: An Integrative Review. Cureus 2024; 16:e60130. [PMID: 38864037 PMCID: PMC11165437 DOI: 10.7759/cureus.60130] [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] [Received: 04/27/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Neuropathic pain (NP), resulting from damage to the somatosensory system, is characterized by either spontaneous or evoked pain. In the context of NP, wherein aberrant signaling pathways contribute to the perception of pain, the thalamus emerges as a key player. This structure is integral to the pain network that includes connections to the dorsal horn of the spinal cord, highlighting its role in the affective-motivational aspects of pain perception. Given its significant involvement, the thalamus is targeted in advanced treatments such as thalamotomy and deep brain stimulation (DBS) when traditional therapies fail, emphasizing the need to understand its function in NP to improve management strategies. This review aimed to provide an overview of the role of the thalamus in the transmission of nociceptive information in NP by discussing the existing evidence, including the effectiveness and safety of current techniques in the management and treatment of NP. This is an integrative review involving the qualitative analysis of scientific articles published in PubMed/MEDLINE, Embase, Scopus, and Web of Science. A total of 687 articles were identified, and after selection, 15 articles were included in this study. All studies reviewed demonstrated varying degrees of effectiveness of DBS and thalamotomy in alleviating painful symptoms, although the relief was often temporary. Many studies noted a reduction in pain perception at the conclusion of treatment compared to pre-treatment levels, with this decrease maintained throughout patient follow-ups. However, adverse events associated with these treatments were also reported. In conclusion, there are some benefits, albeit temporary, to using thalamotomy and DBS to alleviate the painful symptoms of NP. Both procedures are considered advanced forms of surgical intervention that aim to modulate pain pathways in the brain, providing significant relief for patients suffering from chronic pain resistant to conventional treatment. Despite limitations, these surgical interventions offer renewed hope for patients facing disabling chronic pain and can provide a significant improvement in quality of life.
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Affiliation(s)
| | | | | | | | - Yan Bin Fong
- Surgery, Universiti Putra Malaysia, Serdang, MYS
| | - Kang Suen Goh
- Internal Medicine, Monash University Malaysia, Subang Jaya, MYS
| | - Yee Siew Lim
- Surgery, International Medical University, Seremban, MYS
| | - Suber Abdi Mohamed
- Medicine, Jiangsu University, Zhenjiang Jiangbin Hospital, Zhenjiang, CHN
| | - Owen Ngu
- Medicine, University of Malaya, Kuala Lumpur, MYS
| | - Jeshua N Devan
- Surgery, Asian Institute of Medicine, Science and Technology University, Bedong, MYS
| | - Wilhelmina N Hauwanga
- Family Medicine, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA
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Sommer C, Baron R, Sachau J, Papagianni A, Özgül ÖS, Enax-Krumova E. [The EAN-NeuPSIG guideline on the diagnosis of neuropathic pain-a summary]. Schmerz 2024:10.1007/s00482-024-00806-0. [PMID: 38602515 DOI: 10.1007/s00482-024-00806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
In this joint guideline of the scientific societies and working groups mentioned in the title, evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain were developed. The systematic literature search and meta-analysis yielded the following results: Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I‑DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, while S‑LANSS (self-administered LANSS) and PainDETECT received weak recommendations for their use in the diagnostic workup of patients with possible neuropathic pain. There was a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials. The role of confocal corneal microscopy is still unclear. Functional imaging and peripheral nerve blocks are helpful in elucidating the pathophysiology, but current literature does not support their use in diagnosing neuropathic pain. In selected cases, genetic testing in specialized centers may be considered.
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Affiliation(s)
- Claudia Sommer
- Neurologische Klinik, Universitätsklinikum Würzburg, 97080, Würzburg, Deutschland.
| | - Ralf Baron
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Juliane Sachau
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - Özüm S Özgül
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Elena Enax-Krumova
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
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7
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Wu Z, Feng K, Huang J, Ye X, Yang R, Huang Q, Jiang Q. Brain region changes following a spinal cord injury. Neurochem Int 2024; 174:105696. [PMID: 38354751 DOI: 10.1016/j.neuint.2024.105696] [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: 08/11/2023] [Revised: 01/16/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
Brain-related complications are common in clinical practice after spinal cord injury (SCI); however, the molecular mechanisms of these complications are still unclear. Here, we reviewed the changes in the brain regions caused by SCI from three perspectives: imaging, molecular analysis, and electrophysiology. Imaging studies revealed abnormal functional connectivity, gray matter volume atrophy, and metabolic abnormalities in brain regions after SCI, leading to changes in the structure and function of brain regions. At the molecular level, chemokines, inflammatory factors, and damage-associated molecular patterns produced in the injured area were retrogradely transmitted through the corticospinal tract, cerebrospinal fluid, or blood circulation to the specific brain area to cause pathologic changes. Electrophysiologic recordings also suggested abnormal changes in brain electrical activity after SCI. Transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation alleviated pain and improved motor function in patients with SCI; therefore, transcranial therapy may be a new strategy for the treatment of patients with SCI.
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Affiliation(s)
- Zhiwu Wu
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Kaiming Feng
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Jinqing Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Xinyun Ye
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Qianliang Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
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8
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Shrivastava M, Ye L. Neuroimaging and artificial intelligence for assessment of chronic painful temporomandibular disorders-a comprehensive review. Int J Oral Sci 2023; 15:58. [PMID: 38155153 PMCID: PMC10754947 DOI: 10.1038/s41368-023-00254-z] [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: 08/01/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic Painful Temporomandibular Disorders (TMD) are challenging to diagnose and manage due to their complexity and lack of understanding of brain mechanism. In the past few decades' neural mechanisms of pain regulation and perception have been clarified by neuroimaging research. Advances in the neuroimaging have bridged the gap between brain activity and the subjective experience of pain. Neuroimaging has also made strides toward separating the neural mechanisms underlying the chronic painful TMD. Recently, Artificial Intelligence (AI) is transforming various sectors by automating tasks that previously required humans' intelligence to complete. AI has started to contribute to the recognition, assessment, and understanding of painful TMD. The application of AI and neuroimaging in understanding the pathophysiology and diagnosis of chronic painful TMD are still in its early stages. The objective of the present review is to identify the contemporary neuroimaging approaches such as structural, functional, and molecular techniques that have been used to investigate the brain of chronic painful TMD individuals. Furthermore, this review guides practitioners on relevant aspects of AI and how AI and neuroimaging methods can revolutionize our understanding on the mechanisms of painful TMD and aid in both diagnosis and management to enhance patient outcomes.
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Affiliation(s)
- Mayank Shrivastava
- Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Liang Ye
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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Rosner J, de Andrade DC, Davis KD, Gustin SM, Kramer JLK, Seal RP, Finnerup NB. Central neuropathic pain. Nat Rev Dis Primers 2023; 9:73. [PMID: 38129427 DOI: 10.1038/s41572-023-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.
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Affiliation(s)
- Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - John L K Kramer
- International Collaboration on Repair Discoveries, ICORD, University of British Columbia, Vancouver, Canada
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca P Seal
- Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Departments of Neurobiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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10
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Yao D, Chen Y, Chen G. The role of pain modulation pathway and related brain regions in pain. Rev Neurosci 2023; 34:899-914. [PMID: 37288945 DOI: 10.1515/revneuro-2023-0037] [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: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
Pain is a multifaceted process that encompasses unpleasant sensory and emotional experiences. The essence of the pain process is aversion, or perceived negative emotion. Central sensitization plays a significant role in initiating and perpetuating of chronic pain. Melzack proposed the concept of the "pain matrix", in which brain regions associated with pain form an interconnected network, rather than being controlled by a singular brain region. This review aims to investigate distinct brain regions involved in pain and their interconnections. In addition, it also sheds light on the reciprocal connectivity between the ascending and descending pathways that participate in pain modulation. We review the involvement of various brain areas during pain and focus on understanding the connections among them, which can contribute to a better understanding of pain mechanisms and provide opportunities for further research on therapies for improved pain management.
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Affiliation(s)
- Dandan Yao
- Department of Anesthesiology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Yeru Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Gang Chen
- Department of Anesthesiology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
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11
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Deng L, Chen Y, Wang Z, Zeng N, Zhang Q, Zhou T, Chen Y, Wu S. Analysis of the influencing factors related to neuropathic pain in patients with spinal cord injuries: a retrospective study. Br J Neurosurg 2023; 37:1588-1593. [PMID: 35200073 DOI: 10.1080/02688697.2022.2043242] [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: 10/08/2021] [Accepted: 02/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The aim of this study was to investigate the related influencing factors of neuropathic pain (NP) in patients with spinal cord injury (SCI). METHODS Patients diagnosed with SCI between January 2016 and December 2019 in the Department of Rehabilitation Medicine, Affiliated Hospital of Guizhou Medical University, were screened for NP by using the Douleur Neuropathique 4 (DN4) questionnaire. A total of 133 patients diagnosed with SCI with NP were finally included in the study. We collected the patients' basic information, including gender, age, body mass index (BMI), disease course, injury segment, American Spinal Injury Association (ASIA) grade, occupation, educational level, whether painkillers were used, stability of economic support, and pain level. Univariate and multiple ordered logistic regression analyses were used to examine the influencing factors of NP in the patients with SCI. RESULTS The chi-square test revealed that disease course, injury level, severity of SCI (ASIA classification), stable economic support during hospitalization, and the use of painkillers had statistical significance (p < .01). A multivariate logistic regression analysis was performed to analyze the influencing factors of NP. ASIA grade, stable economic support, and use of painkillers were independent influencing factors of NP in patients with SCI, among which injury severity was the independent risk factor (odds ratio [OR] > 1). Stable economic support and painkiller use were protective factors (OR < 1). CONCLUSIONS In this study, we found no significant correlation between NP after SCI and sex, age, BMI, disease course, injury level, and occupation. However, the injury severity was an independent risk factor, and stable economic support and painkiller use were protective factors.
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Affiliation(s)
- Luoyi Deng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Yuan Chen
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Zhitao Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Ni Zeng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Qian Zhang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Tengfei Zhou
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
| | - Yan Chen
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
- School of Clinical Medicine, Guizhou Medical University Guiyang, Guiyang, PR China
| | - Shuang Wu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, PR China
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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13
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Li J, Tian C, Yuan S, Yin Z, Wei L, Chen F, Dong X, Liu A, Wang Z, Wu T, Tian C, Niu L, Wang L, Wang P, Xie W, Cao F, Shen H. Neuropathic pain following spinal cord hemisection induced by the reorganization in primary somatosensory cortex and regulated by neuronal activity of lateral parabrachial nucleus. CNS Neurosci Ther 2023; 29:3269-3289. [PMID: 37170721 PMCID: PMC10580357 DOI: 10.1111/cns.14258] [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: 12/26/2022] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
AIMS Neuropathic pain after spinal cord injury (SCI) remains a common and thorny problem, influencing the life quality severely. This study aimed to elucidate the reorganization of the primary sensory cortex (S1) and the regulatory mechanism of the lateral parabrachial nucleus (lPBN) in the presence of allodynia or hyperalgesia after left spinal cord hemisection injury (LHS). METHODS Through behavioral tests, we first identified mechanical allodynia and thermal hyperalgesia following LHS. We then applied two-photon microscopy to observe calcium activity in S1 during mechanical or thermal stimulation and long-term spontaneous calcium activity after LHS. By slice patch clamp recording, the electrophysiological characteristics of neurons in lPBN were explored. Finally, exploiting chemogenetic activation or inhibition of the neurons in lPBN, allodynia or hyperalgesia was regulated. RESULTS The calcium activity in left S1 was increased during mechanical stimulation of right hind limb and thermal stimulation of tail, whereas in right S1 it was increased only with thermal stimulation of tail. The spontaneous calcium activity in right S1 changed more dramatically than that in left S1 after LHS. The lPBN was also activated after LHS, and exploiting chemogenetic activation or inhibition of the neurons in lPBN could induce or alleviate allodynia and hyperalgesia in central neuropathic pain. CONCLUSION The neuronal activity changes in S1 are closely related to limb pain, which has accurate anatomical correspondence. After LHS, the spontaneously increased functional connectivity of calcium transient in left S1 is likely causing the mechanical allodynia in right hind limb and increased neuronal activity in bilateral S1 may induce thermal hyperalgesia in tail. This state of allodynia and hyperalgesia can be regulated by lPBN.
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Affiliation(s)
- Jing Li
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Chao Tian
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Shiyang Yuan
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Zhenyu Yin
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Liangpeng Wei
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Feng Chen
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Xi Dong
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Aili Liu
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
| | - Zhenhuan Wang
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Tongrui Wu
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Chunxiao Tian
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Lin Niu
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
| | - Lei Wang
- Department of PhysiologyZhuhai Campus of Zunyi Medical UniversityZhuhaiChina
| | - Pu Wang
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Wanyu Xie
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Fujiang Cao
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Hui Shen
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
- Innovation Research Institute of Traditional Chinese MedicineShandong University of Traditional Chinese MedicineJinanChina
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14
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Gustin SM, Bolding M, Willoughby W, Anam M, Shum C, Rumble D, Mark VW, Mitchell L, Cowan RE, Richardson E, Richards S, Trost Z. Cortical Mechanisms Underlying Immersive Interactive Virtual Walking Treatment for Amelioration of Neuropathic Pain after Spinal Cord Injury: Findings from a Preliminary Investigation of Thalamic Inhibitory Function. J Clin Med 2023; 12:5743. [PMID: 37685810 PMCID: PMC10488675 DOI: 10.3390/jcm12175743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropathic pain following spinal cord injury (SCI) affects approximately 60% of individuals with SCI. Effective pharmacological and non-pharmacological treatments remain elusive. We recently demonstrated that our immersive virtual reality walking intervention (VRWalk) may be effective for SCI NP. Additionally, we found that SCI NP may result from a decrease in thalamic γ-aminobutyric-acid (GABA), which disturbs central sensorimotor processing. OBJECTIVE While we identified GABAergic changes associated with SCI NP, a critical outstanding question is whether a decrease in SCI NP generated by our VRWalk intervention causes GABA content to rise. METHOD A subset of participants (n = 7) of our VRWalk trial underwent magnetic resonance spectroscopy pre- and post-VRWalk intervention to determine if the decrease in SCI NP is associated with an increase in thalamic GABA. RESULTS The findings revealed a significant increase in thalamic GABA content from pre- to post-VRWalk treatment. CONCLUSION While the current findings are preliminary and should be interpreted with caution, pre- to post-VRWalk reductions in SCI NP may be mediated by pre- to post-treatment increases in thalamic GABA by targeting and normalizing maladaptive sensorimotor cortex reorganization. Understanding the underlying mechanisms of pain recovery can serve to validate the efficacy of home-based VR walking treatment as a means of managing pain following SCI. Neuromodulatory interventions aimed at increasing thalamic inhibitory function may provide more effective pain relief than currently available treatments.
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Affiliation(s)
- Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney 2052, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney 2031, Australia
| | - Mark Bolding
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - William Willoughby
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Monima Anam
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA (L.M.)
| | - Corey Shum
- Immersive Experience Laboratories LLC, Birmingham, AL 35203, USA
| | - Deanna Rumble
- Department of Psychology and Counseling, University of Central Arkansas, Conway, AR 72035, USA
| | - Victor W. Mark
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lucie Mitchell
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA (L.M.)
| | - Rachel E. Cowan
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Elizabeth Richardson
- Department of Behavioral & Social Sciences, University of Montevallo, Montevallo, AL 35115, USA
| | - Scott Richards
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Zina Trost
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, USA
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15
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Truini A, Aleksovska K, Anderson CC, Attal N, Baron R, Bennett DL, Bouhassira D, Cruccu G, Eisenberg E, Enax-Krumova E, Davis KD, Di Stefano G, Finnerup NB, Garcia-Larrea L, Hanafi I, Haroutounian S, Karlsson P, Rakusa M, Rice ASC, Sachau J, Smith BH, Sommer C, Tölle T, Valls-Solé J, Veluchamy A. Joint European Academy of Neurology-European Pain Federation-Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment. Eur J Neurol 2023; 30:2177-2196. [PMID: 37253688 DOI: 10.1111/ene.15831] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND PURPOSE In these guidelines, we aimed to develop evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain (NeP). METHODS We systematically reviewed studies providing information on the sensitivity and specificity of screening questionnaires, and quantitative sensory testing, neurophysiology, skin biopsy, and corneal confocal microscopy. We also analysed how functional neuroimaging, peripheral nerve blocks, and genetic testing might provide useful information in diagnosing NeP. RESULTS Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I-DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, and S-LANSS (self-administered LANSS) and PainDETECT weak recommendations for their use in the diagnostic pathway for patients with possible NeP. We devised a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials in the NeP diagnosis. Trigeminal reflex testing received a strong recommendation in diagnosing secondary trigeminal neuralgia. Although many studies support the usefulness of corneal confocal microscopy in diagnosing peripheral neuropathy, no study specifically investigated the diagnostic accuracy of this technique in patients with NeP. Functional neuroimaging and peripheral nerve blocks are helpful in disclosing pathophysiology and/or predicting outcomes, but current literature does not support their use for diagnosing NeP. Genetic testing may be considered at specialist centres, in selected cases. CONCLUSIONS These recommendations provide evidence-based clinical practice guidelines for NeP diagnosis. Due to the poor-to-moderate quality of evidence identified by this review, future large-scale, well-designed, multicentre studies assessing the accuracy of diagnostic tests for NeP are needed.
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Affiliation(s)
- Andrea Truini
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Katina Aleksovska
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Christopher C Anderson
- Division of Clinical and Translational Research, Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nadine Attal
- Université Versailles Saint Quentin en Yvelines, Versailles, France
- Inserm U987, Pathophysiology and Clinical Pharmacology of Pain, Centre d'évaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Didier Bouhassira
- Inserm U987, Pathophysiology and Clinical Pharmacology of Pain, Centre d'évaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Giorgio Cruccu
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Elon Eisenberg
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Karen Deborah Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Centre, Aarhus University, Aarhus, Denmark
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
- Centre D'évaluation et de Traitement de la Douleur, Hôpital Neurologique, Lyon, France
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pall Karlsson
- Department of Clinical Medicine, Danish Pain Research Centre, Aarhus University, Aarhus, Denmark
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Blair H Smith
- Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Tölle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Josep Valls-Solé
- Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Abirami Veluchamy
- Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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16
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Pigott T, McPeak A, de Chastelain A, DeMayo MM, Rasic N, Rayner L, Noel M, Miller JV, Harris AD. Changes in Brain GABA and Glutamate and Improvements in Physical Functioning Following Intensive Pain Rehabilitation in Youth With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1288-1297. [PMID: 36966034 DOI: 10.1016/j.jpain.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/27/2023]
Abstract
Intensive interdisciplinary pain treatments (IIPT) have been developed to treat youth with unmanaged chronic pain and functional disability. Dysregulation of metabolites gamma-aminobutyric acid (GABA) and glutamate are thought to play a role in the chronification of pain due to imbalances in inhibition and excitation in adults. Using magnetic resonance spectroscopy (MRS), we investigated the effect of IIPT on GABA and Glx (glutamate + glutamine) in 2 pain-related brain regions: the left posterior insula (LPI) and the anterior cingulate cortex (ACC). Data were collected in 23 youth (mean age = 16.09 ± 1.40, 19 female) at entry and discharge from a hospital-based outpatient IIPT. GABA and Glx were measured using GABA-edited MEGA-PRESS and analyzed using Gannet. Physical measures including a 6-minute walk test were recorded, and patients completed the PLAYSelf Physical Literacy Questionnaire, PROMIS Pain Interference Questionnaire, and Functional Disability Inventory. LPI GABA (P < .05) significantly decreased, but not ACC GABA (P > .05), following IIPT. There were no significant Glx changes (P > .05). The decrease in LPI GABA was associated with increased distance in the 6-minute walk test (P < .001). IIPT may decrease GABAergic inhibitory tone within the LPI, thereby promoting plasticity and contributing to improvements in physical outcomes with IIPT. PERSPECTIVE: Regional GABA changes are associated with a reduction in pain interference and improvement in physical function in youth following intensive pain rehabilitation. GABA may serve as a possible biomarker for IIPT; and may also further aid in the development of IIPT, and other treatments for chronic pain in youth.
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Affiliation(s)
- Taylor Pigott
- Biological Sciences, University of Calgary, Calgary, Alberta, Canada; Psychology, University of Calgary, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Allison McPeak
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda de Chastelain
- Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marilena M DeMayo
- Radiology, University of Calgary, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Nivez Rasic
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Laura Rayner
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Melanie Noel
- Psychology, University of Calgary, Calgary, Alberta, Canada; Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jillian Vinall Miller
- Psychology, University of Calgary, Calgary, Alberta, Canada; Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada.
| | - Ashley D Harris
- Radiology, University of Calgary, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
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17
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Feng T, Zhao C, Rao JS, Guo XJ, Bao SS, He LW, Zhao W, Liu Z, Yang ZY, Li XG. Different macaque brain network remodeling after spinal cord injury and NT3 treatment. iScience 2023; 26:106784. [PMID: 37378337 PMCID: PMC10291247 DOI: 10.1016/j.isci.2023.106784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 06/29/2023] Open
Abstract
Graph theory-based analysis describes the brain as a complex network. Only a few studies have examined modular composition and functional connectivity (FC) between modules in patients with spinal cord injury (SCI). Little is known about the longitudinal changes in hubs and topological properties at the modular level after SCI and treatment. We analyzed differences in FC and nodal metrics reflecting modular interaction to investigate brain reorganization after SCI-induced compensation and neurotrophin-3 (NT3)-chitosan-induced regeneration. Mean inter-modular FC and participation coefficient of areas related to motor coordination were significantly higher in the treatment animals than in the SCI-only ones at the late stage. The magnocellular part of the red nucleus may reflect the best difference in brain reorganization after SCI and therapy. Treatment can enhance information flows between regions and promote the integration of motor functions to return to normal. These findings may reveal the information processing of disrupted network modules.
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Affiliation(s)
- Ting Feng
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, PR China
| | - Jia-Sheng Rao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Xiao-Jun Guo
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Shu-Sheng Bao
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Le-Wei He
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Zuxiang Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, PR China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, PR China
- Department of Biology, College of Life Sciences, University of Chinese Academy of Sciences, Beijing, PR China
| | - Zhao-Yang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Xiao-Guang Li
- School of Biological Science and Medical Engineering, Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, PR China
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18
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Widerström-Noga E. Neuropathic Pain and Spinal Cord Injury: Management, Phenotypes, and Biomarkers. Drugs 2023:10.1007/s40265-023-01903-7. [PMID: 37326804 DOI: 10.1007/s40265-023-01903-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
Chronic neuropathic pain after a spinal cord injury (SCI) continues to be a complex condition that is difficult to manage due to multiple underlying pathophysiological mechanisms and the association with psychosocial factors. Determining the individual contribution of each of these factors is currently not a realistic goal; however, focusing on the primary mechanisms may be more feasible. One approach used to uncover underlying mechanisms includes phenotyping using pain symptoms and somatosensory function. However, this approach does not consider cognitive and psychosocial mechanisms that may also significantly contribute to the pain experience and impact treatment outcomes. Indeed, clinical experience supports that a combination of self-management, non-pharmacological, and pharmacological approaches is needed to optimally manage pain in this population. This article will provide a broad updated summary integrating the clinical aspects of SCI-related neuropathic pain, potential pain mechanisms, evidence-based treatment recommendations, neuropathic pain phenotypes and brain biomarkers, psychosocial factors, and progress regarding how defining neuropathic pain phenotypes and other surrogate measures in the neuropathic pain field may lead to targeted treatments for neuropathic pain after SCI.
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Affiliation(s)
- Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, 1611 NW 12th Avenue, Miami, FL, 33136, USA.
- Department of Neurological Surgery, University of Miami, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
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19
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O'Hagan ET, Cashin AG, Hübscher M, Mohammad Alsaadi S, Gustin S, McAuley JH. Does poor sleep quality lead to increased low back pain the following day? Scand J Pain 2023; 23:333-340. [PMID: 36779377 DOI: 10.1515/sjpain-2022-0064] [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: 05/04/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES This study explored the relationship between sleep quality and next-day pain intensity for people with low back pain and investigated whether there was any evidence that this relationship was causal. METHODS We conducted a secondary analysis of an observational study that investigated sleep quality in people with low back pain. People with low back pain were recruited from primary care and the community. Sleep quality was measured with subjective (self-report) and objective (polysomnography (PSG)) measures. PSG analysis classifies sleep into stages, of which slow-wave sleep (SWS) is thought to have a key role in maintaining or increasing pain intensity. We drew directed acyclic graphs to identify possible confounders of the relationship between both measures of sleep quality, and pain intensity. We constructed two linear regression models to explore the effect of subjective and objective sleep quality on next-day pain intensity before and after confounder adjustment. RESULTS Thirty-nine participants were included in the study. For participants with low back pain, self-reported better quality sleep β=-0.38 (95% CI -0.63 to -0.13), or spending a greater proportion of time in SWS β=-0.12 (95% CI -0.22 to -0.02) was associated with lower next day pain intensity. After confounder adjustment, the effect reduced and was no longer significant for either self-reported β=-0.18 (95% CI -0.46 to 0.10), or SWS β=-0.08 (95% CI -0.18 to 0.03). CONCLUSIONS Sleep quality, whether measured by self-report or proportion of time in SWS, was associated with next day pain intensity for people with low back pain. However, this relationship is likely to be confounded and therefore not likely to be causal.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, 2145NSW,, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Saad Mohammad Alsaadi
- Physiotherapy Department, College of Applied Medical Sciences, The Imam Abdulrahman University, Dammam, Saudi Arabia
| | - Sylvia Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
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20
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Kowalski JL, Morse LR, Troy K, Nguyen N, Battaglino RA, Falci SP, Linnman C. Resting state functional connectivity differentiation of neuropathic and nociceptive pain in individuals with chronic spinal cord injury. Neuroimage Clin 2023; 38:103414. [PMID: 37244076 PMCID: PMC10238876 DOI: 10.1016/j.nicl.2023.103414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
Many individuals with spinal cord injury live with debilitating chronic pain that may be neuropathic, nociceptive, or a combination of both in nature. Identification of brain regions demonstrating altered connectivity associated with the type and severity of pain experience may elucidate underlying mechanisms, as well as treatment targets. Resting state and sensorimotor task-based magnetic resonance imaging data were collected in 37 individuals with chronic spinal cord injury. Seed-based correlations were utilized to identify resting state functional connectivity of regions with established roles in pain processing: the primary motor and somatosensory cortices, cingulate, insula, hippocampus, parahippocampal gyri, thalamus, amygdala, caudate, putamen, and periaqueductal gray matter. Resting state functional connectivity alterations and task-based activation associated with individuals' pain type and intensity ratings on the International Spinal Cord Injury Basic Pain Dataset (0-10 scale) were evaluated. We found that intralimbic and limbostriatal resting state connectivity alterations are uniquely associated with neuropathic pain severity, whereas thalamocortical and thalamolimbic connectivity alterations are associated specifically with nociceptive pain severity. The joint effect and contrast of both pain types were associated with altered limbocortical connectivity. No significant differences in task-based activation were identified. These findings suggest that the experience of pain in individuals with spinal cord injury may be associated with unique alterations in resting state functional connectivity dependent upon pain type.
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Affiliation(s)
- Jesse L Kowalski
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Karen Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, United States.
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Ricardo A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Scott P Falci
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States; Department of Neurosurgery, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO 80113, United States.
| | - Clas Linnman
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
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21
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Liu J, Chen DH, Li XS, Xu CY, Hu T. Activating PV-positive neurons in ventral thalamic reticular nucleus reduces pain sensitivity in mice. Brain Res 2023; 1799:148174. [PMID: 36427592 DOI: 10.1016/j.brainres.2022.148174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
Previous studies have demonstrated that thalamic reticular nucleus (TRN) and the sub-nuclei play important roles in pain sensation. Our previous findings showed that activating parvalbumin-positive (PV+) neurons in dorsal sector of TRN (dTRN) could reduce the pain threshold and consequently increase the pain sensitivity of mice. Recent studies have shown that activation of GABAergic projection of TRN to ventrobasal thalamus (VB) alleviated pathological pain. GABAergic neurons in TRN are mainly PV+ neurons. However, the exact roles of ventral TRN (vTRN) PV+ neurons in pain sensation remain unclear. In this study, the designer receptors exclusively activated by designer drugs (DREADD) method was used to activate the PV+ neurons in vTRN of PV-Cre transgenic mice, and the mechanical threshold and thermal latency were measured to investigate the regulatory effects of vTRN on pain sensitivity in mice. Thereafter, PV-Cre transgenic mice, conditional anterograde axonal tract tracing, and immunohistochemistry were used to investigate the distribution of PV+ neurons fibers in vTRN. The results showed that the activation of PV+ neurons in vTRN increased the mechanical threshold and thermal latency, which indicated reduction of pain sensitivity. The fibers of these neurons mainly projected to ventral posterolateral thalamic nucleus (VPL), ventral posteromedial thalamic nucleus (VPM), ventrolateral thalamic nucleus (VL), centrolateral thalamic nucleus (CL) and various other brain regions. These findings indicated that activation of PV+ neurons in the vTRN decreased pain sensitivity in mice, which provided additional evidence on the mechanisms of PV+ neurons of TRN in regulating neuralgia.
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Affiliation(s)
- Jing Liu
- Department of Cell Biology and Neurobiology, Life Sciences College, Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China
| | - Dan-Hua Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China
| | - Xiao-Shuang Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China
| | - Chuan-Ying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China.
| | - Tao Hu
- Department of Anatomy, Basic Medical College, Xuzhou Medical University, Xuzhou, Jiangsu Province 221004, China.
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22
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Gandhi R, Selvarajah D, Sloan G, Greig M, Wilkinson ID, Shaw PJ, Griffiths P, Tesfaye S. Preservation of thalamic neuronal function may be a prerequisite for pain perception in diabetic neuropathy: A magnetic resonance spectroscopy study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1086887. [PMID: 36688084 PMCID: PMC9852821 DOI: 10.3389/fpain.2022.1086887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023]
Abstract
Introduction In this study, we used proton Magnetic Resonance Spectroscopy (1H-MRS) to determine the neuronal function in the thalamus and primary somatosensory (S1) cortex in different subgroups of DPN, including subclinical- and painful-DPN. Method One-hundred and ten people with type 1 diabetes [20 without DPN (no-DPN); 30 with subclinical-DPN; 30 with painful-DPN; and 30 with painless-DPN] and 20 healthy volunteers, all of whom were right-handed men, were recruited and underwent detailed clinical and neurophysiological assessments. Participants underwent Magnetic Resonance Imaging at 1.5 Tesla with two 1H-MRS spectra obtained from 8 ml cubic volume voxels: one placed within left thalamus to encompass the ventro-posterior lateral sub-nucleus and another within the S1 cortex. Results In the thalamus, participants with painless-DPN had a significantly lower NAA:Cr ratio [1.55 + 0.22 (mean ± SD)] compared to all other groups [HV (1.80 ± 0.23), no-DPN (1.85 ± 0.20), sub-clinical DPN (1.79 ± 0.23), painful-DPN (1.75 ± 0.19), ANOVA p < 0.001]. There were no significant group differences in S1 cortical neurometabolites. Conclusion In this largest cerebral MRS study in DPN, thalamic neuronal dysfunction was found in advanced painless-DPN with preservation of function in subclinical- and painful-DPN. Furthermore, there was a preservation of neuronal function within the S1 cortex in all subgroups of DPN. Therefore, there may be a proximo-distal gradient to central nervous system alterations in painless-DPN, with thalamic neuronal dysfunction occurring only in established DPN. Moreover, these results further highlight the manifestation of cerebral alterations between painful- and painless-DPN whereby preservation of thalamic function may be a prerequisite for neuropathic pain in DPN.
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Affiliation(s)
- Rajiv Gandhi
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom,Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Marni Greig
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Iain D. Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Paul Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom,Correspondence: Solomon Tesfaye
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23
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Neuroimaging reveals a potential brain-based pre-existing mechanism that confers vulnerability to development of chronic painful chemotherapy-induced peripheral neuropathy. Br J Anaesth 2023; 130:83-93. [PMID: 36396483 DOI: 10.1016/j.bja.2022.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/23/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition impacting 30% of cancer survivors. This study is the first to explore whether a brain-based vulnerability to chronic sensory CIPN exists. METHODS This prospective, multicentre cohort study recruited from three sites across Scotland. Brain functional MRI (fMRI) scans (3 Tesla) were carried out on chemotherapy naïve patients at a single fMRI centre in Edinburgh, Scotland. Nociceptive stimuli (with a 256 mN monofilament) were administered during the fMRI. Development of chronic sensory/painful CIPN (CIPN+) was determined based upon European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 changes conducted 9 months after chemotherapy, and imaging data analysed using standard software. RESULTS Of 30 patients recruited (two lung, nine gynaecological, and 19 colorectal malignancies), data from 20 patients at 9 months after chemotherapy was available for analysis. Twelve were classified as CIPN+ (mean age, 63.2[9.6] yr, 9.6; six female), eight as CIPN- (mean age 62.9 [SD 5.5] yr, four female). In response to punctate stimulation, group contrast analysis showed that CIPN+ compared with CIPN- had robust activity in sensory, motor, attentional, and affective brain regions. An a priori chosen region-of-interest analysis focusing on the periaqueductal grey, an area hypothesised as relevant for developing CIPN+, showed significantly increased responses in CIPN- compared with CIPN+ patients. No difference in subcortical volumes between CIPN+ and CIPN- patients was detected. CONCLUSIONS Before administration of any chemotherapy or appearance of CIPN symptoms, we observed altered patterns of brain activity in response to nociceptive stimulation in patients who later developed chronic sensory CIPN. This suggests the possibility of a pre-existing vulnerability to developing CIPN centred on brainstem regions of the descending pain modulatory system.
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24
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Gao F, Li JJ, Liu JY, Li YJ, Cong XY, Talifu Z, Zhang X. Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity: an observational case-control study. Neural Regen Res 2023; 18:582-586. [DOI: 10.4103/1673-5374.350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Robayo LE, Govind V, Salan T, Cherup NP, Sheriff S, Maudsley AA, Widerström-Noga E. Neurometabolite alterations in traumatic brain injury and associations with chronic pain. Front Neurosci 2023; 17:1125128. [PMID: 36908781 PMCID: PMC9997848 DOI: 10.3389/fnins.2023.1125128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) can lead to a variety of comorbidities, including chronic pain. Although brain tissue metabolite alterations have been extensively examined in several chronic pain populations, it has received less attention in people with TBI. Thus, the primary aim of this study was to compare brain tissue metabolite levels in people with TBI and chronic pain (n = 16), TBI without chronic pain (n = 17), and pain-free healthy controls (n = 31). The metabolite data were obtained from participants using whole-brain proton magnetic resonance spectroscopic imaging (1H-MRSI) at 3 Tesla. The metabolite data included N-acetylaspartate, myo-inositol, total choline, glutamate plus glutamine, and total creatine. Associations between N-acetylaspartate levels and pain severity, neuropathic pain symptom severity, and psychological variables, including anxiety, depression, post-traumatic stress disorder (PTSD), and post-concussive symptoms, were also explored. Our results demonstrate N-acetylaspartate, myo-inositol, total choline, and total creatine alterations in pain-related brain regions such as the frontal region, cingulum, postcentral gyrus, and thalamus in individuals with TBI with and without chronic pain. Additionally, NAA levels in the left and right frontal lobe regions were positively correlated with post-concussive symptoms; and NAA levels within the left frontal region were also positively correlated with neuropathic pain symptom severity, depression, and PTSD symptoms in the TBI with chronic pain group. These results suggest that neuronal integrity or density in the prefrontal cortex, a critical region for nociception and pain modulation, is associated with the severity of neuropathic pain symptoms and psychological comorbidities following TBI. Our data suggest that a combination of neuronal loss or dysfunction and maladaptive neuroplasticity may contribute to the development of persistent pain following TBI, although no causal relationship can be determined based on these data.
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Affiliation(s)
- Linda E Robayo
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Teddy Salan
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Nicholas P Cherup
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Andrew A Maudsley
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States.,Department of Neurological Surgery, University of Miami, Miami, FL, United States
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26
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Lütolf R, Rosner J, Curt A, Hubli M. Indicators of central sensitization in chronic neuropathic pain after spinal cord injury. Eur J Pain 2022; 26:2162-2175. [PMID: 36008094 PMCID: PMC9826442 DOI: 10.1002/ejp.2028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Central sensitization is considered a key mechanism underlying neuropathic pain (NP) after spinal cord injury (SCI). METHODS Two novel proxies for central sensitization were investigated in thoracic SCI subjects with (SCI-NP) and without NP (SCI-nonNP) compared to healthy controls (HC). Specifically, temporal summation of pain (TSP) was investigated by examining pain ratings during a 2-min tonic heat application to the volar forearm. Additionally, palmar heat-induced sympathetic skin responses (SSR) were recorded in order to reveal changes in pain-autonomic interaction above the lesion level. Pain extent was assessed as the percentage of the body area and the number of body regions being affected by NP. RESULTS Enhanced TSP was observed in SCI-NP (+66%) compared to SCI-nonNP (-75%, p = 0.009) and HC (-59%, p = 0.021). In contrast, no group differences were found (p = 0.685) for SSR habituation. However, pain extent in SCI-NP was positively correlated with deficient SSR habituation (body area: r = 0.561, p = 0.024; body regions: r = 0.564, p = 0.023). CONCLUSIONS These results support the value of TSP and heat-induced SSRs as proxies for central sensitization in widespread neuropathic pain syndromes after SCI. Measures of pain-autonomic interaction emerged as a promising tool for the objective investigation of sensitized neuronal states in chronic pain conditions. SIGNIFICANCE We present two surrogate readouts for central sensitization in neuropathic pain following SCI. On the one hand, temporal summation of tonic heat pain is enhanced in subjects with neuropathic pain. On the other hand, pain-autonomic interaction reveals potential advanced measures in chronic pain, as subjects with a high extent of neuropathic pain showed diminished habituation of pain-induced sympathetic measures. A possible implication for clinical practice is constituted by an improved assessment of neuronal hyperexcitability potentially enabling mechanism-based treatment.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland,Department of NeurologyUniversity Hospital Bern, Inselspital, University of BernBernSwitzerland
| | - Armin Curt
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Michèle Hubli
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
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27
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Pricope CV, Tamba BI, Stanciu GD, Cuciureanu M, Neagu AN, Creanga-Murariu I, Dobrovat BI, Uritu CM, Filipiuc SI, Pricope BM, Alexa-Stratulat T. The Roles of Imaging Biomarkers in the Management of Chronic Neuropathic Pain. Int J Mol Sci 2022; 23:13038. [PMID: 36361821 PMCID: PMC9657736 DOI: 10.3390/ijms232113038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 08/04/2023] Open
Abstract
Chronic neuropathic pain (CNP) affects around 10% of the general population and has a significant social, emotional, and economic impact. Current diagnosis techniques rely mainly on patient-reported outcomes and symptoms, which leads to significant diagnostic heterogeneity and subsequent challenges in management and assessment of outcomes. As such, it is necessary to review the approach to a pathology that occurs so frequently, with such burdensome and complex implications. Recent research has shown that imaging methods can detect subtle neuroplastic changes in the central and peripheral nervous system, which can be correlated with neuropathic symptoms and may serve as potential markers. The aim of this paper is to review available imaging methods used for diagnosing and assessing therapeutic efficacy in CNP for both the preclinical and clinical setting. Of course, further research is required to standardize and improve detection accuracy, but available data indicate that imaging is a valuable tool that can impact the management of CNP.
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Affiliation(s)
- Cosmin Vasilica Pricope
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bogdan Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Gabriela Dumitrita Stanciu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Magdalena Cuciureanu
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Anca Narcisa Neagu
- Laboratory of Animal Histology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Carol I bvd. No. 22, 700505 Iasi, Romania
| | - Ioana Creanga-Murariu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bogdan-Ionut Dobrovat
- Department of Radiology, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
| | - Cristina Mariana Uritu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Silviu Iulian Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Bianca-Mariana Pricope
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Medical Oncology-Radiotherapy Department, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
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28
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Frere JJ, Serafini RA, Pryce KD, Zazhytska M, Oishi K, Golynker I, Panis M, Zimering J, Horiuchi S, Hoagland DA, Møller R, Ruiz A, Kodra A, Overdevest JB, Canoll PD, Borczuk AC, Chandar V, Bram Y, Schwartz R, Lomvardas S, Zachariou V, tenOever BR. SARS-CoV-2 infection in hamsters and humans results in lasting and unique systemic perturbations after recovery. Sci Transl Med 2022; 14:eabq3059. [PMID: 35857629 PMCID: PMC9210449 DOI: 10.1126/scitranslmed.abq3059] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
The host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in prolonged pathologies collectively referred to as post-acute sequalae of COVID-19 (PASC) or long COVID. To better understand the mechanism underlying long COVID biology, we compared the short- and long-term systemic responses in the golden hamster after either SARS-CoV-2 or influenza A virus (IAV) infection. Results demonstrated that SARS-CoV-2 exceeded IAV in its capacity to cause permanent injury to the lung and kidney and uniquely affected the olfactory bulb (OB) and olfactory epithelium (OE). Despite a lack of detectable infectious virus, the OB and OE demonstrated myeloid and T cell activation, proinflammatory cytokine production, and an interferon response that correlated with behavioral changes extending a month after viral clearance. These sustained transcriptional changes could also be corroborated from tissue isolated from individuals who recovered from COVID-19. These data highlight a molecular mechanism for persistent COVID-19 symptomology and provide a small animal model to explore future therapeutics.
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Affiliation(s)
- Justin J. Frere
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Randal A. Serafini
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Kerri D. Pryce
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Marianna Zazhytska
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Kohei Oishi
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Ilona Golynker
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Maryline Panis
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Jeffrey Zimering
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Shu Horiuchi
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | | | - Rasmus Møller
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Anne Ruiz
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Albana Kodra
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Jonathan B. Overdevest
- Department of Otolaryngology- Head and Neck Surgery, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Peter D. Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Alain C. Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10021
| | - Vasuretha Chandar
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
| | - Yaron Bram
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
| | - Robert Schwartz
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021
| | - Stavros Lomvardas
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Venetia Zachariou
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Benjamin R. tenOever
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
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29
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Terumitsu M, Takado Y, Fukuda KI, Kato E, Tanaka S. Neurometabolite Levels and Relevance to Central Sensitization in Chronic Orofacial Pain Patients: A Magnetic Resonance Spectroscopy Study. J Pain Res 2022; 15:1421-1432. [PMID: 35599974 PMCID: PMC9122062 DOI: 10.2147/jpr.s362793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023] Open
Abstract
Background Patients and Methods Results Conclusion
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Affiliation(s)
- Makoto Terumitsu
- Division of Dental Anesthesiology, Department of Human Biology and Pathophysiology, Health Sciences University of Hokkaido, Hokkaido, Japan
- Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
- Correspondence: Makoto Terumitsu, Division of Dental Anesthesiology, Department of Human Biology and Pathophysiology, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, Hokkaido, 061-0293, Japan, Tel/Fax +81 133 23 1445, Email
| | - Yuhei Takado
- Department of Functional Brain Imaging, Institute of Quantum Medical Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ken-Ichi Fukuda
- Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Eisuke Kato
- Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Sei Tanaka
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan
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Deep Brain Stimulation, Stereotactic Radiosurgery and High-Intensity Focused Ultrasound Targeting the Limbic Pain Matrix: A Comprehensive Review. Pain Ther 2022; 11:459-476. [PMID: 35471626 PMCID: PMC9098763 DOI: 10.1007/s40122-022-00381-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
Abstract
Chronic pain (CP) represents a socio-economic burden for affected patients along with therapeutic challenges for currently available therapies. When conventional therapies fail, modulation of the affective pain matrix using reversible deep brain stimulation (DBS) or targeted irreversible thalamotomy by stereotactic radiosurgery (SRS) and magnetic resonance (MR)-guided focused ultrasound (MRgFUS) appear to be considerable treatment options. We performed a literature search for clinical trials targeting the affective pain circuits (thalamus, anterior cingulate cortex [ACC], ventral striatum [VS]/internal capsule [IC]). PubMed, Ovid, MEDLINE and Scopus were searched (1990–2021) using the terms “chronic pain”, “deep brain stimulation”, “stereotactic radiosurgery”, “radioneuromodulation”, “MR-guided focused ultrasound”, “affective pain modulation”, “pain attention”. In patients with CP treated with DBS, SRS or MRgFUS the somatosensory thalamus and periventricular/periaquaeductal grey was the target of choice in most treated subjects, while affective pain transmission was targeted in a considerably lower number (DBS, SRS) consisting of the following nodi of the limbic pain matrix: the anterior cingulate cortex; centromedian-parafascicularis of the thalamus, pars posterior of the central lateral nucleus and internal capsule/ventral striatum. Although DBS, SRS and MRgFUS promoted a meaningful and sustained pain relief, an effective, evidence-based comparative analysis is biased by heterogeneity of the observation period varying between 3 months and 5 years with different stimulation patterns (monopolar/bipolar contact configuration; frequency 10–130 Hz; intensity 0.8–5 V; amplitude 90–330 μs), source and occurrence of lesioning (radiation versus ultrasound) and chronic pain ethology (poststroke pain, plexus injury, facial pain, phantom limb pain, back pain). The advancement of neurotherapeutics (MRgFUS) and novel DBS targets (ACC, IC/VS), along with established and effective stereotactic therapies (DBS–SRS), increases therapeutic options to impact CP by modulating affective, pain-attentional neural transmission. Differences in trial concept, outcome measures, targets and applied technique promote conflicting findings and limited evidence. Hence, we advocate to raise awareness of the potential therapeutic usefulness of each approach covering their advantages and disadvantages, including such parameters as invasiveness, risk–benefit ratio, reversibility and responsiveness.
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Mashola MK, Korkie E, Mothabeng DJ. The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1600. [PMID: 35281780 PMCID: PMC8905372 DOI: 10.4102/sajp.v78i1.1600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity. Objective To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users. Method This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance. Results The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%). Conclusions Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI. Clinical implications In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.
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Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Diphale J Mothabeng
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
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The Role of Body in Brain Plasticity. Brain Sci 2022; 12:brainsci12020277. [PMID: 35204040 PMCID: PMC8869932 DOI: 10.3390/brainsci12020277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/12/2022] [Indexed: 12/14/2022] Open
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Leemhuis E, Giuffrida V, De Martino ML, Forte G, Pecchinenda A, De Gennaro L, Giannini AM, Pazzaglia M. Rethinking the Body in the Brain after Spinal Cord Injury. J Clin Med 2022; 11:jcm11020388. [PMID: 35054089 PMCID: PMC8780443 DOI: 10.3390/jcm11020388] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injuries (SCI) are disruptive neurological events that severly affect the body leading to the interruption of sensorimotor and autonomic pathways. Recent research highlighted SCI-related alterations extend beyond than the expected network, involving most of the central nervous system and goes far beyond primary sensorimotor cortices. The present perspective offers an alternative, useful way to interpret conflicting findings by focusing on the deafferented and deefferented body as the central object of interest. After an introduction to the main processes involved in reorganization according to SCI, we will focus separately on the body regions of the head, upper limbs, and lower limbs in complete, incomplete, and deafferent SCI participants. On one hand, the imprinting of the body’s spatial organization is entrenched in the brain such that its representation likely lasts for the entire lifetime of patients, independent of the severity of the SCI. However, neural activity is extremely adaptable, even over short time scales, and is modulated by changing conditions or different compensative strategies. Therefore, a better understanding of both aspects is an invaluable clinical resource for rehabilitation and the successful use of modern robotic technologies.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Maria Luisa De Martino
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Giuseppe Forte
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
| | - Anna Pecchinenda
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
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Defrin R, Gruener H, Gaidukov E, Bondi M, Rachamim-Katz O, Ringler E, Blumen N, Zeilig G. From acute to long-term alterations in pain processing and modulation after spinal cord injury: mechanisms related to chronification of central neuropathic pain. Pain 2022; 163:e94-e105. [PMID: 33863855 DOI: 10.1097/j.pain.0000000000002315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A severe and debilitating consequence of a spinal cord injury (SCI) is central neuropathic pain (CNP). Our aim was to investigate the processes leading to CNP emergence and chronification by analyzing causal relationship over time between spinothalamic function, pain excitability, and pain inhibition after SCI. This longitudinal follow-up study included 53 patients with acute SCI and 20 healthy controls. Spinothalamic, pain excitability, and intrasegmental and extrasegmental pain inhibition indices were repeatedly evaluated at 1.5, 3, and 6 months post-SCI. Between- and within-group analyses were conducted among those patients who eventually developed CNP and those who did not. Healthy controls were evaluated twice for repeatability analysis. Patients who developed CNP, compared with those who did not, exhibited increased thermal thresholds (P < 0.05), reduced pain adaptation (P < 0.01), and conditioned pain modulation (P < 0.05), early post-injury, and the CNP group's manifestations remained worse throughout the follow-up. By contrast, allodynia frequency was initially similar across SCI groups, but gradually increased in the subacute phase onward only among the CNP group (P < 0.001), along with CNP emergence. Early worse spinothalamic and pain inhibition preceded CNP and predicted its occurrence, and early worse pain inhibition mediated the link between spinothalamic function and CNP. Crossover associations were observed between early and late pain inhibition and excitability. Inefficient intrasegmental and extrasegmental inhibition, possibly resulting from spinothalamic deafferentation, seems to ignite CNP chronification. Pain excitability probably contributes to CNP maintenance, possibly via further exhaustion of the inhibitory control. Preemptive treatment promoting antinociception early post-SCI may mitigate or prevent CNP.
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Affiliation(s)
- Ruth Defrin
- Department of Physical Therapy at Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hila Gruener
- Department of Physical Therapy at Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gaidukov
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Rachamim-Katz
- Barzilai Day Care Rehabilitation Unit, Barzilai Medical Center, Ashkelon, Israel
| | - Erez Ringler
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nava Blumen
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Richardson EJ, Deutsch G, Deshpande HD, Richards JS. Differences in resting cerebellar and prefrontal cortical blood flow in spinal cord injury-related neuropathic pain: A brief report. J Spinal Cord Med 2021; 44:794-799. [PMID: 32644023 PMCID: PMC8477934 DOI: 10.1080/10790268.2020.1786321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Little is understood about differences in resting neural activity among those with spinal cord injury (SCI)-related neuropathic pain. The purpose of this pilot study was to determine resting cerebral blood flow differences in persons with SCI-related neuropathic pain compared to healthy, pain-free able-bodied controls.Methods: Five persons with paraplegia and ten able-bodied participants were included in this study. Resting blood flow, as measured by a continuous arterial spin labeling (ASL) method of fMRI, was analyzed via statistical parametric mapping.Results: Persons with SCI-related neuropathic pain had significantly lower resting blood flow in the cerebellum (Crus I/II), rostral ventromedial medulla and left insular cortex. In contrast, greater resting blood flow occurred in the medial orbitofrontal cortex among those with SCI-related neuropathic pain compared to controls.Conclusion: Differences in resting blood flow were observed among those with SCI-related pain, particularly in regions that may be involved in affective-motivational and cognitive-evaluative aspects of pain. Larger ASL studies in addition to functional connectivity studies using fMRI are needed to clarify unique neural patterns in this complex and often intractable form of pain.
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Affiliation(s)
- Elizabeth J. Richardson
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA,Correspondence to: Elizabeth J. Richardson, University of Montevallo, Station 6180, Montevallo, AL35115, USA; Phone: 205-665-6446.
| | - Georg Deutsch
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hrishikesh D. Deshpande
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J. Scott Richards
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Huynh V, Lütolf R, Rosner J, Luechinger R, Curt A, Kollias S, Hubli M, Michels L. Supraspinal nociceptive networks in neuropathic pain after spinal cord injury. Hum Brain Mapp 2021; 42:3733-3749. [PMID: 34132441 PMCID: PMC8288099 DOI: 10.1002/hbm.25401] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
Neuropathic pain following spinal cord injury involves plastic changes along the whole neuroaxis. Current neuroimaging studies have identified grey matter volume (GMV) and resting-state functional connectivity changes of pain processing regions related to neuropathic pain intensity in spinal cord injury subjects. However, the relationship between the underlying neural processes and pain extent, a complementary characteristic of neuropathic pain, is unknown. We therefore aimed to reveal the neural markers of widespread neuropathic pain in spinal cord injury subjects and hypothesized that those with greater pain extent will show higher GMV and stronger connectivity within pain related regions. Thus, 29 chronic paraplegic subjects and 25 healthy controls underwent clinical and electrophysiological examinations combined with neuroimaging. Paraplegics were demarcated based on neuropathic pain and were thoroughly matched demographically. Our findings indicate that (a) spinal cord injury subjects with neuropathic pain display stronger connectivity between prefrontal cortices and regions involved with sensory integration and multimodal processing, (b) greater neuropathic pain extent, is associated with stronger connectivity between the posterior insular cortex and thalamic sub-regions which partake in the lateral pain system and (c) greater intensity of neuropathic pain is related to stronger connectivity of regions involved with multimodal integration and the affective-motivational component of pain. Overall, this study provides neuroimaging evidence that the pain phenotype of spinal cord injury subjects is related to the underlying function of their resting brain.
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Affiliation(s)
- Vincent Huynh
- Department of Neuroradiology, Clinical Neuroscience CenterUniversity Hospital Zurich & University of ZurichZurichSwitzerland
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Robin Lütolf
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
- Department of Neurology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Roger Luechinger
- Institute for Biomedical EngineeringUniversity and ETH ZürichZürichSwitzerland
| | - Armin Curt
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Spyridon Kollias
- Department of Neuroradiology, Clinical Neuroscience CenterUniversity Hospital Zurich & University of ZurichZurichSwitzerland
| | - Michèle Hubli
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Lars Michels
- Department of Neuroradiology, Clinical Neuroscience CenterUniversity Hospital Zurich & University of ZurichZurichSwitzerland
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Tang Y, Ren C, Wang M, Dai G, Xiao Y, Wang S, Han F, Chen G. Altered gray matter volume and functional connectivity in patients with herpes zoster and postherpetic neuralgia. Brain Res 2021; 1769:147608. [PMID: 34343527 DOI: 10.1016/j.brainres.2021.147608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/29/2021] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Numerous neuroimaging studies on postherpetic neuralgia (PHN) and herpes zoster (HZ) have revealed abnormalities in brain structure/microstructure and function. However, few studies have focused on changes in gray matter (GM) volume and intrinsic functional connectivity (FC) in the transition from HZ to PHN. This study combined voxel-based morphometry and FC analysis methods to investigate GM volume and FC differences in 28 PHN patients, 25 HZ patients, and 21 well-matched healthy controls (HCs). Compared to HCs, PHN patients exhibited a reduction in GM volume in the bilateral putamen. Compared with HZ patients, PHN patients showed decreased GM volume in the left parahippocampal gyrus, putamen, anterior cingulate cortex, and right caudate and increased GM volume in the right thalamus. However, no regions with significant GM volume changes were found between the HZ and HC groups. Correlation analysis revealed that GM volume in the right putamen was positively associated with illness duration in PHN patients. Furthermore, lower FCs between the right putamen and right middle frontal gyrus/brainstem were observed in PHN patients than in HCs. These results indicate that aberrant GM volumes and FC in several brain regions, especially in the right putamen, are closely associated with chronification from HZ to PHN; moreover, these changes profoundly affect multiple dimensions of pain processing. These findings may provide new insights into the pathophysiological mechanisms of PHN.
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Affiliation(s)
- Yu Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Changhe Ren
- Department of Pain, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Maohua Wang
- Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Guidong Dai
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yan Xiao
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fugang Han
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| | - Guangxiang Chen
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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Rullo L, Posa L, Caputi FF, Stamatakos S, Formaggio F, Caprini M, Liguori R, Candeletti S, Romualdi P. Nociceptive behavior and central neuropeptidergic dysregulations in male and female mice of a Fabry disease animal model. Brain Res Bull 2021; 175:158-167. [PMID: 34339779 DOI: 10.1016/j.brainresbull.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
Fabry disease (FD) is an X-linked inherited disorder characterized by glycosphingolipid accumulation due to deficiency of α-galactosidase A (α-Gal A) enzyme. Chronic pain and mood disorders frequently coexist in FD clinical setting, however underlying pathophysiologic mechanisms are still unclear. Here we investigated the mechanical and thermal sensitivity in α-Gal A (-/0) hemizygous male and the α-Gal A (-/-) homozygous female mice. We also characterized the gene expression of dynorphinergic, nociceptinergic and CRFergic systems, known to be involved in pain control and mood disorders, in the prefrontal cortex, amygdala and thalamus of α-Gal A (-/0) hemizygous male and the α-Gal A (-/-) homozygous female mice. Moreover, KOP receptor protein levels were evaluated in the same areas. Fabry knock-out male, but not female, mice displayed a decreased pain threshold in both mechanical and thermal tests compared to their wild type littermates. In the amygdala and prefrontal cortex, we observed a decrease of pDYN mRNA levels in males, whereas an increase was assessed in females, thus suggesting sex-related dysregulation of stress coping and pain mechanisms. Elevated mRNA levels for pDYN/KOP and CRF/CRFR1 systems were observed in male and female thalamus, a critical crossroad for both painful signals and cognitive/emotional processes. KOP receptor protein level changes assessed in the investigated areas, appeared mostly in agreement with KOP gene expression alterations. Our data suggest that α-Gal A enzyme deficiency in male and female mice is associated with distinct neuropeptide gene and protein expression dysregulations of investigated systems, possibly related to the neuroplasticity underlying the neurological features of FD.
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Affiliation(s)
- Laura Rullo
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Luca Posa
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy; Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Francesca Felicia Caputi
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Serena Stamatakos
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Francesco Formaggio
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Marco Caprini
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences, Bologna, Italy; Dept. of Biomedical and Neuromotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Via Altura 3, Bologna, 40139, Italy
| | - Sanzio Candeletti
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Patrizia Romualdi
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy.
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Kang D, Hesam-Shariati N, McAuley JH, Alam M, Trost Z, Rae CD, Gustin SM. Disruption to normal excitatory and inhibitory function within the medial prefrontal cortex in people with chronic pain. Eur J Pain 2021; 25:2242-2256. [PMID: 34242465 DOI: 10.1002/ejp.1838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Growing evidence indicates a link between changes in the medial prefrontal cortex and the pathophysiology of chronic pain. In particular, chronic pain is associated with altered medial prefrontal anatomy and biochemistry. Due to the comorbid affective disorders seen across all pain conditions, the medial prefrontal cortex is a region of significance as it is involved in emotional processing. We have recently reported that a decrease in medial prefrontal N-acetylaspartate and glutamate is associated with increased emotional dysregulation, indicating there are neurotransmitter imbalances in chronic pain. Therefore, we compared medial prefrontal neurochemistry in 24 people with chronic pain conditions to 24 age and sex-matched healthy controls with no history of chronic pain. METHOD GABA-edited MEGA-PRESS was used to measure GABA+ levels, and short TE PRESS was used to measure glutamate levels in the medial prefrontal cortex. Psychometric measures regarding pain intensity a week before scanning, during the scan and the total duration of chronic pain, were also recorded and compared to measured GABA+ and glutamate levels. RESULTS This study reveals that the presence of chronic pain is associated with significant decreases in medial prefrontal GABA+ and glutamate. These findings support the hypothesis that chronic pain is associated with altered medial prefrontal biochemistry. CONCLUSION The dysregulation of glutamatergic and GABAergic neurotransmitter systems supports a model of disinhibition of chronic pain, which may play a key role in both the experience of persistent pain and its associated affective disturbances. SIGNIFICANCE This study reveals a significant reduction in γ-aminobutyric acid (GABA+ ) and glutamate within the medial prefrontal cortex in chronic pain sufferers. While the current findings should be considered with reference to a small sample size, the disruption to normal excitatory and inhibitory medial prefrontal cortex function may be key in the development and maintenance of chronic pain and comorbid mental health disorders.
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Affiliation(s)
- David Kang
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Monzurul Alam
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
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Peek AL, Leaver AM, Foster S, Oeltzschner G, Puts NA, Galloway G, Sterling M, Ng K, Refshauge K, Aguila MER, Rebbeck T. Increased GABA+ in People With Migraine, Headache, and Pain Conditions- A Potential Marker of Pain. THE JOURNAL OF PAIN 2021; 22:1631-1645. [PMID: 34182103 DOI: 10.1016/j.jpain.2021.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstrate modest results. A greater understanding of underlying pain mechanisms may better inform treatments and improve outcomes. Increased GABA+ has been identified in recent studies of migraine, however, it is unclear if this is present in other headache, and pain conditions. We primarily investigated GABA+ levels in the posterior cingulate gyrus (PCG) of people with migraine, whiplash-headache and low back pain compared to age- and sex-matched controls, GABA+ levels in the anterior cingulate cortex (ACC) and thalamus formed secondary aims. Using a cross-sectional design, we studied people with migraine, whiplash-headache or low back pain (n = 56) and compared them with a pool of age- and sex-matched controls (n = 22). We used spectral-edited magnetic resonance spectroscopy at 3T (MEGA-PRESS) to determine levels of GABA+ in the PCG, ACC and thalamus. PCG GABA+ levels were significantly higher in people with migraine and low back pain compared with controls (eg, migraine 4.89 IU ± 0.62 vs controls 4.62 IU ± 0.38; P = .02). Higher GABA+ levels in the PCG were not unique to migraine and could reflect a mechanism of chronic pain in general. A better understanding of pain at a neurochemical level informs the development of treatments that target aberrant brain neurochemistry to improve patient outcomes. PERSPECTIVE: This study provides insights into the underlying mechanisms of chronic pain. Higher levels of GABA+ in the PCG may reflect an underlying mechanism of chronic headache and pain conditions. This knowledge may help improve patient outcomes through developing treatments that specifically address this aberrant brain neurochemistry.
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Affiliation(s)
- Aimie L Peek
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Queensland, Australia.
| | - Andrew M Leaver
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sheryl Foster
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Radiology, Westmead Hospital, New South Wales, Australia
| | - Georg Oeltzschner
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Nicolaas A Puts
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, UK
| | - Graham Galloway
- The University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Michele Sterling
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Queensland, Australia; RECOVER Injury Research Centre, Herston, Queensland, Australia
| | - Karl Ng
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Neurology, Royal North Shore Hospital, New South Wales, Australia
| | - Kathryn Refshauge
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Trudy Rebbeck
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Queensland, Australia
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Kyathanahally SP, Azzarito M, Rosner J, Calhoun VD, Blaiotta C, Ashburner J, Weiskopf N, Wiech K, Friston K, Ziegler G, Freund P. Microstructural plasticity in nociceptive pathways after spinal cord injury. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325580. [PMID: 34039630 PMCID: PMC8292587 DOI: 10.1136/jnnp-2020-325580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/12/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To track the interplay between (micro-) structural changes along the trajectories of nociceptive pathways and its relation to the presence and intensity of neuropathic pain (NP) after spinal cord injury (SCI). METHODS A quantitative neuroimaging approach employing a multiparametric mapping protocol was used, providing indirect measures of myelination (via contrasts such as magnetisation transfer (MT) saturation, longitudinal relaxation (R1)) and iron content (via effective transverse relaxation rate (R2*)) was used to track microstructural changes within nociceptive pathways. In order to characterise concurrent changes along the entire neuroaxis, a combined brain and spinal cord template embedded in the statistical parametric mapping framework was used. Multivariate source-based morphometry was performed to identify naturally grouped patterns of structural variation between individuals with and without NP after SCI. RESULTS In individuals with NP, lower R1 and MT values are evident in the primary motor cortex and dorsolateral prefrontal cortex, while increases in R2* are evident in the cervical cord, periaqueductal grey (PAG), thalamus and anterior cingulate cortex when compared with pain-free individuals. Lower R1 values in the PAG and greater R2* values in the cervical cord are associated with NP intensity. CONCLUSIONS The degree of microstructural changes across ascending and descending nociceptive pathways is critically implicated in the maintenance of NP. Tracking maladaptive plasticity unravels the intimate relationships between neurodegenerative and compensatory processes in NP states and may facilitate patient monitoring during therapeutic trials related to pain and neuroregeneration.
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Affiliation(s)
- Sreenath P Kyathanahally
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Michela Azzarito
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS): Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Claudia Blaiotta
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
| | - Nikolaus Weiskopf
- Neurophysics, Max-Planck-Institut fur Kognitions- und Neurowissenschaften, Leipzig, Germany
| | - Katja Wiech
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Karl Friston
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
| | - Gabriel Ziegler
- German Center for Neurodegenerative Disease (DZNE), Magdeburg, Germany
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
- Neurophysics, Max-Planck-Institut fur Kognitions- und Neurowissenschaften, Leipzig, Germany
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42
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Ton HT, Raffensperger K, Shoykhet M. Early Thalamic Injury After Resuscitation From Severe Asphyxial Cardiac Arrest in Developing Rats. Front Cell Dev Biol 2021; 9:737319. [PMID: 34950655 PMCID: PMC8688916 DOI: 10.3389/fcell.2021.737319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Children who survive cardiac arrest often develop debilitating sensorimotor and cognitive deficits. In animal models of cardiac arrest, delayed neuronal death in the hippocampal CA1 region has served as a fruitful paradigm for investigating mechanisms of injury and neuroprotection. Cardiac arrest in humans, however, is more prolonged than in most experimental models. Consequently, neurologic deficits in cardiac arrest survivors arise from injury not solely to CA1 but to multiple vulnerable brain structures. Here, we develop a rat model of prolonged pediatric asphyxial cardiac arrest and resuscitation, which better approximates arrest characteristics and injury severity in children. Using this model, we characterize features of microglial activation and neuronal degeneration in the thalamus 24 h after resuscitation from 11 and 12 min long cardiac arrest. In addition, we test the effect of mild hypothermia to 34°C for 8 h after 12.5 min of arrest. Microglial activation and neuronal degeneration are most prominent in the thalamic Reticular Nucleus (nRT). The severity of injury increases with increasing arrest duration, leading to frank loss of nRT neurons at longer arrest times. Hypothermia does not prevent nRT injury. Interestingly, injury occurs selectively in intermediate and posterior nRT segments while sparing the anterior segment. Since all nRT segments consist exclusively of GABA-ergic neurons, we asked if GABA-ergic neurons in general are more susceptible to hypoxic-ischemic injury. Surprisingly, cortical GABA-ergic neurons, like their counterparts in the anterior nRT segment, do not degenerate in this model. Hence, we propose that GABA-ergic identity alone is not sufficient to explain selective vulnerability of intermediate and posterior nRT neurons to hypoxic-ischemic injury after cardiac arrest and resuscitation. Our current findings align the animal model of pediatric cardiac arrest with human data and suggest novel mechanisms of selective vulnerability to hypoxic-ischemic injury among thalamic GABA-ergic neurons.
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43
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Xu X, Xu DS. Prospects for the application of transcranial magnetic stimulation in diabetic neuropathy. Neural Regen Res 2021; 16:955-962. [PMID: 33229735 PMCID: PMC8178790 DOI: 10.4103/1673-5374.297062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Encouraging results have been reported for the use of transcranial magnetic stimulation-based nerve stimulation in studies of the mechanisms of neurological regulation, nerve injury repair, and nerve localization. However, to date, there are only a few reviews on the use of transcranial magnetic stimulation for diabetic neuropathy. Patients with diabetic neuropathy vary in disease progression and show neuropathy in the early stage of the disease with mild symptoms, making it difficult to screen and identify. In the later stage of the disease, irreversible neurological damage occurs, resulting in treatment difficulties. In this review, we summarize the current state of diabetic neuropathy research and the prospects for the application of transcranial magnetic stimulation in diabetic neuropathy. We review significant studies on the beneficial effects of transcranial magnetic stimulation in diabetic neuropathy treatment, based on the outcomes of its use to treat neurodegeneration, pain, blood flow change, autonomic nervous disorders, vascular endothelial injury, and depression. Collectively, the studies suggest that transcranial magnetic stimulation can produce excitatory/inhibitory stimulation of the cerebral cortex or local areas, promote the remodeling of the nervous system, and that it has good application prospects for the localization of the injury, neuroprotection, and the promotion of nerve regeneration. Therefore, transcranial magnetic stimulation is useful for the screening and early treatment of diabetic neuropathy. Transcranial magnetic stimulation can also alleviate pain symptoms by changing the cortical threshold and inhibiting the conduction of sensory information in the thalamo-spinal pathway, and therefore it has therapeutic potential for the treatment of pain and pain-related depressive symptoms in patients with diabetic neuropathy. Additionally, based on the effect of transcranial magnetic stimulation on local blood flow and its ability to change heart rate and urine protein content, transcranial magnetic stimulation has potential in the treatment of autonomic nerve dysfunction and vascular injury in diabetic neuropathy. Furthermore, oxidative stress and the inflammatory response are involved in the process of diabetic neuropathy, and transcranial magnetic stimulation can reduce oxidative damage. The pathological mechanisms of diabetic neuropathy should be further studied in combination with transcranial magnetic stimulation technology.
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Affiliation(s)
- Xi Xu
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Dong-Sheng Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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44
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Tang Y, Wang M, Zheng T, Xiao Y, Wang S, Han F, Chen G. Structural and functional brain abnormalities in postherpetic neuralgia: A systematic review of neuroimaging studies. Brain Res 2020; 1752:147219. [PMID: 33358730 DOI: 10.1016/j.brainres.2020.147219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023]
Abstract
In recent decades, an increasing number of neuroimaging studies utilizing magnetic resonance imaging (MRI) have explored the differential effects of postherpetic neuralgia (PHN) on brain structure and function. We systematically reviewed and integrated the findings from relevant neuroimaging studies in PHN patients. A total of 15 studies with 16 datasets were ultimately included in the present study, which were categorized by the different neuroimaging modalities. The results revealed that PHN was closely associated with structural/microstructural and functional abnormalities of the brain mainly located in the 'pain matrix', including the thalamus, insula, parahippocampus, amygdala, dorsolateral prefrontal cortex, precentral gyrus and inferior parietal lobe, as well as other regions, such as the precuneus, lentiform nucleus and brainstem. Furthermore, a disruption of multiple networks, including the default-mode network, salience network and limbic system, may contribute to the neurophysiological mechanisms underlying PHN. The findings indicate that the cerebral abnormalities of PHN were not restricted to the pain matrix but extended to other regions, profoundly affecting the regulation and moderation of pain processing in PHN. Future prospective and longitudinal neuroimaging studies with larger samples will elucidate the progressive trajectory of neural changes in the pathophysiological process of PHN.
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Affiliation(s)
- Yu Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Maohua Wang
- Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Ting Zheng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yan Xiao
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fugang Han
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Guangxiang Chen
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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45
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Hesam-Shariati N, Newton-John T, Singh AK, Tirado Cortes CA, Do TTN, Craig A, Middleton JW, Jensen MP, Trost Z, Lin CT, Gustin SM. Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines. JMIR Res Protoc 2020; 9:e20979. [PMID: 32990249 PMCID: PMC7556378 DOI: 10.2196/20979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuropathic pain is a debilitating secondary condition for many individuals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. OBJECTIVE The primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for individuals with neuropathic pain following spinal cord injury. METHODS We have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration. RESULTS This study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021. CONCLUSIONS This clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large samples is not feasible. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943; https://bit.ly/2RY1jRx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/20979.
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Affiliation(s)
- Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Avinash K Singh
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | | | | | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, University of Sydney, Kolling Institute, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, University of Sydney, Kolling Institute, Sydney, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Chin-Teng Lin
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
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46
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review and synthesize current literature in which neurochemical and structural brain imaging were used to investigate chronic migraine (CM) pathophysiology and to further discuss the clinical implications. RECENT FINDINGS Spectroscopic and structural MRI studies have shown the presence of both impaired metabolism and structural alterations in the brain of CM patients. Metabolic changes in key brain regions support the notion of altered energetics and homeostasis as part of CM pathophysiology. Furthermore, CM, like other chronic pain disorders, may undergo structural reorganization in pain-related brain regions following near persistent endogenous painful input. Finally, both imaging techniques may provide potential biomarkers of disease state and progression and may help guide novel therapeutic interventions or strategies. Spectroscopic and structural MRI have revealed novel aspects of CM pathophysiology. Findings from the former support the metabolic theory of migraine pathogenesis.
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Affiliation(s)
- Kuan-Lin Lai
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - David M Niddam
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei, 112, Taiwan.
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47
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Wang Z, Huang S, Yu X, Li L, Yang M, Liang S, Liu W, Tao J. Altered thalamic neurotransmitters metabolism and functional connectivity during the development of chronic constriction injury induced neuropathic pain. Biol Res 2020; 53:36. [PMID: 32843088 PMCID: PMC7448455 DOI: 10.1186/s40659-020-00303-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the thalamic neurotransmitters and functional connections in the development of chronic constriction injury (CCI)-induced neuropathic pain. Methods The paw withdrawal threshold was measured by mechanical stimulation the right hind paw with the von frey hair in the rats of CCI-induced neuropathic pain. The N-acetylaspartate (NAA) and Glutamate (Glu) in thalamus were detected by magnetic resonance spectrum (MRS) process. The thalamic functional connectivity with other brain regions was scanned by functional magnetic resonance image (fMRI). Results The paw withdrawal threshold of the ipsilateral side showed a noticeable decline during the pathological process. Increased concentrations of Glu and decreased levels of NAA in the thalamus were significantly correlated with mechanical allodynia in the neuropathic pain states. The thalamic regional homogeneity (ReHo) decreased during the process of neuropathic pain. The functional connectivity among the thalamus with the insula and somatosensory cortex were significantly increased at different time points (7, 14, 21 days) after CCI surgery. Conclusion Our study suggests that dynamic changes in thalamic NAA and Glu levels contribute to the thalamic functional connection hyper-excitation during CCI-induced neuropathic pain. Enhanced thalamus-insula functional connection might have a significant effect on the occurrence of neuropathic pain.
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Affiliation(s)
- Zhifu Wang
- College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Sheng Huang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, Fujian, China
| | - Xiangmei Yu
- College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Long Li
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, Fujian, China
| | - Minguang Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, Fujian, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, Fujian, China
| | - Weilin Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
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Wu L, Niu Z, Hu X, Liu H, Li S, Chen L, Zheng D, Liu Z, Liu T, Xu F, Manyande A, Wang J, Xia H. Regional cerebral metabolic levels and turnover in awake rats after acute or chronic spinal cord injury. FASEB J 2020; 34:10547-10559. [PMID: 32592196 DOI: 10.1096/fj.202000447r] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Liang Wu
- Department of Neurosurgery General Hospital of Ningxia Medical University Yinchuan P.R. China
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- Ningxia Key Laboratory of Cerebrocranial Diseases Yinchuan P.R. China
- School of Clinical Medicine Ningxia Medical University Yinchuan P.R. China
| | - Zhanfeng Niu
- Department of Neurosurgery General Hospital of Ningxia Medical University Yinchuan P.R. China
| | - Xulei Hu
- Department of Neurosurgery General Hospital of Ningxia Medical University Yinchuan P.R. China
- Ningxia Key Laboratory of Cerebrocranial Diseases Yinchuan P.R. China
- School of Clinical Medicine Ningxia Medical University Yinchuan P.R. China
| | - Huili Liu
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- University of Chinese Academy of Sciences Beijing P.R. China
| | - Shuang Li
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
| | - Lei Chen
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
| | - Danhao Zheng
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- University of Chinese Academy of Sciences Beijing P.R. China
| | - Zhuang Liu
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- University of Chinese Academy of Sciences Beijing P.R. China
| | - Taotao Liu
- Department of Anesthesiology Peking University Third Hospital Beijing P.R. China
| | - Fuqiang Xu
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- University of Chinese Academy of Sciences Beijing P.R. China
| | - Anne Manyande
- School of Human and Social Sciences University of West London London UK
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics Wuhan Institute of Physics and MathematicsChinese Academy of SciencesInnovation Academy for Precision Measurement Science and Technology Wuhan P.R. China
- University of Chinese Academy of Sciences Beijing P.R. China
- Hebei Provincial Key Laboratory of Basic Medicine for Diabetes 2nd Hospital of Shijiazhuang Shijiazhuang P.R. China
| | - Hechun Xia
- Department of Neurosurgery General Hospital of Ningxia Medical University Yinchuan P.R. China
- Ningxia Human Stem Cell Research Institute General Hospital of Ningxia Medical University Yinchuan P.R. China
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Osinski T, Acapo S, Bensmail D, Bouhassira D, Martinez V. Central Nervous System Reorganization and Pain After Spinal Cord Injury: Possible Targets for Physical Therapy-A Systematic Review of Neuroimaging Studies. Phys Ther 2020; 100:946-962. [PMID: 32201890 DOI: 10.1093/ptj/pzaa043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/31/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS). PURPOSE This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs. DATA SOURCES A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018. STUDY SELECTION Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery. DATA EXTRACTION Data were extracted by 2 blinded reviewers. DATA SYNTHESIS There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity. LIMITATIONS AND CONCLUSION Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.
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Affiliation(s)
- Thomas Osinski
- INSERM UMR 987-CETD-Hôpital Ambroise Paré, 9 Avenue Charles De Gaulle, Boulogne-Billancourt, 92100 France; and Université Versailles Saint-Quentin, Versailles, France
| | - Sessi Acapo
- Laboratoire de Thérapeutique, Faculté de Médecine, Université de Nantes, Nantes, France
| | - Djamel Bensmail
- Université Versailles Saint-Quentin; and Service de Médecine Physique et Réadaptation, Hôpital Raymond-Poincaré, Garches, France
| | - Didier Bouhassira
- INSERM UMR 987-CETD-Hôpital Ambroise Paré; and Université Versailles Saint-Quentin
| | - Valéria Martinez
- INSERM UMR 987-CETD-Hôpital Ambroise Paré; Université Versailles Saint-Quentin; Service d'Anesthésie, Hôpital Raymond-Poincaré; and Assistance Publique Hôpitaux de Paris, Garches, France
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Osinski T, Martinez V, Bensmail D, Hatem S, Bouhassira D. Interplay between body schema, visuospatial perception and pain in patients with spinal cord injury. Eur J Pain 2020; 24:1400-1410. [DOI: 10.1002/ejp.1600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas Osinski
- Inserm U987 APHPCHU Ambroise Paré HospitalUVSQ, Paris‐Saclay University Boulogne‐Billancourt France
| | - Valeria Martinez
- Inserm U987 APHPCHU Ambroise Paré HospitalUVSQ, Paris‐Saclay University Boulogne‐Billancourt France
- Anesthesiology Department Hôpital Raymond PoincaréAPHP Garches France
| | - Djamel Bensmail
- Physical Medicine and Rehabilitation Department Hôpital Raymond PoincaréAPHPUVSQ Garches France
| | - Samar Hatem
- Physical Medicine and Rehabilitation Brugmann University Hospital Brussels Belgium
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Didier Bouhassira
- Inserm U987 APHPCHU Ambroise Paré HospitalUVSQ, Paris‐Saclay University Boulogne‐Billancourt France
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