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Pintea S, Maier P. Mind over chronic pain: A meta-analysis of cognitive restructuring in chronically ill adults. J Psychosom Res 2024; 184:111837. [PMID: 38954864 DOI: 10.1016/j.jpsychores.2024.111837] [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: 12/19/2023] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This meta-analysis synthesizes research on the impact of cognitive restructuring on chronic pain intensity, aiming to integrate diverse methodologies and findings while evaluating potential moderators. METHODS Following PRISMA guidelines, we systematically searched multiple databases (PubMed, Web of Science, JSTOR, Sage, Social Science Research Network, PsycArticles, ScienceDirect, and Education Resources Information Center) until July 2023. Studies involving adults (≥18 years) diagnosed with chronic conditions who underwent cognitive restructuring to reduce chronic pain intensity, were included. Eligible studies compared this intervention with a control group. We excluded studies incorporating cognitive restructuring within broader interventions, lacking statistical data, or not written in English. Study quality was assessed using the Cochrane Risk of Bias tool (RoB 2). RESULTS After reviewing 18,312 studies, we selected 11 studies published between 1991 and 2022, involving 693 participants with chronic conditions. A significant large overall effect size was found (d = 0.94, 95% CI 0.48 to 1.40). Moderation analyses revealed significant differences based on sex and study quality, with effects less pronounced among females and more substantial in higher-quality studies. CONCLUSION Despite limitations such as statistical instability due to a small number of studies in certain moderator categories and methodological variability, this meta-analysis highlights the robust effects of cognitive restructuring on chronic pain intensity. The findings are valuable for guiding power calculations and future research expectations. Clinically, these results support the significant effect of cognitive restructuring in both individual and group settings, regardless of age, particularly when facilitated by teams that include psychologists.
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Affiliation(s)
| | - Paula Maier
- Department of Psychology, Babeș-Bolyai University, Romania.
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2
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Medeiros AC, Medeiros P, Pigatto GR, Maione S, Coimbra NC, de Freitas RL. Cannabidiol in the dorsal hippocampus attenuates emotional and cognitive impairments related to neuropathic pain: The role of prelimbic neocortex-hippocampal connections. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111039. [PMID: 38797491 DOI: 10.1016/j.pnpbp.2024.111039] [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: 02/21/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND PURPOSE Chronic neuropathic pain (NP) is commonly associated with cognitive and emotional impairments. Cannabidiol (CBD) presents a broad spectrum of action with a potential analgesic effect. This work investigates the CBD effect on comorbidity between chronic NP, depression, and memory impairment. EXPERIMENTAL APPROACH The connection between the neocortex and the hippocampus was investigated with biotinylated dextran amine (BDA) deposits in the prelimbic cortex (PrL). Wistar rats were submitted to chronic constriction injury (CCI) of the sciatic nerve and CA1 treatment with CBD (15, 30, 60 nmol). KEY RESULTS BDA-labeled perikarya and terminal buttons were found in CA1 and dentate gyrus. CCI-induced mechanical and cold allodynia increased c-Fos protein expression in the PrL and CA1. The number of astrocytes in PrL and CA1 increased, and the number of neuroblasts decreased in CA1. Animals submitted to CCI procedure showed increasing depressive-like behaviors, such as memory impairment. CBD (60 nmol) treatment decreased mechanical and cold allodynia, attenuated depressive-associated behaviors, and improved memory performance. Cobalt chloride (CoCl2: 1 nM), WAY-100635 (0.37 nmol), and AM251 (100 nmol) intra-PrL reversed the effect of CA1 treatment with CBD (60 nmol) on nociceptive, cognitive, and depressive behaviors. CONCLUSION CBD represents a promising therapeutic perspective in the pharmacological treatment of chronic NP and associated comorbidities such as depression and memory impairments. The CBD effects possibly recruit the CA1-PrL pathway, inducing neuroplasticity. CBD acute treatment into the CA1 produces functional and molecular morphological improvements.
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Affiliation(s)
- Ana Carolina Medeiros
- Multi-User Center of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Laboratory of Neurosciences of Pain & Emotions, Department of Surgery and Anatomy, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, SP 14050-220, Brazil
| | - Priscila Medeiros
- Multi-User Center of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Laboratory of Neurosciences of Pain & Emotions, Department of Surgery and Anatomy, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Department of General and Specialized Nursing, Ribeirão Preto Nursing School of the University of São Paulo (EERP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Glauce Regina Pigatto
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Sabatino Maione
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Norberto Cysne Coimbra
- Multi-User Center of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, SP 14050-220, Brazil
| | - Renato Leonardo de Freitas
- Multi-User Center of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Laboratory of Neurosciences of Pain & Emotions, Department of Surgery and Anatomy, FMRP-USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, SP 14050-220, Brazil; Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy.
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Zhong CC, Xu Z, Gan J, Yu YM, Tang HM, Zhu Y, Yang JX, Ding HL, Cao JL. Acute Ongoing Nociception Delays Recovery of Consciousness from Sevoflurane Anesthesia via a Midbrain Circuit. J Neurosci 2024; 44:e0740242024. [PMID: 39019613 PMCID: PMC11340287 DOI: 10.1523/jneurosci.0740-24.2024] [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: 04/19/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
Although anesthesia provides favorable conditions for surgical procedures, recent studies have revealed that the brain remains active in processing noxious signals even during anesthesia. However, whether and how these responses affect the anesthesia effect remains unclear. The ventrolateral periaqueductal gray (vlPAG), a crucial hub for pain regulation, also plays an essential role in controlling general anesthesia. Hence, it was hypothesized that the vlPAG may be involved in the regulation of general anesthesia by noxious stimuli. Here, we found that acute noxious stimuli, including capsaicin-induced inflammatory pain, acetic acid-induced visceral pain, and incision-induced surgical pain, significantly delayed recovery from sevoflurane anesthesia in male mice, whereas this effect was absent in the spared nerve injury-induced chronic pain. Pretreatment with peripheral analgesics could prevent the delayed recovery induced by acute nociception. Furthermore, we found that acute noxious stimuli, induced by the injection of capsaicin under sevoflurane anesthesia, increased c-Fos expression and activity in the GABAergic neurons of the ventrolateral periaqueductal gray. Specific reactivation of capsaicin-activated vlPAGGABA neurons mimicked the effect of capsaicin and its chemogenetic inhibition prevented the delayed recovery from anesthesia induced by capsaicin. Finally, we revealed that the vlPAGGABA neurons regulated the recovery from anesthesia through the inhibition of ventral tegmental area dopaminergic neuronal activity, thus decreasing dopamine (DA) release and activation of DA D1-like receptors in the brain. These findings reveal a novel, cell- and circuit-based mechanism for regulating anesthesia recovery by nociception, and it is important to provide new insights for guiding the management of the anesthesia recovery period.
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Affiliation(s)
- Chao-Chao Zhong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Zheng Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Jun Gan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Yu-Mei Yu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Hui-Mei Tang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Yangzi Zhu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Jun-Xia Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Hai-Lei Ding
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. Nat Commun 2024; 15:6017. [PMID: 39019888 PMCID: PMC11255344 DOI: 10.1038/s41467-024-50103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
Drug treatments for pain often do not outperform placebo, and a better understanding of placebo mechanisms is needed to improve treatment development and clinical practice. In a large-scale fMRI study (N = 392) with pre-registered analyses, we tested whether placebo analgesic treatment modulates nociceptive processes, and whether its effects generalize from conditioned to unconditioned pain modalities. Placebo treatment caused robust analgesia in conditioned thermal pain that generalized to unconditioned mechanical pain. However, placebo did not decrease pain-related fMRI activity in brain measures linked to nociceptive pain, including the Neurologic Pain Signature (NPS) and spinothalamic pathway regions, with strong support for null effects in Bayes Factor analyses. In addition, surprisingly, placebo increased activity in some spinothalamic regions for unconditioned mechanical pain. In contrast, placebo reduced activity in a neuromarker associated with higher-level contributions to pain, the Stimulus Intensity Independent Pain Signature (SIIPS), and affected activity in brain regions related to motivation and value, in both pain modalities. Individual differences in behavioral analgesia were correlated with neural changes in both modalities. Our results indicate that cognitive and affective processes primarily drive placebo analgesia, and show the potential of neuromarkers for separating treatment influences on nociception from influences on evaluative processes.
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Affiliation(s)
- Rotem Botvinik-Nezer
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Bogdan Petre
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Marta Ceko
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
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AlSahman L, AlBagieh H, AlSahman R. Is There a Relationship between Salivary Cortisol and Temporomandibular Disorder: A Systematic Review. Diagnostics (Basel) 2024; 14:1435. [PMID: 39001325 PMCID: PMC11241310 DOI: 10.3390/diagnostics14131435] [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: 05/28/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND This systematic review examines and evaluates the relationship between salivary cortisol levels and temporomandibular disorder (TMD) in young adult patients. METHOD Six databases-PubMed, Scopus, Web of Science, Google Scholar, ProQuest, and Cochrane Library-were utilized to screen eligible studies. A systematic search was performed based on PECO questions and eligibility criteria. The research question for this review was "Do salivary cortisol levels correlate with TMD in individuals aged 18-40?" The risk of bias for quality assessment was determined by the Cochrane tool. PRISMA guidelines were followed while performing this review. RESULT A total of fourteen studies were included in this review. Of these, eleven were observational studies (four cross-sectional and seven case-control), and three were randomized control trials. Eleven of the included studies presented a low to moderate risk in the qualitative synthesis. The total sample size of the included studies was 751 participants. The included studies suggest higher salivary cortisol levels in TMD patients than in healthy individuals. CONCLUSIONS The findings of this review indicate higher salivary cortisol levels in adult patients with TMD than in healthy controls. Thus, supportive psychological treatment and clinical modalities should be provided to patients with TMD. Moreover, higher-quality studies with low heterogeneity are required to support this finding.
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Affiliation(s)
- Lujain AlSahman
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh 57448, Saudi Arabia;
| | - Hamad AlBagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University Riyadh, Riyadh 57448, Saudi Arabia;
| | - Roba AlSahman
- Faculty of Dentistry, Royal College of Surgeons, D02YN77 Dublin, Ireland;
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Franciosa F, Acuña MA, Nevian NE, Nevian T. A cellular mechanism contributing to pain-induced analgesia. Pain 2024:00006396-990000000-00640. [PMID: 38968393 DOI: 10.1097/j.pain.0000000000003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/27/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT The anterior cingulate cortex (ACC) plays a crucial role in the perception of pain. It is consistently activated by noxious stimuli and its hyperactivity in chronic pain indicates plasticity in the local neuronal network. However, the way persistent pain effects and modifies different neuronal cell types in the ACC and how this contributes to sensory sensitization is not completely understood. This study confirms the existence of 2 primary subtypes of pyramidal neurons in layer 5 of the rostral, agranular ACC, which we could classify as intratelencephalic (IT) and cortico-subcortical (SC) projecting neurons, similar to other cortical brain areas. Through retrograde labeling, whole-cell patch-clamp recording, and morphological analysis, we thoroughly characterized their different electrophysiological and morphological properties. When examining the effects of peripheral inflammatory pain on these neuronal subtypes, we observed time-dependent plastic changes in excitability. During the acute phase, both subtypes exhibited reduced excitability, which normalized to pre-inflammatory levels after day 7. Daily conditioning with nociceptive stimuli during this period induced an increase in excitability specifically in SC neurons, which was correlated with a decrease in mechanical sensitization. Subsequent inhibition of the activity of SC neurons projecting to the periaqueductal gray with in vivo chemogenetics, resulted in reinstatement of the hypersensitivity. Accordingly, it was sufficient to enhance the excitability of these neurons chemogenetically in the inflammatory pain condition to induce hypoalgesia. These findings suggest a cell type-specific effect on the descending control of nociception and a cellular mechanism for pain-induced analgesia. Furthermore, increased excitability in this neuronal population is hypoalgesic rather than hyperalgesic.
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Hasırcı Bayır BR, Aksu S, Gezegen H, Karaaslan Z, Yüceer H, Cerrahoğlu Şirin T, Küçükali Cİ, Kurt A, Karamürsel S, Yılmaz V, Baykan B. Effects of Transcranial Direct Current Stimulation on Clinical Outcomes, Calcitonin Gene-Related Peptide, and Pituitary Adenylate Cyclase-Activating Polypeptide-38 Levels in Menstrual Migraine. Neuromodulation 2024; 27:835-846. [PMID: 38506767 DOI: 10.1016/j.neurom.2024.01.005] [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: 05/24/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) has been suggested as an alternative treatment option for migraine. The present study aimed to evaluate the efficacy of tDCS on clinical outcomes in addition to calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide 38 (PACAP-38) levels in individuals with menstrual-related migraine (MRM) for the first time. MATERIALS AND METHODS In this parallel study, 58 female patients between the ages of 18 and 45 years, including 36 with MRM and 22 with nonmenstrual migraines (nMM), were recruited. Sessions of 2-mA 20-minute anodal tDCS were administered over the left dorsolateral prefrontal cortex within three consecutive days (1:1 active and sham stimulation). Migraine attack frequency, severity, analgesic usage, CGRP, and PACAP-38 levels of the patients were evaluated before and one month after tDCS. RESULTS After tDCS, in the active group compared with the sham group, the frequency (p = 0.031), the severity of attacks (p = 0.003), the number of days with headache (p = 0.004), and the analgesic usage (p = 0.024) were all decreased. In both MRM and nMM groups, the frequency and severity of attacks and analgesic usage were decreased in those receiving active stimulation (p < 0.001 for each). CGRP and PACAP-38 levels were no different in the active group and the sham group after tDCS. CONCLUSIONS tDCS was shown to be efficacious in migraine prophylaxis and a valuable option for migraine and MRM treatment. The absence of changes in serum CGRP and PACAP-38 levels suggests that tDCS efficacy may stem from distinct cerebral electrophysiological mechanisms.
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Affiliation(s)
- Buse Rahime Hasırcı Bayır
- Haydarpaşa Numune Reasearch and Training Hospital, Istanbul, Turkey; Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Muğla Sıtkı Koçman University, Muğla, Turkey; Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşim Gezegen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zerrin Karaaslan
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hande Yüceer
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Tuba Cerrahoğlu Şirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Şişli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Kurt
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Vuslat Yılmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Ma L, Yue L, Liu S, Zhang Y, Zhang M, Cui S, Liu FY, Yi M, Wan Y. Dynamic Changes of the Infralimbic Cortex and Its Regulation of the Prelimbic Cortex in Rats with Chronic Inflammatory Pain. Neurosci Bull 2024; 40:872-886. [PMID: 38180711 PMCID: PMC11250740 DOI: 10.1007/s12264-023-01159-x] [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: 07/09/2023] [Accepted: 09/19/2023] [Indexed: 01/06/2024] Open
Abstract
The prelimbic cortex (PL) is actively engaged in pain modulation. The infralimbic cortex (IL) has been reported to regulate the PL. However, how this regulation affects pain remains unclear. In the present study, we recorded temporary hyper-activity of PL pyramidal neurons responding to nociceptive stimuli, but a temporary hypo-function of the IL by in vivo electrophysiological recording in rats with peripheral inflammation. Manipulation of the PL or IL had opposite effects on thermal hyperalgesia. Furthermore, the functional connectivity and chemogenetic regulation between the subregions indicated an inhibitory influence of the IL on the PL. Activation of the pathway from the IL to the PL alleviated thermal hyperalgesia, whereas its inhibition exacerbated chronic pain. Overall, our results suggest a new mechanism underlying the role of the medial prefrontal cortex in chronic pain: hypo-function of the IL leads to hyperactivity of the PL, which regulates thermal hyperalgesia, and thus contributes to the chronicity of pain.
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Affiliation(s)
- Longyu Ma
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
| | - Lupeng Yue
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, 100101, China
| | - Shuting Liu
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
| | - Yu Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, CAMS & PUMC, Beijing, 100021, China
| | - Meng Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shuang Cui
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
| | - Feng-Yu Liu
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China
| | - Ming Yi
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China.
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, 100083, China.
| | - You Wan
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Peking University, Beijing, 100083, China.
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, 100083, China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China.
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Waisman A, Katz J. The autobiographical memory system and chronic pain: A neurocognitive framework for the initiation and maintenance of chronic pain. Neurosci Biobehav Rev 2024; 162:105736. [PMID: 38796124 DOI: 10.1016/j.neubiorev.2024.105736] [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: 09/13/2023] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Chronic pain affects approximately 20% of the world's population, exerting a substantial burden on the affected individual, their families, and healthcare systems globally. Deficits in autobiographical memory have been identified among individuals living with chronic pain, and even found to pose a risk for the transition to chronicity. Recent neuroimaging studies have simultaneously implicated common brain regions central to autobiographical memory processing in the maintenance of and susceptibility to chronic pain. The present review proposes a novel neurocognitive framework for chronic pain explained by mechanisms underlying the autobiographical memory system. Here, we 1) summarize the current literature on autobiographical memory in pain, 2) discuss the role of the hippocampus and cortical brain regions including the ventromedial prefrontal cortex, anterior temporal lobe, and amygdala in relation to autobiographical memory, memory schemas, emotional processing, and pain, 3) synthesize these findings in a neurocognitive framework that explains these relationships and their implications for patients' pain outcomes, and 4) propose translational directions for the prevention, management, and treatment of chronic pain.
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Affiliation(s)
- Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada.
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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10
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Murillo C, López-Sola M, Cagnie B, Suñol M, Smeets RJEM, Coppieters I, Cnockaert E, Meeus M, Timmers I. Gray Matter Adaptations to Chronic Pain in People with Whiplash-Associated Disorders are Partially Reversed After Treatment: A Voxel-based Morphometry Study. THE JOURNAL OF PAIN 2024; 25:104471. [PMID: 38232862 DOI: 10.1016/j.jpain.2024.01.336] [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: 06/23/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Gray matter (GM) changes are often observed in people with chronic spinal pain, including those with chronic whiplash-associated disorders (CWAD). These GM adaptations may be reversed with treatment, at least partially. Pain neuroscience education combined with exercise (PNE+Exercise) is an effective treatment, but its neural underlying mechanisms still remain unexplored in CWAD. Here, we performed both cross-sectional and longitudinal voxel-based morphometry to 1) identify potential GM alterations in people with CWAD (n = 63) compared to age- and sex-matched pain-free controls (n = 32), and 2) determine whether these GM alterations might be reversed following PNE+Exercise (compared to conventional physiotherapy). The cross-sectional whole-brain analysis revealed that individuals with CWAD had less GM volume in the right and left dorsolateral prefrontal cortex and left inferior temporal gyrus which was, in turn, associated with higher pain vigilance. Fifty individuals with CWAD and 29 pain-free controls were retained in the longitudinal analysis. GM in the right dorsolateral prefrontal cortex increased after treatment in people with CWAD. Moreover, the longitudinal whole-brain analysis revealed that individuals with CWAD had decreases in GM volumes of the left and right central operculum and supramarginal after treatment. These changes were not specific to treatment modality and some were not observed in pain-free controls over time. Herewith, we provide the first evidence on how GM adaptations to CWAD respond to treatment. PERSPECTIVE: This article presents which gray matter adaptations are present in people with chronic pain after whiplash injuries. Then, we examine the treatment effect on these alterations as well as whether other neuroplastic effects on GM following treatment occur.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Marina López-Sola
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - María Suñol
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Iris Coppieters
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Department of chronic diseases and metabolism, Faculty of Medicine, KU Leuven, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Elise Cnockaert
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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11
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Bell TR, Franz CE, Eyler LT, Fennema-Notestine C, Puckett OK, Dorros SM, Panizzon MS, Pearce RC, Hagler DJ, Lyons MJ, Beck A, Elman JA, Kremen WS. Probable chronic pain, brain structure, and Alzheimer's plasma biomarkers in older men. THE JOURNAL OF PAIN 2024; 25:104463. [PMID: 38199594 DOI: 10.1016/j.jpain.2024.01.006] [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: 08/23/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
Chronic pain leads to tau accumulation and hippocampal atrophy in mice. In this study, we provide one of the first assessments in humans, examining the associations of probable chronic pain with hippocampal volume, integrity of the locus coeruleus (LC)-an upstream site of tau deposition-and Alzheimer's Disease-related plasma biomarkers. Participants were mostly cognitively unimpaired men. Probable chronic pain was defined as moderate-to-severe pain in 2+ study waves at average ages 56, 62, and 68. At age 68, 424 participants underwent structural magnestic resonance imaging (MRI) of hippocampal volume and LC-sensitive MRI providing an index of LC integrity (LC contrast-to-noise ratio). Analyses adjusted for confounders including major health conditions, depressive symptoms, and opioid use. Models showed that men with probable chronic pain had smaller hippocampal volume and lower rostral-middle-but not caudal-LC contrast-to-noise ratio compared to men without probable chronic pain. Men with probable chronic pain also had higher levels of plasma total tau, beta-amyloid-42, and beta-amyloid-40 compared to men without probable chronic pain. These findings suggest that probable chronic pain is associated with tau accumulation and reduced structural brain integrity in regions affected early in the development of Alzheimer's Disease. PERSPECTIVE: Probable chronic pain was associated with plasma biomarkers and brain regions that are affected early in Alzheimer's disease (AD). Reducing pain in midlife and elucidating biological mechanisms may help to reduce the risk of AD in older adults.
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Affiliation(s)
- Tyler R Bell
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Carol E Franz
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California
| | - Christine Fennema-Notestine
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California; Department of Radiology, University of California San Diego, San Diego, La Jolla, California
| | - Olivia K Puckett
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Stephen M Dorros
- Department of Radiology, University of California San Diego, San Diego, La Jolla, California
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Rahul C Pearce
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Donald J Hagler
- Department of Radiology, University of California San Diego, San Diego, La Jolla, California; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California
| | - Michael J Lyons
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Asad Beck
- Graduate Program in Neuroscience, University of Washington, Seattle, Washington
| | - Jeremy A Elman
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - William S Kremen
- Department of Psychiatry, University of California San Diego, San Diego, La Jolla, California; Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
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12
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Poublan-Couzardot A, Talmi D. Pain perception as hierarchical Bayesian inference: A test case for the theory of constructed emotion. Ann N Y Acad Sci 2024; 1536:42-59. [PMID: 38837401 DOI: 10.1111/nyas.15141] [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] [Indexed: 06/07/2024]
Abstract
An intriguing perspective about human emotion, the theory of constructed emotion considers emotions as generative models according to the Bayesian brain hypothesis. This theory brings fresh insight to existing findings, but its complexity renders it challenging to test experimentally. We argue that laboratory studies of pain could support the theory because although some may not consider pain to be a genuine emotion, the theory must at minimum be able to explain pain perception and its dysfunction in pathology. We review emerging evidence that bear on this question. We cover behavioral and neural laboratory findings, computational models, placebo hyperalgesia, and chronic pain. We conclude that there is substantial evidence for a predictive processing account of painful experience, paving the way for a better understanding of neuronal and computational mechanisms of other emotions.
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Affiliation(s)
- Arnaud Poublan-Couzardot
- Université Claude Bernard Lyon 1, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, Bron, France
| | - Deborah Talmi
- Department of Psychology, University of Cambridge, Cambridge, UK
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13
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Collier L, Seah C, Hicks EM, Holtzheimer PE, Krystal JH, Girgenti MJ, Huckins LM, Johnston KJA. The impact of chronic pain on brain gene expression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.20.24307630. [PMID: 38826319 PMCID: PMC11142271 DOI: 10.1101/2024.05.20.24307630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Chronic pain affects one fifth of American adults, contributing significant public health burden. Chronic pain mechanisms can be further understood through investigating brain gene expression. Methods We tested differentially expressed genes (DEGs) in chronic pain, migraine, lifetime fentanyl and oxymorphone use, and with chronic pain genetic risk in four brain regions (dACC, DLPFC, MeA, BLA) and imputed cell type expression data from 304 postmortem donors. We compared findings across traits and with independent transcriptomics resources, and performed gene-set enrichment. Results We identified two chronic pain DEGs: B4GALT and VEGFB in bulk dACC. We found over 2000 (primarily BLA microglia) chronic pain cell type DEGs. Findings were enriched for mouse microglia pain genes, and for hypoxia and immune response. Cross-trait DEG overlap was minimal. Conclusions Chronic pain-associated gene expression is heterogeneous across cell type, largely distinct from that in pain-related traits, and shows BLA microglia are a key cell type.
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Affiliation(s)
- Lily Collier
- Department of Biological Sciences, Columbia University, New York City, NY
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University, New Haven, CT
| | - Carina Seah
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Emily M Hicks
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Paul E Holtzheimer
- National Center for PTSD, U.S. Department of Veterans Affairs
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - John H Krystal
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University, New Haven, CT
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
| | - Matthew J Girgenti
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University, New Haven, CT
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
| | - Laura M Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University, New Haven, CT
| | - Keira J A Johnston
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University, New Haven, CT
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14
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Yanagimura H, Sasaki M, Baba H, Kamiya Y. Influence of the descending pain-inhibiting serotonergic pathway on the antihyperalgesic effect of gabapentin in neuropathic pain model rats. Neurosci Res 2024; 202:20-29. [PMID: 37944901 DOI: 10.1016/j.neures.2023.11.003] [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: 07/31/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Gabapentinoids are used worldwide as first-line agents for the treatment of neuropathic pain. Accumulating evidence indicates that one of the antihyperalgesic mechanisms of gabapentinoids is through activation of the noradrenergic pathway of the descending pain inhibition system. However, the involvement of the serotonin pathway is unclear. We investigated the effects of gabapentin (GBP) on the serotonergic pathway of the descending inhibitory system using the spinal nerve ligation (SNL) rat model. As in previous reports, administration of GBP to SNL rats improved paw withdrawal thresholds (PWT). Intrathecally administered serotonin receptor antagonists abolished GBP's amelioration in PWT. GBP did not ameliorate PWT in noradrenaline-depleted SNL rats by DSP-4. However, GBP ameliorated PWT in serotonin-depleted SNL rats by para-chlorophenylalanine, which was not inhibited by intrathecal administration of a serotonin receptor antagonist. Immunohistochemical analysis of serotonin in the spinal dorsal horn revealed a slight, albeit statistically insignificant, increase in 5-HT levels in SNL rats compared to naive rats. However, no apparent changes were observed before or after GBP administration in naive and SNL rats. In conclusion, the involvement of the serotonergic pathway in the antihyperalgesic effects of GBP on the spinal cord is secondary, although it cooperates with the noradrenergic system to produce analgesia.
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Affiliation(s)
- Harue Yanagimura
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata City 951-8510, Japan
| | - Mika Sasaki
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata City 951-8510, Japan; Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan
| | - Hiroshi Baba
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata City 951-8510, Japan
| | - Yoshinori Kamiya
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata City 951-8510, Japan; Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan.
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15
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Caldichoury A, Garcia-Larrea L, Frot M. Focal changes in alpha oscillations during short-term memorization of pain: a high-density electroencephalogram study with source localization. Eur J Neurosci 2024; 59:2778-2791. [PMID: 38511229 DOI: 10.1111/ejn.16317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Memories of painful events constitute the basis for assessing patients' pain. This study explores the brain oscillatory activity during short-term memorization of a nociceptive stimulus. High-density EEG activity (128 electrodes) was recorded in 13 healthy subjects during a match-to-sample sensory discrimination task, whereby participants compared the intensity of a thumb-located electric shock (S2) with a prior stimulus to the same location (S1) delivered 8-10 s earlier. Stimuli were above or below the individual nociceptive threshold. EEG activity with intracortical source localization via LORETA source reconstruction was analysed during the inter-stimuli period and contrasted with a non-memory-related control task. The inter-stimulus memorization phase was characterized by a focal alpha-activity enhancement, significant during the nociceptive condition only, which progressed from bilateral occipital regions (cuneus and mid-occipital gyri) during the first encoding-memorization phase towards the right-superior and right mid-temporal gyri during the 2-4 s immediately preceding S2. Initial alpha enhancement in occipital areas/cuneus is consistent with rapid non-specific inhibition of task-irrelevant visual processing during initial stimulus encoding. Its transfer to the right-temporal regions was concomitant to the temporary upholding of the stimulus perceptual representation, previous to receiving S2, and suggests an active and local blockade of external interferences while these regions actively maintain internal information. These results add to a growing field indicating that alpha oscillations, while indicating local inhibitory processes, can also indirectly reveal active stimulus handling, including maintenance in short-term memory buffers, by objectivizing the filtering out of irrelevant and potentially disrupting inputs in brain regions engaged in internally driven operations.
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Affiliation(s)
- Argitxu Caldichoury
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Neurologique, Lyon, France
| | - Maud Frot
- Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, France
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16
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Malkani R, Paramasivam S, Wolfensohn S. How does chronic pain impact the lives of dogs: an investigation of factors that are associated with pain using the Animal Welfare Assessment Grid. Front Vet Sci 2024; 11:1374858. [PMID: 38638643 PMCID: PMC11025458 DOI: 10.3389/fvets.2024.1374858] [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: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Chronic pain can profoundly affect the wellbeing of dogs and our understanding is limited regarding the multidimensional impact it has on dog quality of life. This study aimed to assess the factors that are significant and predictive of behavior problems in dogs using the Animal Welfare Assessment Grid (AWAG) to further understand what factors influence their welfare. Methods Seventy six AWAG assessments were undertaken across 46 dogs that clinicians diagnosed as having musculoskeletal conditions that caused chronic pain. Wilcoxon-rank sum tests were used to assess the difference in scores between dogs with behavior disorders and a cohort of healthy dogs (n = 143). Results All physical factors besides body condition, and all psychological, environmental, and procedural factors were significantly different between healthy dogs and dogs with chronic pain, evidencing how chronic pain impacts all domains of a dog's life. Spearman Rank Correlation Coefficient (RS) revealed several significant strong positive correlations such as the association between the severity of clinical symptoms with poorer mobility and the frequency at which the dog experienced fearful stimuli. Logistic regression showed that fears and anxieties frequency, the dog's reaction to stressors, engagement with enrichment, and social interactions were significant predictors of chronic pain in dogs. Discussion This highlights that typical signs of musculoskeletal disorders such as gait changes, stiffness, lameness might manifest after behavioral changes such as increased fearfulness, prolonged recovery from a stressful event, a reduced interested in social interactions, toys or play. Owners only seeking veterinary attention when the presence of physical signs of disease are evident may result in a delayed veterinary attention resulting in reduced welfare. Regular veterinary assessments combined with use of the AWAG can proactively identify these behavioral indicators and result in prompt treatment and improved quality of life.
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Affiliation(s)
- Rachel Malkani
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
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17
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Song A, Sunday K, Silfies SP, Vendemia JMC. MRI Compatible Lumbopelvic Movement Measurement System to Validate and Capture Task Performance During Neuroimaging. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1380-1385. [PMID: 38512737 PMCID: PMC11026086 DOI: 10.1109/tnsre.2024.3380057] [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] [Indexed: 03/23/2024]
Abstract
Research suggests that structural and functional changes within the brain are associated with chronic low back pain, and these cortical alterations might contribute to impaired sensorimotor control of the trunk and hips in this population. However, linking sensorimotor brain changes with altered movement of the trunk and hips during task-based neuroimaging presents significant challenges. An MRI-safe pressure measurement system was developed to ensure proper task completion during neuroimaging by capturing movement patterns of the trunk (sensors under the lower back) and hips (sensors embedded in the foam roll under the knees). Pressure changes were measured outside of the scanner by digital differential pressure sensors to capture time-series data and analog pressure gauges for real-time determination of task performance occurring within an MRI bore during brain imaging. This study examined the concurrent validity of air pressure changes between the digital and analog sensors. The digital and analog data were compared in 23 participants during the performance of modified bilateral and unilateral right and left hip bridges. Spearman's correlations were calculated for each sensor during the three bridging tasks and showed high positive correlations, indicating that over 87% of pressure change from the analog gauge can be explained by the pressure from the digital sensor. Bland-Altman plots showed no bias and mean differences were under three mmHg. This pressure system improves the rigor of future studies by validating the digital data from the system and increasing the capabilities of capturing lumbopelvic task performance occurring inside the scanner bore.
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18
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Kleckner IR, Manuweera T, Lin PJ, Chung KH, Kleckner AS, Gewandter JS, Culakova E, Tivarus ME, Dunne RF, Loh KP, Mohile NA, Kesler SR, Mustian KM. Pilot trial testing the effects of exercise on chemotherapy-induced peripheral neurotoxicity (CIPN) and the interoceptive brain system. RESEARCH SQUARE 2024:rs.3.rs-4022351. [PMID: 38559210 PMCID: PMC10980099 DOI: 10.21203/rs.3.rs-4022351/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Purpose Chemotherapy-induced peripheral neurotoxicity (CIPN) is a prevalent, dose-limiting, tough-to-treat toxicity involving numbness, tingling, and pain in the extremities with enigmatic pathophysiology. This randomized controlled pilot study explored the feasibility and preliminary efficacy of exercise during chemotherapy on CIPN and the role of the interoceptive brain system, which processes bodily sensations. Methods Nineteen patients (65±11 years old, 52% women; cancer type: breast, gastrointestinal, multiple myeloma) starting neurotoxic chemotherapy were randomized to 12 weeks of exercise (home-based, individually tailored, moderate intensity, progressive walking and resistance training) or active control (nutrition education). At pre-, mid-, and post-intervention, we assessed CIPN symptoms (primary clinical outcome: CIPN-20), CIPN signs (tactile sensitivity using monofilaments), and physical function (leg strength). At pre- and post-intervention, we used task-free ("resting") fMRI to assess functional connectivity in the interoceptive brain system, involving the salience and default mode networks. Results The study was feasible (74-89% complete data across measures) and acceptable (95% retention). We observed moderate/large beneficial effects of exercise on CIPN symptoms (CIPN-20, 0-100 scale: -7.9±5.7, effect size [ES]=-0.9 at mid-intervention; -4.8±7.3, -ES=0.5 at post-intervention), CIPN signs (ES=-1.0 and -0.1), and physical function (ES=0.4 and 0.3). Patients with worse CIPN after neurotoxic chemotherapy had lower functional connectivity within the default mode network (R2=40-60%) and higher functional connectivity within the salience network (R2=20-40%). Exercise tended to increase hypoconnectivity and decrease hyperconnectivity seen in CIPN (R2 = 12%). Conclusion Exercise during neurotoxic chemotherapy is feasible and may attenuate CIPN symptoms and signs, perhaps via changes in interoceptive brain circuitry. Future work should test for replication with larger samples. ClinicalTrials.gov identifier NCT03021174.
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Affiliation(s)
| | | | - Po-Ju Lin
- University of Rochester Medical Center
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19
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Granovsky Y, Sprecher E, Yarovinsky N, Shor M, Crystal S. Body-site effect on CPM efficiency in healthy subjects: Central vs. peripheral stimulation. Heliyon 2024; 10:e25156. [PMID: 38317925 PMCID: PMC10839622 DOI: 10.1016/j.heliyon.2024.e25156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
Structural changes in the peripheral nerve system in neuropathic states alter sensory capacity of the affected area, thus biasing results of conditioned pain modulation (CPM) responses. The aim of this study was to evaluate CPM efficiency of central (i.e. trunk) vs. peripheral (i.e. limb) application of 'test' and 'conditioning' stimuli. Methods: Healthy volunteers (ages 18-73 yrs) underwent two CPM protocols: 'CPM Limb' and 'CPM Trunk'. Each included two types of test stimuli (Ts) (pressure pain threshold: PPT; and contact heat) conditioned either to hand immersion in cold noxious water (CPM limb), or to noxious contact heat applied on lower back (CPM trunk). Results: Both protocols generated efficient pain inhibition for each of the applied Ts; the PPT-based protocol induced more efficient CPM when the conditioned stimulus was applied on the trunk (p = 0.016). Moreover, the PPT-based CPM responses were significantly correlated (ρ = 0.349; p = 0.007). Conclusions: An efficient CPM induced by both central and peripheral stimulation, along with significant correlation between PPT-based responses, advances using the central 'CPM Trunk' protocol in patients with peripheral neuropathy.
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Affiliation(s)
- Y. Granovsky
- Laboratory of Clinical Neurophysiology, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - E. Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - N. Yarovinsky
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - M. Shor
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - S. Crystal
- Laboratory of Clinical Neurophysiology, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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20
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Lv SS, Lv XJ, Cai YQ, Hou XY, Zhang ZZ, Wang GH, Chen LQ, Lv N, Zhang YQ. Corticotropin-releasing hormone neurons control trigeminal neuralgia-induced anxiodepression via a hippocampus-to-prefrontal circuit. SCIENCE ADVANCES 2024; 10:eadj4196. [PMID: 38241377 PMCID: PMC10798562 DOI: 10.1126/sciadv.adj4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Anxiety and depression are frequently observed in patients suffering from trigeminal neuralgia (TN), but neural circuits and mechanisms underlying this association are poorly understood. Here, we identified a dedicated neural circuit from the ventral hippocampus (vHPC) to the medial prefrontal cortex (mPFC) that mediates TN-related anxiodepression. We found that TN caused an increase in excitatory synaptic transmission from vHPCCaMK2A neurons to mPFC inhibitory neurons marked by the expression of corticotropin-releasing hormone (CRH). Activation of CRH+ neurons subsequently led to feed-forward inhibition of layer V pyramidal neurons in the mPFC via activation of the CRH receptor 1 (CRHR1). Inhibition of the vHPCCaMK2A-mPFCCRH circuit ameliorated TN-induced anxiodepression, whereas activating this pathway sufficiently produced anxiodepressive-like behaviors. Thus, our studies identified a neural pathway driving pain-related anxiodepression and a molecular target for treating pain-related psychiatric disorders.
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Affiliation(s)
- Su-Su Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xue-Jing Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ya-Qi Cai
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xin-Yu Hou
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Zhi-Zhe Zhang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Guo-Hong Wang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Li-Qiang Chen
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ning Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Gnall KE, Sinnott SM, Laumann LE, Park CL, David A, Emrich M. Changes in Interoception in Mind-body Therapies for Chronic Pain: A Systematic Review and Meta-Analysis. Int J Behav Med 2024:10.1007/s12529-023-10249-z. [PMID: 38169051 DOI: 10.1007/s12529-023-10249-z] [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] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Emerging literature has demonstrated deficits in interoception (i.e., the perception of physical sensations from inside the body) in individuals with chronic pain conditions. Mind-body therapies (MBTs) are purported to improve chronic pain in part through improving or restoring interoceptive abilities. The present systematic review and meta-analysis aimed to examine changes in interoception in MBTs for chronic pain conditions. METHODS A systematic search of PubMed, PsycINFO, Scopus, CINAHL, and ProQuest Dissertation and Theses was conducted from database inception to February 2023. English language intervention studies evaluating the effect of MBTs on interoception in adults with chronic pain conditions were examined. Changes in pain (severity and interference) following treatment were examined as secondary outcomes. RESULTS A total of 11 studies (10 unique samples) were identified. Meta-analytic results reveal significant improvements in total interoceptive awareness (Becker's d = 1.168, p < .01) as well as improvements in seven of eight subdomains of interoceptive awareness (ds = 0.28 to 0.81). MBTs were also associated with reductions in both pain intensity (d = -1.46, p = .01) and pain interference (d = -1.07, p < .001). CONCLUSIONS Preliminary research suggests that MBTs demonstrate improvements in interoceptive awareness and reduce pain in adults with chronic pain. Literature on changes in other domains of interoception, such as interoceptive accuracy, following MBTs is severely lacking. Although more rigorous studies are needed to corroborate results, the present findings lay an important foundation for future research to examine interoception as a possible underlying mechanism of MBTs to improve pain outcomes.
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Affiliation(s)
- Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA.
| | - Sinead M Sinnott
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Laura E Laumann
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Adam David
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Mariel Emrich
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
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Fauchon C, Bastuji H, Peyron R, Garcia-Larrea L. Fractal Similarity of Pain Brain Networks. ADVANCES IN NEUROBIOLOGY 2024; 36:639-657. [PMID: 38468056 DOI: 10.1007/978-3-031-47606-8_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The conscious perception of pain is the result of dynamic interactions of neural activities from local brain regions to distributed brain networks. Mapping out the networks of functional connections between brain regions that form and disperse when an experimental participant received nociceptive stimulations allow to characterize the pattern of network connections related to the pain experience.Although the pattern of intra- and inter-areal connections across the brain are incredibly complex, they appear also largely scale free, with "fractal" connectivity properties reproducing at short and long-time scales. Our results combining intracranial recordings and functional imaging in humans during pain indicate striking similarities in the activity and topological representation of networks at different orders of temporality, with reproduction of patterns of activation from the millisecond to the multisecond range. The connectivity analyzed using graph theory on fMRI data was organized in four sets of brain regions matching those identified through iEEG (i.e., sensorimotor, default mode, central executive, and amygdalo-hippocampal).Here, we discuss similarities in brain network organization at different scales or "orders," in participants as they feel pain. Description of this fractal-like organization may provide clues about how our brain regions work together to create the perception of pain and how pain becomes chronic when its organization is altered.
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Affiliation(s)
- Camille Fauchon
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France.
- Université Jean Monnet, Inserm, CRNL, NeuroPain, Saint-Etienne, France.
| | - Hélène Bastuji
- Université Claude Bernard Lyon 1, UJM, Inserm, CRNL, NeuroPain, Bron, France
| | - Roland Peyron
- Université Jean Monnet, Inserm, CRNL, NeuroPain, Saint-Etienne, France
- CHU, centre de la douleur, Saint-Etienne, France
| | - Luis Garcia-Larrea
- Université Claude Bernard Lyon 1, UJM, Inserm, CRNL, NeuroPain, Bron, France
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23
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Kerr PL, Gregg JM. The Roles of Endogenous Opioids in Placebo and Nocebo Effects: From Pain to Performance to Prozac. ADVANCES IN NEUROBIOLOGY 2024; 35:183-220. [PMID: 38874724 DOI: 10.1007/978-3-031-45493-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Placebo and nocebo effects have been well documented for nearly two centuries. However, research has only relatively recently begun to explicate the neurobiological underpinnings of these phenomena. Similarly, research on the broader social implications of placebo/nocebo effects, especially within healthcare delivery settings, is in a nascent stage. Biological and psychosocial outcomes of placebo/nocebo effects are of equal relevance. A common pathway for such outcomes is the endogenous opioid system. This chapter describes the history of placebo/nocebo in medicine; delineates the current state of the literature related to placebo/nocebo in relation to pain modulation; summarizes research findings related to human performance in sports and exercise; discusses the implications of placebo/nocebo effects among diverse patient populations; and describes placebo/nocebo influences in research related to psychopharmacology, including the relevance of endogenous opioids to new lines of research on antidepressant pharmacotherapies.
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Affiliation(s)
- Patrick L Kerr
- West Virginia University School of Medicine-Charleston, Charleston, WV, USA.
| | - John M Gregg
- Department of Surgery, VTCSOM, Blacksburg, VA, USA
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24
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Ghavidel-Parsa B, Bidari A. The crosstalk of the pathophysiologic models in fibromyalgia. Clin Rheumatol 2023; 42:3177-3187. [PMID: 37749410 DOI: 10.1007/s10067-023-06778-3] [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: 08/04/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023]
Abstract
Fibromyalgia (FM) is a heterogeneous condition with various mechanisms (endotype) and manifestations (phenotypes). Many worthy endeavors have been dedicated to exploring the main trajectories of FM pathogenesis, depicted as the models of FM development. The Imbalance of Threat and Soothing Systems (FITSS) model, which is an advancing psychosocial form of the "central sensitization" model, and autonomic nervous system (ANS) model, besides new discoveries of potential pathways for FM development such as autoimmunity, small fiber pathology, and gut-brain axis currently comprise all our knowledge assets about FM pathogenesis. The pathophysiology of fibromyalgia is too complex to justify with one model, one main loop of pathogenesis, and one terminator. It appears that the variable FM models could justify some phenotypes of FM. Currently, our knowledge about FM pathogenesis and trying to match the different pathways and links mimic solving a puzzle in the hands of beginners. Until unraveling many missed interconnections and formulas between numerous scrambled pieces of the FM puzzle, proposing an integrated model seems not possible. This review focuses on the main trajectories of FM pathogenesis proposed thus far and tries to illuminate the crosstalking between them. We also propose the subgrouping FM into more homogenous categories based on the endotype-phenotype characteristics. It could provide a more pragmatic approach toward understanding of the diverse network of FM pathogenesis as well as the personalized stratification of FM. Key Points • The disentangled nature of FM pathogenesis escapes from embracing under one integrated model. • There appears to be no way for formulizing FM pathogenesis except the acknowledgment of the different pathways and their crosstalk explored as yet. • Acknowledging the different endotypes/phenotypes of FM spectrum and classifying them into more homogenous groups can help to the pragmatic approach to FM.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Sardar Jangal St, Rasht, Iran.
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
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25
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Xiao S, Sun H, Zhu Y, Shen Z, Zhu X, Yao PA, Wang Y, Zhang C, Yu W, Wu Z, Sun J, Xu C, Du J, He X, Fang J, Shao X. Electroacupuncture alleviates the relapse of pain-related aversive memory by activating KOR and inhibiting GABAergic neurons in the insular cortex. Cereb Cortex 2023; 33:10711-10721. [PMID: 37679857 PMCID: PMC10560575 DOI: 10.1093/cercor/bhad321] [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: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
Pain-related aversive memory is common in chronic pain patients. Electroacupuncture has been demonstrated to block pain-related aversive memory. The insular cortex is a key region closely related to aversive behaviors. In our study, a potential mechanism underlying the effect of electroacupuncture treatment on pain-related aversive memory behaviors relative to the insular cortex was investigated. Our study used the chemogenetic method, pharmacological method, electroacupuncture intervention, and behavioral detection. Our study showed that both inhibition of gamma-aminobutyric acidergic neurons and activation of the kappa opioid receptor in the insular cortex blocked the pain-related aversive memory behaviors induced by 2 crossover injections of carrageenan in mice; conversely, both the activation of gamma-aminobutyric acidergic neurons and inhibition of kappa opioid receptor in the insular cortex play similar roles in inducing pain-related aversive memory behaviors following 2 crossover injections of carrageenan. In addition, activation of gamma-aminobutyric acidergic neurons in the insular cortex reversed the effect of kappa opioid receptor activation in the insular cortex. Moreover, electroacupuncture effectively blocked pain-related aversive memory behaviors in model mice, which was reversed by both activation of gamma-aminobutyric acidergic neurons and inhibition of kappa opioid receptor in the insular cortex. The effect of electroacupuncture on blocking pain-related aversive memory behaviors may be related to the activation of the kappa opioid receptor and inhibition of gamma-aminobutyric acidergic neurons in the insular cortex.
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Affiliation(s)
- Siqi Xiao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Haiju Sun
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yichen Zhu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Zui Shen
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xixiao Zhu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ping-an Yao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yifang Wang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Chi Zhang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Wei Yu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Zemin Wu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310060, China
| | - Jing Sun
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Chi Xu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Junying Du
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xiaofen He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
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Yang HJ, Wu HM, Li XH, Jin R, Zhang L, Dong T, Zhou XQ, Zhang B, Zhang QJ, Mao CP. Functional disruptions of the brain network in low back pain: a graph-theoretical study. Neuroradiology 2023; 65:1483-1495. [PMID: 37608218 DOI: 10.1007/s00234-023-03209-7] [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: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The aim of this study was to investigate alterations in the topological organization of whole-brain functional networks in patients with chronic low back pain (CLBP) and characterize the relationship of these alterations with pain characteristics. METHODS Thirty-three CLBP patients and 34 matched healthy controls (HCs) underwent fMRI scans. A graph-theoretical approach was applied to identify brain network changes in patients suffering from chronic low back pain given its nonspecific etiology and complexity. Graph theory-based analysis was used to construct functional connectivity matrices and extract the features of small-world networks of the brain in both groups. Then, the whole-brain functional connectivity differences were characterized by network-based statistics (NBS) analysis, and the relationship between the altered brain features and clinical measures was explored. RESULTS At the global level, patients with CLBP showed significantly decreased gamma, sigma, global efficiency, and local efficiency and increased lambda and shortest path length compared with HCs. At the regional level, there were deficits in nodal efficiency within the default mode network and salience network. NBS analysis demonstrated that decreased functional connectivity was present in the CLBP patients, mainly in the frontolimbic circuit and temporal regions. Furthermore, aspects of topological dysfunctions in CLBP were correlated with pain severity. CONCLUSION This study highlighted the aberrant topological organization of functional brain networks in CLBP, which may shed light on the pathophysiology of CLBP and support the development of pain management approaches.
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Affiliation(s)
- Hua Juan Yang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Hong Mei Wu
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Hui Li
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Rui Jin
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Lei Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Ting Dong
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Qian Zhou
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Bo Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Qiu Juan Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
| | - Cui Ping Mao
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.21.558825. [PMID: 37790543 PMCID: PMC10543005 DOI: 10.1101/2023.09.21.558825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Placebo analgesia is a replicable and well-studied phenomenon, yet it remains unclear to what degree it includes modulation of nociceptive processes. Some studies find effects consistent with nociceptive effects, but meta-analyses show that these effects are often small. We analyzed placebo analgesia in a large fMRI study (N = 392), including placebo effects on brain responses to noxious stimuli. Placebo treatment caused robust analgesia in both conditioned thermal and unconditioned mechanical pain. Placebo did not decrease fMRI activity in nociceptive pain regions, including the Neurologic Pain Signature (NPS) and pre-registered spinothalamic pathway regions, with strong support from Bayes Factor analyses. However, placebo treatment affected activity in pre-registered analyses of a second neuromarker, the Stimulus Intensity Independent Pain Signature (SIIPS), and several associated a priori brain regions related to motivation and value, in both thermal and mechanical pain. Individual differences in behavioral analgesia were correlated with neural changes in both thermal and mechanical pain. Our results indicate that processes related to affective and cognitive aspects of pain primarily drive placebo analgesia.
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Salazar-Méndez J, Cuyul-Vásquez I, Viscay-Sanhueza N, Morales-Verdugo J, Mendez-Rebolledo G, Ponce-Fuentes F, Lluch-Girbés E. Structural and functional brain changes in people with knee osteoarthritis: a scoping review. PeerJ 2023; 11:e16003. [PMID: 37701842 PMCID: PMC10493091 DOI: 10.7717/peerj.16003] [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: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023] Open
Abstract
Background Knee osteoarthritis is a highly prevalent disease worldwide that leads to functional disability and chronic pain. It has been shown that not only changes are generated at the joint level in these individuals, but also neuroplastic changes are produced in different brain areas, especially in those areas related to pain perception, therefore, the objective of this research was to identify and compare the structural and functional brain changes in knee OA versus healthy subjects. Methodology Searches in MEDLINE (PubMed), EMBASE, WOS, CINAHL, SCOPUS, Health Source, and Epistemonikos databases were conducted to explore the available evidence on the structural and functional brain changes occurring in people with knee OA. Data were recorded on study characteristics, participant characteristics, and brain assessment techniques. The methodological quality of the studies was analysed with Newcastle Ottawa Scale. Results Sixteen studies met the inclusion criteria. A decrease volume of the gray matter in the insular region, parietal lobe, cingulate cortex, hippocampus, visual cortex, temporal lobe, prefrontal cortex, and basal ganglia was found in people with knee OA. However, the opposite occurred in the frontal lobe, nucleus accumbens, amygdala region and somatosensory cortex, where an increase in the gray matter volume was evidenced. Moreover, a decreased connectivity to the frontal lobe from the insula, cingulate cortex, parietal, and temporal areas, and an increase in connectivity from the insula to the prefrontal cortex, subcallosal area, and temporal lobe was shown. Conclusion All these findings are suggestive of neuroplastic changes affecting the pain matrix in people with knee OA.
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Affiliation(s)
- Joaquín Salazar-Méndez
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
- Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Nelson Viscay-Sanhueza
- Unidad de medicina física y rehabilitación, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile
| | - Juan Morales-Verdugo
- Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Felipe Ponce-Fuentes
- Facultad de Medicina y Ciencias de la Salud, Escuela de Kinesiología, Universidad Mayor, Temuco, Chile
| | - Enrique Lluch-Girbés
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Senba E, Kami K. Exercise therapy for chronic pain: How does exercise change the limbic brain function? NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100143. [PMID: 38099274 PMCID: PMC10719519 DOI: 10.1016/j.ynpai.2023.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023]
Abstract
We are exposed to various external and internal threats which might hurt us. The role of taking flexible and appropriate actions against threats is played by "the limbic system" and at the heart of it there is the ventral tegmental area and nucleus accumbens (brain reward system). Pain-related fear causes excessive excitation of amygdala, which in turn causes the suppression of medial prefrontal cortex, leading to chronification of pain. Since the limbic system of chronic pain patients is functionally impaired, they are maladaptive to their situations, unable to take goal-directed behavior and are easily caught by fear-avoidance thinking. We describe the neural mechanisms how exercise activates the brain reward system and enables chronic pain patients to take goal-directed behavior and overcome fear-avoidance thinking. A key to getting out from chronic pain state is to take advantage of the behavioral switching function of the basal nucleus of amygdala. We show that exercise activates positive neurons in this nucleus which project to the nucleus accumbens and promote reward behavior. We also describe fear conditioning and extinction are affected by exercise. In chronic pain patients, the fear response to pain is enhanced and the extinction of fear memories is impaired, so it is difficult to get out of "fear-avoidance thinking". Prolonged avoidance of movement and physical inactivity exacerbate pain and have detrimental effects on the musculoskeletal and cardiovascular systems. Based on the recent findings on multiple bran networks, we propose a well-balanced exercise prescription considering the adherence and pacing of exercise practice. We conclude that therapies targeting the mesocortico-limbic system, such as exercise therapy and cognitive behavioral therapy, may become promising tools in the fight against chronic pain.
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Affiliation(s)
- Emiko Senba
- Department of Physical Therapy, Osaka Yukioka College of Health Science, 1-1-41 Sojiji, Ibaraki-City, Osaka 567-0801, Japan
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Katsuya Kami
- Department of Rehabilitation, Wakayama Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, 2252 Nakanoshima, Wakayama City, Wakayama 640-8392, Japan
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
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30
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Wrightson R, Albertini M, Pirrone F, McPeake K, Piotti P. The Relationship between Signs of Medical Conditions and Cognitive Decline in Senior Dogs. Animals (Basel) 2023; 13:2203. [PMID: 37443999 DOI: 10.3390/ani13132203] [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: 05/15/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Canine cognitive dysfunction syndrome (CCDS) is a progressive age-related neurodegenerative disorder in dogs. Minimal research has been performed to investigate how clinical signs may be impacted by other medical conditions. A cross-sectional study was performed using the Canine Cognitive Assessment Scale (CCAS) to evaluate cognitive impairment as reported by owners. Owner-reported health-related measures included behaviour changes, the body condition score, and veterinary diagnoses of disease. The responses from 804 dogs in the last 25% of their expected lifespan were analysed. Factors were identified in the owner-reported behavioural signs of disease representing pathologies in four body systems: musculoskeletal-neurological, digestive, metabolic, and dermatological, with the items comprising these factors also compiled into a cumulative measure of health. The results showed a strong correlation between the CCAS score and both the musculoskeletal-neurological factor and the overall cumulative measure of health. Moderate correlations between the CCAS score and the digestive factor and metabolic factor were also observed. The correlation between the dermatological factor and the CCAS score was weak. This study highlights the need to screen dogs for concurrent diseases when using scales to assess cognitive impairment and to monitor dogs who have health conditions, particularly those that are painful, for the onset of cognitive impairment.
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Affiliation(s)
- Rosalind Wrightson
- The Royal (Dick) School of Veterinary Studies, Midlothian, Edinburgh EH25 9RG, UK
| | - Mariangela Albertini
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900 Lodi, Italy
| | - Federica Pirrone
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900 Lodi, Italy
| | - Kevin McPeake
- The Royal (Dick) School of Veterinary Studies, Midlothian, Edinburgh EH25 9RG, UK
| | - Patrizia Piotti
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900 Lodi, Italy
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Tanguay-Sabourin C, Fillingim M, Guglietti GV, Zare A, Parisien M, Norman J, Sweatman H, Da-Ano R, Heikkala E, Perez J, Karppinen J, Villeneuve S, Thompson SJ, Martel MO, Roy M, Diatchenko L, Vachon-Presseau E. A prognostic risk score for development and spread of chronic pain. Nat Med 2023; 29:1821-1831. [PMID: 37414898 PMCID: PMC10353938 DOI: 10.1038/s41591-023-02430-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/31/2023] [Indexed: 07/08/2023]
Abstract
Chronic pain is a complex condition influenced by a combination of biological, psychological and social factors. Using data from the UK Biobank (n = 493,211), we showed that pain spreads from proximal to distal sites and developed a biopsychosocial model that predicted the number of coexisting pain sites. This data-driven model was used to identify a risk score that classified various chronic pain conditions (area under the curve (AUC) 0.70-0.88) and pain-related medical conditions (AUC 0.67-0.86). In longitudinal analyses, the risk score predicted the development of widespread chronic pain, the spreading of chronic pain across body sites and high-impact pain about 9 years later (AUC 0.68-0.78). Key risk factors included sleeplessness, feeling 'fed-up', tiredness, stressful life events and a body mass index >30. A simplified version of this score, named the risk of pain spreading, obtained similar predictive performance based on six simple questions with binarized answers. The risk of pain spreading was then validated in the Northern Finland Birth Cohort (n = 5,525) and the PREVENT-AD cohort (n = 178), obtaining comparable predictive performance. Our findings show that chronic pain conditions can be predicted from a common set of biopsychosocial factors, which can aid in tailoring research protocols, optimizing patient randomization in clinical trials and improving pain management.
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Affiliation(s)
- Christophe Tanguay-Sabourin
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Matt Fillingim
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gianluca V Guglietti
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Azin Zare
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Marc Parisien
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Jax Norman
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Hilary Sweatman
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ronrick Da-Ano
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Eveliina Heikkala
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jordi Perez
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jaro Karppinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Rehabilitation Services of Southern Karelia Social and Health Care District, Lappeenranta, Finland
| | - Sylvia Villeneuve
- Douglas Mental Health Institute Research Centre, McGill University, Montreal, Quebec, Canada
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Scott J Thompson
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Marc O Martel
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Mathieu Roy
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Etienne Vachon-Presseau
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada.
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You T, Leveille SG, Yeh GY, Wayne PM. Is Tai Chi beneficial for multisite pain syndrome in older adults? Aging Clin Exp Res 2023; 35:1443-1448. [PMID: 37256489 PMCID: PMC10428171 DOI: 10.1007/s40520-023-02439-2] [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: 03/10/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.
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Affiliation(s)
- Tongjian You
- Department of Exercise and Health Sciences, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA.
| | - Suzanne G Leveille
- Department of Nursing, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Gloria Y Yeh
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Motzkin JC, Kanungo I, D’Esposito M, Shirvalkar P. Network targets for therapeutic brain stimulation: towards personalized therapy for pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1156108. [PMID: 37363755 PMCID: PMC10286871 DOI: 10.3389/fpain.2023.1156108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Precision neuromodulation of central brain circuits is a promising emerging therapeutic modality for a variety of neuropsychiatric disorders. Reliably identifying in whom, where, and in what context to provide brain stimulation for optimal pain relief are fundamental challenges limiting the widespread implementation of central neuromodulation treatments for chronic pain. Current approaches to brain stimulation target empirically derived regions of interest to the disorder or targets with strong connections to these regions. However, complex, multidimensional experiences like chronic pain are more closely linked to patterns of coordinated activity across distributed large-scale functional networks. Recent advances in precision network neuroscience indicate that these networks are highly variable in their neuroanatomical organization across individuals. Here we review accumulating evidence that variable central representations of pain will likely pose a major barrier to implementation of population-derived analgesic brain stimulation targets. We propose network-level estimates as a more valid, robust, and reliable way to stratify personalized candidate regions. Finally, we review key background, methods, and implications for developing network topology-informed brain stimulation targets for chronic pain.
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Affiliation(s)
- Julian C. Motzkin
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
| | - Ishan Kanungo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Prasad Shirvalkar
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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Nemes B, László S, Zsidó BZ, Hetényi C, Feher A, Papp F, Varga Z, Szőke É, Sándor Z, Pintér E. Elucidation of the binding mode of organic polysulfides on the human TRPA1 receptor. Front Physiol 2023; 14:1180896. [PMID: 37351262 PMCID: PMC10282659 DOI: 10.3389/fphys.2023.1180896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction: Previous studies have established that endogenous inorganic polysulfides have significant biological actions activating the Transient Receptor Potential Ankyrin 1 (TRPA1) receptor. Organic polysulfides exert similar effects, but they are much more stable molecules, therefore these compounds are more suitable as drugs. In this study, we aimed to better understand the mechanism of action of organic polysulfides by identification of their binding site on the TRPA1 receptor. Methods: Polysulfides can readily interact with the thiol side chain of the cysteine residues of the protein. To investigate their role in the TRPA1 activation, we replaced several cysteine residues by alanine via site-directed mutagenesis. We searched for TRPA1 mutant variants with decreased or lost activating effect of the polysulfides, but with other functions remaining intact (such as the effects of non-electrophilic agonists and antagonists). The binding properties of the mutant receptors were analyzed by in silico molecular docking. Functional changes were tested by in vitro methods: calcium sensitive fluorescent flow cytometry, whole-cell patch-clamp and radioactive calcium-45 liquid scintillation counting. Results: The cysteines forming the conventional binding site of electrophilic agonists, namely C621, C641 and C665 also bind the organic polysulfides, with the key role of C621. However, only their combined mutation abolished completely the organic polysulfide-induced activation of the receptor. Discussion: Since previous papers provided evidence that organic polysulfides exert analgesic and anti-inflammatory actions in different in vivo animal models, we anticipate that the development of TRPA1-targeted, organic polysulfide-based drugs will be promoted by this identification of the binding site.
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Affiliation(s)
- Balázs Nemes
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs László
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
- Department of Inorganic and Analytical Chemistry, Faculty of Chemical Technology and Biotechnology, Budapest University of Technology and Economics, Budapest, Hungary
| | - Balázs Zoltán Zsidó
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Csaba Hetényi
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Adam Feher
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Papp
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Varga
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Éva Szőke
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Sándor
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Erika Pintér
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary
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Chatterjee I, Baumgartner L, Cho M. Detection of brain regions responsible for chronic pain in osteoarthritis: an fMRI-based neuroimaging study using deep learning. Front Neurol 2023; 14:1195923. [PMID: 37333009 PMCID: PMC10273207 DOI: 10.3389/fneur.2023.1195923] [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: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Chronic pain is a multifaceted condition that has yet to be fully comprehended. It is frequently linked with a range of disorders, particularly osteoarthritis (OA), which arises from the progressive deterioration of the protective cartilage that cushions the bone endings over time. Methods In this paper, we examine the impact of chronic pain on the brain using advanced deep learning (DL) algorithms that leverage resting-state functional magnetic resonance imaging (fMRI) data from both OA pain patients and healthy controls. Our study encompasses fMRI data from 51 pain patients and 20 healthy subjects. To differentiate chronic pain-affected OA patients from healthy controls, we introduce a DL-based computer-aided diagnosis framework that incorporates Multi-Layer Perceptron and Convolutional Neural Networks (CNN), separately. Results Among the examined algorithms, we discovered that CNN outperformed the others and achieved a notable accuracy rate of nearly 85%. In addition, our investigation scrutinized the brain regions affected by chronic pain and successfully identified several regions that have not been mentioned in previous literature, including the occipital lobe, the superior frontal gyrus, the cuneus, the middle occipital gyrus, and the culmen. Discussion This pioneering study explores the applicability of DL algorithms in pinpointing the differentiating brain regions in OA patients who experience chronic pain. The outcomes of our research could make a significant contribution to medical research on OA pain patients and facilitate fMRI-based pain recognition, ultimately leading to enhanced clinical intervention for chronic pain patients.
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Affiliation(s)
- Indranath Chatterjee
- Department of Computer Engineering, Tongmyong University, Busan, Republic of Korea
- School of Technology, Woxsen University, Telangana, India
| | - Lea Baumgartner
- Department of Computer Engineering, Tongmyong University, Busan, Republic of Korea
- Department of Media, Hochschule der Medien, University of Applied Science, Stuttgart, Germany
| | - Migyung Cho
- Department of Game Engineering, Tongmyong University, Busan, Republic of Korea
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Seymour B, Crook RJ, Chen ZS. Post-injury pain and behaviour: a control theory perspective. Nat Rev Neurosci 2023; 24:378-392. [PMID: 37165018 PMCID: PMC10465160 DOI: 10.1038/s41583-023-00699-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
Injuries of various types occur commonly in the lives of humans and other animals and lead to a pattern of persistent pain and recuperative behaviour that allows safe and effective recovery. In this Perspective, we propose a control-theoretic framework to explain the adaptive processes in the brain that drive physiological post-injury behaviour. We set out an evolutionary and ethological view on how animals respond to injury, illustrating how the behavioural state associated with persistent pain and recuperation may be just as important as phasic pain in ensuring survival. Adopting a normative approach, we suggest that the brain implements a continuous optimal inference of the current state of injury from diverse sensory and physiological signals. This drives the various effector control mechanisms of behavioural homeostasis, which span the modulation of ongoing motivation and perception to drive rest and hyper-protective behaviours. However, an inherent problem with this is that these protective behaviours may partially obscure information about whether injury has resolved. Such information restriction may seed a tendency to aberrantly or persistently infer injury, and may thus promote the transition to pathological chronic pain states.
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Affiliation(s)
- Ben Seymour
- Institute for Biomedical Engineering, University of Oxford, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, Headington, Oxford, UK.
| | - Robyn J Crook
- Department of Biology, San Francisco State University, San Francisco, CA, USA.
| | - Zhe Sage Chen
- Departments of Psychiatry, Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA.
- Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY, USA.
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Stieglitz J, Buoro Y, Beheim B, Trumble BC, Kaplan H, Gurven M. Labour's pain: strenuous subsistence work, mechanical wear-and-tear and musculoskeletal pain in a non-industrialized population. Proc Biol Sci 2023; 290:20222497. [PMID: 37161336 PMCID: PMC10170198 DOI: 10.1098/rspb.2022.2497] [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: 12/14/2022] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
Musculoskeletal pain is the most debilitating human health condition. Neurophysiological pain mechanisms are highly conserved and promote somatic maintenance and learning to avoid future harm. However, some chronic pain might be more common owing to mismatches between modern lifestyles and traits that originally evolved under distinct premodern conditions. To inform assumptions about factors affecting chronic pain vulnerability prior to industrialization, we assess pain prevalence, perceived causes, and predictors among Tsimane forager-horticulturalists. Habitual subsistence work is the primary reported cause of pain throughout life for both sexes, and pain is more common with age, especially in the back, and for those with more musculoskeletal problems. Sex differences in pain are relatively weak, and we find no association between women's reproductive history and pain, contrary to the hypothesis that reproduction causes women's greater pain susceptibility. Age-standardized current pain prevalence is 1.7-8.2 times higher for Tsimane than other select populations, and Tsimane chronic pain prevalence is within the range of variation observed elsewhere. Chronic low back pain is not a 'mismatch disease' limited to post-industrialized populations. Hominin musculoskeletal changes supporting bipedalism probably imposed health costs, which, after millions of years of evolution, remain an epidemiological burden that may be exacerbated by modern conditions.
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Affiliation(s)
- Jonathan Stieglitz
- Institute for Advanced Study in Toulouse, Université Toulouse 1 Capitole, Toulouse 31080, France
| | - Yoann Buoro
- Department of Anthropology, University of California-Santa Barbara, Santa Barbara, CA 93106, USA
| | - Bret Beheim
- Department of Human Behavior, Ecology and Culture, Max-Planck Institute for Evolutionary Anthropology, Leipzig 04103, Germany
| | - Benjamin C. Trumble
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ 85287, USA
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA
| | - Hillard Kaplan
- Economic Science Institute, Chapman University, 1 University Drive, Orange, CA 92866, USA
| | - Michael Gurven
- Department of Anthropology, University of California-Santa Barbara, Santa Barbara, CA 93106, USA
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We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis. J Psychopharmacol 2023; 37:437-448. [PMID: 37171242 DOI: 10.1177/02698811221144635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The opioid crisis’ pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis’ toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.
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Jefferson T, Kim HR, Martina M. Impaired muscarinic modulation of the rat prelimbic cortex in neuropathic pain is sexually dimorphic and associated with cold allodynia. Front Cell Neurosci 2023; 17:984287. [PMID: 36846207 PMCID: PMC9947152 DOI: 10.3389/fncel.2023.984287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Cholinergic modulation of the brain cortex is critical for cognitive processes, and altered cholinergic modulation of the prefrontal cortex is emerging as an important mechanism of neuropathic pain. Sex differences in pain prevalence and perception are well known, yet the precise nature of the mechanisms responsible for sexual dimorphism in chronic neuropathic pain are poorly understood. Here we investigated potential sex differences in cholinergic modulation of layer five commissural pyramidal neurons of the rat prelimbic cortex in control conditions and in the SNI model of neuropathic pain. We discovered that cholinergic modulation is stronger in cells from male compared with female rats, and that in neuropathic pain rats, cholinergic excitation of pyramidal neurons was more severely impaired in males than in females. Finally, we found that selective pharmacological blockade of the muscarinic M1 subunit in the prefrontal cortex induces cold sensitivity (but not mechanical allodynia) in naïve animals of both sexes.
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Affiliation(s)
| | | | - Marco Martina
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Teigen PK, Hagemann CT, Fors EA, Stauri E, Hoffmann RL, Schei B. Chronic vulvar pain in gynecological outpatients. Scand J Pain 2023; 23:97-103. [PMID: 35822705 DOI: 10.1515/sjpain-2021-0223] [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: 12/15/2021] [Accepted: 05/18/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Chronic vulvar pain (CVP) is pain in the vulvar area exceeding three months of duration. Previous studies have reported a prevalence of 7-8% in the general population and observed an association between CVP and other chronic pain, affective disorders and early life stressors. The aim of this study was to estimate the prevalence of CVP among gynecological outpatients and to explore its association with child sexual abuse, comorbid fibromyalgia and mental health. METHODS We conducted a questionnaire-based cross-sectional study among consecutive women attending an unselected general gynecological outpatient clinic at St Olav's University Hospital, Trondheim, Norway, during the period August 1st, 2017, to June 30th, 2018. CVP was defined as having experienced either vulvar burning, sharp pain or allodynia for three months or more within the previous year. Fibromyalgia was defined as widespread pain in the past six months in conjunction with a symptom severity score ≥5 on the fibromyalgia symptom severity score inventory, an ordinal scale from zero to 12. We collected information on sexual coercion experience and assessed mental health with the mental health inventory (MHI-5) of the SF-36 health survey, which yields a zero to five scale. RESULTS Of 1,125 questionnaires distributed, 810 (72%) were returned, and 762 (68%) included in final analyses. Among these, 130 (17.1%) reported CVP within the previous year and 92 (16.7%) were classified as suffering from fibromyalgia. Fibromyalgia was associated with CVP (adjusted OR of 1.8, 95% CI 1.1-3.1). Child sexual abuse was reported by 96 (13.1%) and was associated with CVP (adjusted OR 2.0, 95% CI 1.2-3.3). CVP and fibromyalgia were both associated with lower mental health scores; 0.51 and 0.58 points on the MHI-5 scale, respectively. CONCLUSIONS Chronic vulvar pain is common among women in a gynecological outpatient clinic and associated with child sexual abuse, comorbid fibromyalgia and worse mental health. Ethical committee number: REK Midt No. 2016/2150.
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Affiliation(s)
- Per Kristen Teigen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway
| | - Cecilie Therese Hagemann
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Egil Andreas Fors
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Elisabeth Stauri
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Risa Lonnée Hoffmann
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway
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Zhang J, Shi P, Du J, Yu H. A study based on functional near-infrared spectroscopy: Cortical responses to music interventions in patients with myofascial pain syndrome. Front Hum Neurosci 2023; 17:1119098. [PMID: 36778036 PMCID: PMC9911431 DOI: 10.3389/fnhum.2023.1119098] [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: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Object This study measured cerebral blood oxygen changes in patients with myofascial pain syndrome (MPS) using functional near-infrared spectroscopy (fNIRS). The aim was to investigate the effect of music intervention on pain relief in MPS patients. Materials and methods A total of 15 patients with MPS participated in this study. A self-controlled block task design was used to collect the oxy-hemoglobin ([HbO2]) and deoxy-hemoglobin ([HbR]) concentrations in the prefrontal cortex (PFC) and motor cortex using fNIRS. The cerebral cortex response and channel connectivity were further analyzed. In the experiment, the therapist was asked to apply compression of 3-4 kg/cm2 vertically using the thumb to induce pain. Soothing synthetic music with frequencies of 8-150 Hz and 50-70 dB was used as the audio for the music intervention. Result Compared to the group without music intervention, the activation of brain regions showed a decreasing trend in the group with music intervention under the onset of pain. The results of paired t-tests showed that nine of the data were significantly different (p < 0.05). It was also found that with music intervention, inter-channel connectivity was diminished. Besides, their dorsolateral prefrontal cortex (dlPFC) was significantly correlated with the anterior prefrontal cortex (aPFC) for pain response (r = 0.82), and weakly correlated with the premotor cortex (r = 0.40). Conclusion This study combines objective assessment indicators and subjective scale assessments to demonstrate that appropriate music interventions can be effective in helping to relieve pain to some extent. The analgesic mechanisms between relevant brain regions under music intervention were explored in depth. New insights into effective analgesic methods and quantitative assessment of pain conditions are presented.
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Barczyk I, Masłyk D, Walczuk N, Kijak K, Skomro P, Gronwald H, Pawlak M, Rusińska A, Sadowska N, Gronwald B, Garstka AA, Lietz-Kijak D. Potential Clinical Applications of Ozone Therapy in Dental Specialties-A Literature Review, Supported by Own Observations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032048. [PMID: 36767415 PMCID: PMC9915530 DOI: 10.3390/ijerph20032048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 05/31/2023]
Abstract
Apart from conventional treatment, dentists are increasingly relying on physical therapy modalities in their clinical practice. The aim of this literature review is to analyze the clinical relevance and potential uses of ozone in modern dentistry. The research question is geared towards detailing the multiple potential applications of ozone therapy in a range of dental specialties. Based on the available literature, accessed via the PubMed, Google Scholar, Scopus, and EBSCO databases, a detailed search of the electronic literature was performed for 2001-2022. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: ozone, ozone therapy, therapeutic applications, oxidants, dental disinfectants, oral medicine, physical therapy in dentistry. Out of 834 manuscripts, 273 studies were curated. A total of 70 publications were used in the final consideration. After assessing their quality, they were analyzed to determine the relevance and potential use of ozone in the various aspects of modern dentistry. Ozone therapy is used mainly as an adjunct to the primary clinical or pharmacological treatment. In some cases of oral mucosal disease, it has proven effective as a primary therapy. During the literature analysis, it was noted that ozone therapy in dentistry is a subject of ongoing research, and the results are not always consistent. The multitude of studies in the literature on the applications of ozone in dentistry reflects the search for its undiscovered physical therapeutic potential.
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Affiliation(s)
- Izabela Barczyk
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Diana Masłyk
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Natalia Walczuk
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Karina Kijak
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Piotr Skomro
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Helena Gronwald
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Maria Pawlak
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Angelika Rusińska
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Natalia Sadowska
- Student Scientific Society at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Barbara Gronwald
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
- Doctoral Studies at the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Adam Andrzej Garstka
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Danuta Lietz-Kijak
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland
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Macionis V. Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion. FRONTIERS IN PAIN RESEARCH 2023; 4:1037376. [PMID: 36890855 PMCID: PMC9986610 DOI: 10.3389/fpain.2023.1037376] [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: 09/05/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.
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Sanmugananthan VV, Cheng JC, Hemington KS, Rogachov A, Osborne NR, Bosma RL, Kim JA, Inman RD, Davis KD. Can we characterize A-P/IAP behavioural phenotypes in people with chronic pain? FRONTIERS IN PAIN RESEARCH 2023; 4:1057659. [PMID: 36874441 PMCID: PMC9975728 DOI: 10.3389/fpain.2023.1057659] [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: 09/29/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Two behavioural phenotypes in healthy people have been delineated based on their intrinsic attention to pain (IAP) and whether their reaction times (RT) during a cognitively-demanding task are slower (P-type) or faster (A-type) during experimental pain. These behavioural phenotypes were not previously studied in chronic pain populations to avoid using experimental pain in a chronic pain context. Since pain rumination (PR) may serve as a supplement to IAP without needing noxious stimuli, we attempted to delineate A-P/IAP behavioural phenotypes in people with chronic pain and determined if PR can supplement IAP. Behavioural data acquired in 43 healthy controls (HCs) and 43 age-/sex-matched people with chronic pain associated with ankylosing spondylitis (AS) was retrospectively analyzed. A-P behavioural phenotypes were based on RT differences between pain and no-pain trials of a numeric interference task. IAP was quantified based on scores representing reported attention towards or mind-wandering away from experimental pain. PR was quantified using the pain catastrophizing scale, rumination subscale. The variability in RT was higher during no-pain trials in the AS group than HCs but was not significantly different in pain trials. There were no group differences in task RTs in no-pain and pain trials, IAP or PR scores. IAP and PR scores were marginally significantly positively correlated in the AS group. RT differences and variability were not significantly correlated with IAP or PR scores. Thus, we propose that experimental pain in the A-P/IAP protocols can confound testing in chronic pain populations, but that PR could be a supplement to IAP to quantify attention to pain.
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Affiliation(s)
- Vaidhehi Veena Sanmugananthan
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua C Cheng
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kasey S Hemington
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anton Rogachov
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Natalie Rae Osborne
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rachael L Bosma
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Junseok Andrew Kim
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Robert D Inman
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Deborah Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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Pinto CB, Bielefeld J, Barroso J, Yip B, Huang L, Schnitzer T, Apkarian AV. Chronic pain domains and their relationship to personality, abilities, and brain networks. Pain 2023; 164:59-71. [PMID: 35612403 PMCID: PMC9582040 DOI: 10.1097/j.pain.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/23/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Chronic pain is a multidimensional pathological state. Recent evidence suggests that specific brain properties and patients' psychological and physical traits are distorted in chronic pain patients. However, the relationship between these alterations and pain dimensions remains poorly understood. Here, we first evaluated multiple dimensions of chronic pain by assessing a broad battery of pain-related questionnaire scores (23 outcomes) of 107 chronic low back pain patients and identified 3 distinct chronic pain domains: magnitude, affect & disability, and quality. Second, we investigated the pain domains relationship with measures of personality, social interaction, psychological traits, and ability traits (77 biopsychosocial & ability [biopsy&ab] outcomes). Pain magnitude (out-of-sample [OOS]
) is associated with emotional control, attention, and working memory, with higher pain scores showing lower capacity to regulate and adapt behaviorally. Pain affect & disability (OOS
associated with anxiety, catastrophizing and social relationships dysfunction. Pain quality did not relate significantly to biopsy&ab variables. Third, we mapped these 3 pain domains to brain functional connectivity. Pain magnitude mainly associated with the sensorimotor and the cingulo-opercular networks (OOS
). Pain affect & disability related to frontoparietal and default mode networks (OOS
. Pain quality integrated sensorimotor, auditory, and cingulo-opercular networks (OOS
). Mediation analysis could link functional connectivity and biopsy&ab models to respective pain domains. Our results provide a global overview of the complexity of chronic pain, showing how underlying distinct domains of the experience map to different biopsy&ab correlates and underlie unique brain network signatures.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joana Barroso
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Byron Yip
- Departments of Physical Medicine and Rehabilitation
| | - Lejian Huang
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Thomas Schnitzer
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
- Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
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Chen ZS. Hierarchical predictive coding in distributed pain circuits. Front Neural Circuits 2023; 17:1073537. [PMID: 36937818 PMCID: PMC10020379 DOI: 10.3389/fncir.2023.1073537] [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: 10/18/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Predictive coding is a computational theory on describing how the brain perceives and acts, which has been widely adopted in sensory processing and motor control. Nociceptive and pain processing involves a large and distributed network of circuits. However, it is still unknown whether this distributed network is completely decentralized or requires networkwide coordination. Multiple lines of evidence from human and animal studies have suggested that the cingulate cortex and insula cortex (cingulate-insula network) are two major hubs in mediating information from sensory afferents and spinothalamic inputs, whereas subregions of cingulate and insula cortices have distinct projections and functional roles. In this mini-review, we propose an updated hierarchical predictive coding framework for pain perception and discuss its related computational, algorithmic, and implementation issues. We suggest active inference as a generalized predictive coding algorithm, and hierarchically organized traveling waves of independent neural oscillations as a plausible brain mechanism to integrate bottom-up and top-down information across distributed pain circuits.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, United States
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY, United States
- *Correspondence: Zhe Sage Chen
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Jia T, Wang YD, Chen J, Zhang X, Cao JL, Xiao C, Zhou C. A nigro-subthalamo-parabrachial pathway modulates pain-like behaviors. Nat Commun 2022; 13:7756. [PMID: 36522327 PMCID: PMC9755217 DOI: 10.1038/s41467-022-35474-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
The basal ganglia including the subthalamic nucleus (STN) and substantia nigra pars reticulata (SNr) are involved in pain-related responses, but how they regulate pain processing remains unknown. Here, we identify a pathway, consisting of GABAergic neurons in the SNr (SNrGABA) and glutamatergic neurons in the STN (STNGlu) and the lateral parabrachial nucleus (LPBGlu), that modulates acute and persistent pain states in both male and female mice. The activity of STN neurons was enhanced in acute and persistent pain states. This enhancement was accompanied by hypoactivity in SNrGABA neurons and strengthening of the STN-LPB glutamatergic projection. Reversing the dysfunction in the SNrGABA-STNGlu-LPBGlu pathway attenuated activity of LPBGlu neurons and mitigated pain-like behaviors. Therefore, the SNrGABA-STNGlu-LPBGlu pathway regulates pathological pain and is a potential target for pain management.
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Affiliation(s)
- Tao Jia
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Ying-Di Wang
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Jing Chen
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Xue Zhang
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Jun-Li Cao
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Cheng Xiao
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
| | - Chunyi Zhou
- grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China ,grid.417303.20000 0000 9927 0537NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, 221004 Xuzhou, Jiangsu China
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Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain. Brain Sci 2022; 12:brainsci12121654. [PMID: 36552115 PMCID: PMC9776085 DOI: 10.3390/brainsci12121654] [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: 11/08/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Chronic pain is associated with abnormal cortical excitability and increased pain intensity. Research investigating the potential for transcranial direct current stimulation (tDCS) to modulate motor cortex excitability and reduce pain in individuals with chronic lower back pain (CLBP) yield mixed results. The present randomised, placebo-controlled study examined the impact of anodal-tDCS over left-dorsolateral prefrontal cortex (left-DLPFC) on motor cortex excitability and pain in those with CLBP. Nineteen participants with CLBP (Mage = 53.16 years, SDage = 14.80 years) received 20-min of sham or anodal tDCS, twice weekly, for 4 weeks. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse Transcranial Magnetic Stimulation prior to and immediately following the tDCS intervention. Linear Mixed Models revealed no significant effect of tDCS group or time, on SICI or ICF. The interactions between tDCS group and time on SICI and ICF only approached significance. Bayesian analyses revealed the anodal-tDCS group demonstrated higher ICF and SICI following the intervention compared to the sham-tDCS group. The anodal-tDCS group also demonstrated a reduction in pain intensity and self-reported disability compared to the sham-tDCS group. These findings provide preliminary support for anodal-tDCS over left-DLPFC to modulate cortical excitability and reduce pain in CLBP.
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Abstract
Pain is driven by sensation and emotion, and in turn, it motivates decisions and actions. To fully appreciate the multidimensional nature of pain, we formulate the study of pain within a closed-loop framework of sensory-motor prediction. In this closed-loop cycle, prediction plays an important role, as the interaction between prediction and actual sensory experience shapes pain perception and subsequently, action. In this Perspective, we describe the roles of two prominent computational theories-Bayesian inference and reinforcement learning-in modeling adaptive pain behaviors. We show that prediction serves as a common theme between these two theories, and that each of these theories can explain unique aspects of the pain perception-action cycle. We discuss how these computational theories and models can improve our mechanistic understandings of pain-centered processes such as anticipation, attention, placebo hypoalgesia, and pain chronification.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA,Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Corresponding author
| | - Jing Wang
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA,Corresponding author
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