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Pires MP, McBenedict B, Ahmed IE, Yau RCC, Fong YB, Goh KS, Lim YS, Mohamed SA, Ngu O, Devan JN, Hauwanga WN, Lima Pessôa B. Exploring the Thalamus as a Target for Neuropathic Pain Management: An Integrative Review. Cureus 2024; 16:e60130. [PMID: 38864037 PMCID: PMC11165437 DOI: 10.7759/cureus.60130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Neuropathic pain (NP), resulting from damage to the somatosensory system, is characterized by either spontaneous or evoked pain. In the context of NP, wherein aberrant signaling pathways contribute to the perception of pain, the thalamus emerges as a key player. This structure is integral to the pain network that includes connections to the dorsal horn of the spinal cord, highlighting its role in the affective-motivational aspects of pain perception. Given its significant involvement, the thalamus is targeted in advanced treatments such as thalamotomy and deep brain stimulation (DBS) when traditional therapies fail, emphasizing the need to understand its function in NP to improve management strategies. This review aimed to provide an overview of the role of the thalamus in the transmission of nociceptive information in NP by discussing the existing evidence, including the effectiveness and safety of current techniques in the management and treatment of NP. This is an integrative review involving the qualitative analysis of scientific articles published in PubMed/MEDLINE, Embase, Scopus, and Web of Science. A total of 687 articles were identified, and after selection, 15 articles were included in this study. All studies reviewed demonstrated varying degrees of effectiveness of DBS and thalamotomy in alleviating painful symptoms, although the relief was often temporary. Many studies noted a reduction in pain perception at the conclusion of treatment compared to pre-treatment levels, with this decrease maintained throughout patient follow-ups. However, adverse events associated with these treatments were also reported. In conclusion, there are some benefits, albeit temporary, to using thalamotomy and DBS to alleviate the painful symptoms of NP. Both procedures are considered advanced forms of surgical intervention that aim to modulate pain pathways in the brain, providing significant relief for patients suffering from chronic pain resistant to conventional treatment. Despite limitations, these surgical interventions offer renewed hope for patients facing disabling chronic pain and can provide a significant improvement in quality of life.
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Affiliation(s)
| | | | | | | | - Yan Bin Fong
- Surgery, Universiti Putra Malaysia, Serdang, MYS
| | - Kang Suen Goh
- Internal Medicine, Monash University Malaysia, Subang Jaya, MYS
| | - Yee Siew Lim
- Surgery, International Medical University, Seremban, MYS
| | - Suber Abdi Mohamed
- Medicine, Jiangsu University, Zhenjiang Jiangbin Hospital, Zhenjiang, CHN
| | - Owen Ngu
- Medicine, University of Malaya, Kuala Lumpur, MYS
| | - Jeshua N Devan
- Surgery, Asian Institute of Medicine, Science and Technology University, Bedong, MYS
| | - Wilhelmina N Hauwanga
- Family Medicine, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA
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2
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Latypov TH, So MC, Hung PSP, Tsai P, Walker MR, Tohyama S, Tawfik M, Rudzicz F, Hodaie M. Brain imaging signatures of neuropathic facial pain derived by artificial intelligence. Sci Rep 2023; 13:10699. [PMID: 37400574 DOI: 10.1038/s41598-023-37034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
Advances in neuroimaging have permitted the non-invasive examination of the human brain in pain. However, a persisting challenge is in the objective differentiation of neuropathic facial pain subtypes, as diagnosis is based on patients' symptom descriptions. We use artificial intelligence (AI) models with neuroimaging data to distinguish subtypes of neuropathic facial pain and differentiate them from healthy controls. We conducted a retrospective analysis of diffusion tensor and T1-weighted imaging data using random forest and logistic regression AI models on 371 adults with trigeminal pain (265 classical trigeminal neuralgia (CTN), 106 trigeminal neuropathic pain (TNP)) and 108 healthy controls (HC). These models distinguished CTN from HC with up to 95% accuracy, and TNP from HC with up to 91% accuracy. Both classifiers identified gray and white matter-based predictive metrics (gray matter thickness, surface area, and volume; white matter diffusivity metrics) that significantly differed across groups. Classification of TNP and CTN did not show significant accuracy (51%) but highlighted two structures that differed between pain groups-the insula and orbitofrontal cortex. Our work demonstrates that AI models with brain imaging data alone can differentiate neuropathic facial pain subtypes from healthy data and identify regional structural indicates of pain.
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Affiliation(s)
- Timur H Latypov
- Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada
| | - Matthew C So
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Shih-Ping Hung
- Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada
| | - Pascale Tsai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew R Walker
- Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Sarasa Tohyama
- A.A. Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA
| | - Marina Tawfik
- Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Abstract
Pain is an unpleasant sensory and emotional experience. Understanding the neural mechanisms of acute and chronic pain and the brain changes affecting pain factors is important for finding pain treatment methods. The emergence and progress of non-invasive neuroimaging technology can help us better understand pain at the neural level. Recent developments in identifying brain-based biomarkers of pain through advances in advanced imaging can provide some foundations for predicting and detecting pain. For example, a neurologic pain signature (involving brain regions that receive nociceptive afferents) and a stimulus intensity-independent pain signature (involving brain regions that do not show increased activity in proportion to noxious stimulus intensity) were developed based on multivariate modeling to identify processes related to the pain experience. However, an accurate and comprehensive review of common neuroimaging techniques for evaluating pain is lacking. This paper reviews the mechanism, clinical application, reliability, strengths, and limitations of common neuroimaging techniques for assessing pain to promote our further understanding of pain.
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Affiliation(s)
- Jing Luo
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hui-Qi Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Bo Gou
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China.
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
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Dai W, Liu RH, Qiu E, Liu Y, Chen Z, Chen X, Ao R, Zhuo M, Yu S. Cortical mechanisms in migraine. Mol Pain 2021; 17:17448069211050246. [PMID: 34806494 PMCID: PMC8606910 DOI: 10.1177/17448069211050246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Migraine is the second most prevalent disorder in the world; yet, its underlying mechanisms are still poorly understood. Cumulative studies have revealed pivotal roles of cerebral cortex in the initiation, propagation, and termination of migraine attacks as well as the interictal phase. Investigation of basic mechanisms of the cortex in migraine not only brings insight into the underlying pathophysiology but also provides the basis for designing novel treatments. We aim to summarize the current research literatures and give a brief overview of the cortex and its role in migraine, including the basic structure and function; structural, functional, and biochemical neuroimaging; migraine-related genes; and theories related to cortex in migraine pathophysiology. We propose that long-term plasticity of synaptic transmission in the cortex encodes migraine.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | - Ren-Hao Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China
| | - Enchao Qiu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Ran Ao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China.,International Institute for Brain Research, Qingdao International Academician Park, Qingdao, China.,Department of Physiology, 1 King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Kim D, Chae Y, Park HJ, Lee IS. Effects of Chronic Pain Treatment on Altered Functional and Metabolic Activities in the Brain: A Systematic Review and Meta-Analysis of Functional Neuroimaging Studies. Front Neurosci 2021; 15:684926. [PMID: 34290582 PMCID: PMC8287208 DOI: 10.3389/fnins.2021.684926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
Previous studies have identified altered brain changes in chronic pain patients, however, it remains unclear whether these changes are reversible. We summarized the neural and molecular changes in patients with chronic pain and employed a meta-analysis approach to quantify the changes. We included 75 studies and 11 of these 75 studies were included in the activation likelihood estimation (ALE) analysis. In the 62 functional magnetic resonance imaging (fMRI) studies, the primary somatosensory and motor cortex (SI and MI), thalamus, insula, and anterior cingulate cortex (ACC) showed significantly decreased activity after the treatments compared to baseline. In the 13 positron emission tomography (PET) studies, the SI, MI, thalamus, and insula showed significantly increased glucose uptake, blood flow, and opioid-receptor binding potentials after the treatments compared to baseline. A meta-analysis of fMRI studies in patients with chronic pain, during pain-related tasks, showed a significant deactivation likelihood cluster in the left medial posterior thalamus. Further studies are warranted to understand brain reorganization in patients with chronic pain compared to the normal state, in terms of its relationship with symptom reduction and baseline conditions.
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Affiliation(s)
- Dongwon Kim
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - In-Seon Lee
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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Tran The J, Magistretti PJ, Ansermet F. Interoception Disorder and Insular Cortex Abnormalities in Schizophrenia: A New Perspective Between Psychoanalysis and Neuroscience. Front Psychol 2021; 12:628355. [PMID: 34276464 PMCID: PMC8281924 DOI: 10.3389/fpsyg.2021.628355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
The existence of disturbances in the perception of somatic states and in the representation of the body with the presence of cœnesthetic hallucinations, of delusional hypochondriac ideas or of dysmorphophobias is a recognized fact in the psychopathology of schizophrenia. Freudian psychoanalytic theory had accorded a privileged place to the alteration of the perception of the body in schizophrenia. Freud had attributed to these phenomena a primary and prodromal role in the psychopathology of psychosis. We propose to look at this theory in a new way, starting from the perspective of recent studies about the role of the insula in the perception and representation of somatic states, since this structure has been identified as underpinning the sense of interoception. The data in the neurobiological literature about abnormalities in the insular cortex in schizophrenia has shown that insula dysfunction could constitute one of the biological substrates of disorders of body perception in schizophrenia, and could be a source of the alteration of the sense of self that is characteristic of this psychiatric pathology. Moreover, this alteration could thus be involved in the positive symptomatology of schizophrenia.
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Affiliation(s)
- Jessica Tran The
- Département d'études Psychanalytiques, Université de Paris, Paris, France.,Agalma Foundation, Geneva, Switzerland.,Faculté de Biologie et de Médecine, University of Lausanne, Lausanne, Switzerland
| | - Pierre J Magistretti
- Agalma Foundation, Geneva, Switzerland.,Brain Mind Institute, Federal Institute of Technology in Lausanne, Sion, Switzerland.,Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Francois Ansermet
- Agalma Foundation, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Zhang F, Li F, Yang H, Jin Y, Lai W, Roberts N, Jia Z, Gong Q. Effect of experimental orthodontic pain on gray and white matter functional connectivity. CNS Neurosci Ther 2021; 27:439-448. [PMID: 33369178 PMCID: PMC7941220 DOI: 10.1111/cns.13557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 02/05/2023] Open
Abstract
AIM Over 90% of patients receiving orthodontic treatment experience clinically significant pain. However, little is known about the neural correlates of orthodontic pain and which has therefore been investigated in the present study of healthy subjects using an experimental paradigm. METHODS Resting-state functional magnetic resonance imaging (rsfMRI) was performed in 44 healthy subjects 24 hours after an elastic separator had been introduced between the first and the second molar on the right side of the lower jaw and in 49 age- and sex-matched healthy control (HC) subjects. A K-means clustering algorithm was used to identify functional gray matter (GM) and white matter (WM) resting-state networks, and differences in functional connectivity (FC) of GM and WM between the group of subjects with experimental orthodontic pain and HC were analyzed. RESULTS Twelve GM networks and 14 WM networks with high stability were identified. Compared with HC, subjects with orthodontic pain showed significantly increased FC between WM12, which includes posterior thalamic radiation and posterior cingulum bundle, and most GM networks. Besides, the WM12 network showed significant differences in FC with three GM-WM loops involving the default mode network, dorsal attention network, and salience network, respectively. CONCLUSIONS Orthodontic pain is shown to produce an alteration of FC in networks relevant to pain processing, which may be mediated by a WM network relevant to emotion perception and cognitive processing.
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Affiliation(s)
- Feifei Zhang
- Huaxi MR Research Center (HMRRC)Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Fei Li
- Huaxi MR Research Center (HMRRC)Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Hong Yang
- State Key Laboratory of Oral DiseaseDepartment of OrthodonticsWest China School of Stomatology, Sichuan UniversityChengdu
| | - Yu Jin
- State Key Laboratory of Oral DiseaseDepartment of OrthodonticsWest China School of Stomatology, Sichuan UniversityChengdu
| | - Wenli Lai
- State Key Laboratory of Oral DiseaseDepartment of OrthodonticsWest China School of Stomatology, Sichuan UniversityChengdu
| | - Neil Roberts
- School of Clinical SciencesUniversity of EdinburghEdinburghUK
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC)Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan UniversityChengduChina
- Department of Nuclear MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC)Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
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8
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Bonanno L, Lo Buono V, De Salvo S, Ruvolo C, Torre V, Bramanti P, Marino S, Corallo F. Brain morphologic abnormalities in migraine patients: an observational study. J Headache Pain 2020; 21:39. [PMID: 32334532 PMCID: PMC7183590 DOI: 10.1186/s10194-020-01109-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is a common neurological disorder characterized by a complex physiopathology. We assessed brain morphologic differences in migraine and the possible pathogenetic mechanism underlying this disease. Methods We analyzed brain morphologic images of migraine patients, 14 with aura (MwA) [the mean (SD) age was 42.36 (2.95) years (range, 37–47)] and 14 without aura (MwoA) [the mean (SD) age was 43.5 (3.25) years (range, 39–50)] during episodic attack compared with health subjects balanced (HS) [the mean (SD) age was 42.5 (5.17) years (range, 34–51)]. All subjects underwent a Magnetic Resonance Imaging (MRI) examination with a scanner operating at 3.0 T and voxel based morphometry (VBM) approach was used to examine the gray matter volume (GMV). The statistical analysis to compare clinicl characteristics was performed using unpaired t-test an one-way Anova. Results: Total cerebral GMV showed a significant difference between MwA and HS (p = 0.02), and between MwoA and HS (p = 0.003). In addition, not significative differences were found between MwA and MwoA groups (p = 0.17). We found three clusters of regions which showed significant GMV reduction in MwA compared with MwoA. MwA subjects showed a less of GMV in 4 clusters if compared with HS, and MwoA subjects showed a less of GMV in 3 clusters if compared with HS. We observed that MwA and MwoA patients had a significant reduction of GMV in the frontal and temporal lobe and the cerebellum, if compared to HS. The bilateral fusiform gyrus and the cingulate gyrus were increase in MwoA patients compared with HS. Conclusion Our findings could provide a approach to understand possible differences in the pathogenesis of two type of migraine.
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Affiliation(s)
- Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy.
| | - Simona De Salvo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Claudio Ruvolo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Viviana Torre
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C. da Casazza, 98124, Messina, Italy
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Wang S, Wang H, Zhao D, Liu X, Yan W, Wang M, Zhao R. Grey matter changes in patients with vestibular migraine. Clin Radiol 2019; 74:898.e1-898.e5. [PMID: 31451181 DOI: 10.1016/j.crad.2019.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
AIM To identify structural changes in the brain regions of patients with vestibular migraine (VM) so as to better understand its pathophysiology. MATERIAL AND METHODS The differences in grey matter (GM) in patients with VM, patients with migraine without aura (MWoA), and healthy controls (HC) were investigated. Using a GE Signa 3 T magnetic resonance imaging (MRI) system, 3D structural images were acquired from 18 VM, 21 MWoA, and 21 age-, gender-, and education level-matched HC using a T1-weighted magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequence. The volumetric abnormalities of GM were estimated by voxel-based morphometry. Analysis of variance and Bonferroni multiple comparisons were applied. RESULTS Compared with HC, patients with VM had significantly increased GM volume of the right medial superior frontal gyrus (p=0.008) and the right angular gyrus (p=0.009). Compared to patients with MWoA, patients with VM also had significantly increased volume of the right medial superior frontal gyrus (p=0.001), the right angular gyrus (p=0.008), and the left middle frontal gyrus (p=0.001). CONCLUSIONS The GM volume of some brain regions of patients with VM is significantly larger than the other two groups. The increased GM volume in these brain regions in patients with VM may be related to self-adaptation of the nervous system, leading to an abnormal brain sensitization. Some of the brain regions with increased GM volume identified in this study were involved in assessment, integration, and expectations of pain and were strongly related to mood and anxiety.
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Affiliation(s)
- S Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - H Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China.
| | - D Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - X Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - W Yan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - M Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - R Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
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10
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Borg C, Chouchou F, Dayot-Gorlero J, Zimmerman P, Maudoux D, Laurent B, Michael GA. Pain and emotion as predictive factors of interoception in fibromyalgia. J Pain Res 2018; 11:823-835. [PMID: 29719416 PMCID: PMC5914549 DOI: 10.2147/jpr.s152012] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction This study investigated interoception in fibromyalgia (FM), a disorder characterized by chronic pain accompanied by mood deregulation. Based on observations on the relationship between somatosensory processing and pain in FM and considering the affective symptoms of this disorder, we tested in FM three dimensions of interoception: interoceptive accuracy (IA), interoceptive awareness (IAW) and interoceptive sensibility (IS). Materials and methods Twenty-one female FM patients (Mage = 50.3) and 21 female matched controls (Mage = 46.3) completed a heartbeat tracking task as an assessment of IA, rated confidence in their responses as a measure of IAW and completed the Multidimensional Assessment of Interoceptive Awareness as a measure of IS. Furthermore, they completed self-report scales that, according to a principal component analysis, targeted anxiety, emotional consciousness and pain-related affect and reactions. Results Multiple regression analyses showed that increased pain-related affect and reactions decrease IA in FM. When the results of each group were examined separately, such effect was found only in FM patients. On its turn, IS was predicted by emotional consciousness and pain-related affect and reactions, but these effects did not differ between FM and controls. Finally, none of the variables we used predicted IAW. Discussion Pain-related affect and reactions in FM patients can reduce their interoceptive ability. Our results help to better understand the integration between bodily signals and emotional processing in chronic pain.
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Affiliation(s)
- Céline Borg
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint-Priest-en-Jarez, France.,Department of Psychology, University of Lyon, Lyon, France.,Université de Lyon, Université Lyon 2, Laboratory EMC (EA 3082), Bron, France
| | - Florian Chouchou
- Central Integration of Pain (NeuroPain), Inserm U1028, UCB Lyon1, Saint-Etienne, France
| | - Jenny Dayot-Gorlero
- Université de Lyon, Université Lyon 2, Laboratory EMC (EA 3082), Bron, France
| | - Perrine Zimmerman
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint-Priest-en-Jarez, France
| | - Delphine Maudoux
- EA SNA-EPIS, Department of Clinical and Exercise Physiology, CHU de Saint-Etienne, Saint-Etienne, France
| | - Bernard Laurent
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint-Priest-en-Jarez, France.,Central Integration of Pain (NeuroPain), Inserm U1028, UCB Lyon1, Saint-Etienne, France
| | - George A Michael
- Université de Lyon, Université Lyon 2, Laboratory EMC (EA 3082), Bron, France
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11
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Phantom Acupuncture Induces Placebo Credibility and Vicarious Sensations: A Parallel fMRI Study of Low Back Pain Patients. Sci Rep 2018; 8:930. [PMID: 29343693 PMCID: PMC5772373 DOI: 10.1038/s41598-017-18870-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/19/2017] [Indexed: 02/06/2023] Open
Abstract
Although acupuncture is an effective therapeutic intervention for pain reduction, the exact difference between real and sham acupuncture has not been clearly understood because a somatosensory tactile component is commonly included in the existing sham acupuncture protocols. In an event-related fMRI experiment, we implemented a novel form of sham acupuncture, phantom acupuncture, that reproduces the acupuncture needling procedure without somatosensory tactile stimulation while maintaining the credibility of the acupuncture treatment context. Fifty-six non-specific low back pain patients received either real (REAL) or phantom (PHNT) acupuncture stimulation in a parallel group study. The REAL group exhibited greater activation in the posterior insula and anterior cingulate cortex, reflecting the needling-specific components of acupuncture. We demonstrated that PHNT could be delivered credibly. Interestingly, the PHNT-credible group exhibited bilateral activation in SI/SII and also reported vicarious acupuncture sensations without needling stimulation. The PHNT group showed greater activation in the bilateral dorsolateral/ventrolateral prefrontal cortex (dlPFC/vlPFC). Moreover, the PHNT group exhibited significant pain reduction, with a significant correlation between the subjective fMRI signal in the right dlPFC/vlPFC and a score assessing belief in acupuncture effectiveness. These results support an expectation-related placebo analgesic effect on subjective pain intensity ratings, possibly mediated by right prefrontal cortex activity.
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Lesniak A, Aarnio M, Diwakarla S, Norberg T, Nyberg F, Gordh T. Characterization of the binding site for d-deprenyl in human inflamed synovial membrane. Life Sci 2017; 194:26-33. [PMID: 29221756 DOI: 10.1016/j.lfs.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 01/23/2023]
Abstract
AIMS d-Deprenyl when used as a positron emission tomography tracer visualizes peripheral inflammation. The major aim of the current study was to identify and investigate the properties of the binding target for d-deprenyl in synovial membrane explants from arthritic patients. MAIN METHODS Thirty patients diagnosed with arthritis or osteoarthritis were enrolled into the study. Homologous and competitive radioligand binding assays utilizing [3H]d-deprenyl were performed to investigate the biochemical characteristics of the binding site and assess differences in the binding profile in synovial membranes exhibiting varying levels of inflammation. KEY FINDINGS The [3H]d-deprenyl binding assay confirmed the existence of a single, saturable population of membrane-bound protein binding sites in synovial membrane homogenates. The macroscopically determined level of inflammation correlated with an increase in [3H]d-deprenyl binding affinity, without significant alterations in binding site density. Selective monoamine oxidase B inhibitor, selegiline competed for the same site as [3H]d-deprenyl, but failed to differentiate the samples with regard to their inflammation grade. A monoamine oxidase A inhibitor, pirlindole mesylate showed only weak displacement of [3H]d-deprenyl binding. No significant alterations in monoamine oxidase B expression was detected, thus it was not confirmed whether it could serve as a marker for ongoing inflammation. SIGNIFICANCE Our study was the first to show the biochemical characteristics of the [3H]d-deprenyl binding site in inflamed human synovium. We confirmed that d-deprenyl could differentiate between patients with varying severity of synovitis in the knee joint by binding to a protein target distinct from monoamine oxidase B.
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Affiliation(s)
- Anna Lesniak
- Uppsala University, Department of Pharmaceutical Biosciences, SE 751 24 Uppsala, Sweden; Medical University of Warsaw, Department of Pharmacodynamics, Centre for Preclinical Research and Technology, 02-097 Warsaw, Poland.
| | - Mikko Aarnio
- Uppsala University Hospital, Department of Surgical Sciences, Anaesthesiology and Intensive Care, SE 751 85 Uppsala, Sweden
| | - Shanti Diwakarla
- Uppsala University, Department of Pharmaceutical Biosciences, SE 751 24 Uppsala, Sweden
| | - Thomas Norberg
- Uppsala University, Department of Physical Organic Chemistry, SE 751 23 Uppsala, Sweden
| | - Fred Nyberg
- Uppsala University, Department of Pharmaceutical Biosciences, SE 751 24 Uppsala, Sweden
| | - Torsten Gordh
- Uppsala University Hospital, Department of Surgical Sciences, Anaesthesiology and Intensive Care, SE 751 85 Uppsala, Sweden
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Peng K, Steele SC, Becerra L, Borsook D. Brodmann area 10: Collating, integrating and high level processing of nociception and pain. Prog Neurobiol 2017; 161:1-22. [PMID: 29199137 DOI: 10.1016/j.pneurobio.2017.11.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/08/2023]
Abstract
Multiple frontal cortical brain regions have emerged as being important in pain processing, whether it be integrative, sensory, cognitive, or emotional. One such region, Brodmann Area 10 (BA 10), is the largest frontal brain region that has been shown to be involved in a wide variety of functions including risk and decision making, odor evaluation, reward and conflict, pain, and working memory. BA 10, also known as the anterior prefrontal cortex, frontopolar prefrontal cortex or rostral prefrontal cortex, is comprised of at least two cytoarchitectonic sub-regions, medial and lateral. To date, the explicit role of BA 10 in the processing of pain hasn't been fully elucidated. In this paper, we first review the anatomical pathways and functional connectivity of BA 10. Numerous functional imaging studies of experimental or clinical pain have also reported brain activations and/or deactivations in BA 10 in response to painful events. The evidence suggests that BA 10 may play a critical role in the collation, integration and high-level processing of nociception and pain, but also reveals possible functional distinctions between the subregions of BA 10 in this process.
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Affiliation(s)
- Ke Peng
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States.
| | - Sarah C Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
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Di Lernia D, Serino S, Riva G. Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev 2016; 71:328-341. [DOI: 10.1016/j.neubiorev.2016.09.015] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 12/25/2022]
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Functional brain imaging: what has it brought to our understanding of neuropathic pain? A special focus on allodynic pain mechanisms. Pain 2016; 157 Suppl 1:S67-S71. [PMID: 26785157 DOI: 10.1097/j.pain.0000000000000387] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brain responses to nociception are well identified. The same is not true for allodynic pain, a strong painful sensation in response to touch or innocuous cold stimuli that may be experienced by patients with neuropathic pain. Brain (or spinal cord) reorganization that may explain this paradoxical perception still remains largely unknown. Allodynic pain is associated with abnormally increased activity in SII and in the anterior insular cortex, contralateral and/or ipsilateral to allodynia. Because a bilateral increase in activity has been repeatedly reported in these areas in nociceptive conditions, the observed activation during allodynia can explain that a physiologically nonpainful stimulus could be perceived by the damaged nervous system as a painful one. Both secondary somatosensory and insular cortices receive input from the thalamus, which is a major relay of sensory and spinothalamic pathways, the involvement of which is known to be crucial for the development of neuropathic pain. Both thalamic function and structure have been reported to be abnormal or impaired in neuropathic pain conditions including in the basal state, possibly explaining the spontaneous component of neuropathic pain. A further indication as to how the brain can create neuropathic pain response in SII and insular cortices stems from examples of diseases, including single-case reports in whom a focal brain lesion leads to central pain disappearance. Additional studies are required to certify the contribution of these areas to the disease processes, to disentangle abnormalities respectively related to pain and to deafferentation, and, in the future, to guide targeting of stimulation studies.
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16
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Leone M, May A, Franzini A, Broggi G, Dodick D, Rapoport A, Goadsby PJ, Schoenen J, Bonavita V, Bussone G. Deep Brain Stimulation for Intractable Chronic Cluster Headache: Proposals for Patient Selection. Cephalalgia 2016; 24:934-7. [PMID: 15482354 DOI: 10.1111/j.1468-2982.2004.00742.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cluster headache is the most severe of the primary headaches. Positron emission tomography and functional MRI studies have shown that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients. These changes are highly specific for the condition and suggest that the cluster headache generator may be located in that brain area; they further suggest that electrical stimulation of that region might produce clinical improvement in chronic cluster headache sufferers refractory to medical therapy. In five patients with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side-effects. We therefore consider it essential to propose criteria for selecting chronic cluster headache patients for hypothalamic deep brain stimulation before this procedure is undertaken at other academic medical centres.
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Affiliation(s)
- M Leone
- Headache Centre and Cerebrovascular Disease Department, Istituto Nazionale Neurologico Carlo Besta, Milano, Italy. leone@istituto-besta
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Gao Q, Xu F, Jiang C, Chen Z, Chen H, Liao H, Zhao L. Decreased functional connectivity density in pain-related brain regions of female migraine patients without aura. Brain Res 2015; 1632:73-81. [PMID: 26688226 DOI: 10.1016/j.brainres.2015.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 01/01/2023]
Abstract
Migraine is one of the most prevalent neurological disorders which is suggested to be associated with dysfunctions of the central nervous system. The purpose of the present study was to detect the altered functional connectivity architecture in the large-scale network of the whole brain in migraine without aura (MWoA). Meanwhile, the brain functional hubs which are targeted by MWoA could be identified. A new voxel-based method named functional connectivity density (FCD) mapping was applied to resting-state functional magnetic resonance imaging data of 55 female MWoA patients and 44 age-matched female healthy controls (HC). Comparing to HC, MWoA patients showed abnormal short-range FCD values in bilateral hippocampus, bilateral insula, right amygdale, right anterior cingulate cortex, bilateral putamen, bilateral caudate nucleus and the prefrontal cortex. The results suggested decreased intraregional connectivity of these pain-related brain regions in female MWoA. In addition, short-range FCD values in left prefrontal cortex, putamen and caudate nucleus were significantly negatively correlated with duration of disease in MWoA group, implying the repeated migraine attacks over time may consistently affect the resting-state functional connectivity architecture of these brain hubs. Our findings revealed the dysfunction of brain hubs in female MWoA, and suggested the left prefrontal cortex, putamen and caudate nucleus served as sensitive neuroimaging markers for reflecting the disease duration of female MWoA. This may provide us new insights into the changes in the organization of the large-scale brain network in MWoA.
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Affiliation(s)
- Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Fei Xu
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Cui Jiang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Zhifeng Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Huaqiang Liao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
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Alhourani A, McDowell MM, Randazzo MJ, Wozny TA, Kondylis ED, Lipski WJ, Beck S, Karp JF, Ghuman AS, Richardson RM. Network effects of deep brain stimulation. J Neurophysiol 2015; 114:2105-17. [PMID: 26269552 DOI: 10.1152/jn.00275.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
The ability to differentially alter specific brain functions via deep brain stimulation (DBS) represents a monumental advance in clinical neuroscience, as well as within medicine as a whole. Despite the efficacy of DBS in the treatment of movement disorders, for which it is often the gold-standard therapy when medical management becomes inadequate, the mechanisms through which DBS in various brain targets produces therapeutic effects is still not well understood. This limited knowledge is a barrier to improving efficacy and reducing side effects in clinical brain stimulation. A field of study related to assessing the network effects of DBS is gradually emerging that promises to reveal aspects of the underlying pathophysiology of various brain disorders and their response to DBS that will be critical to advancing the field. This review summarizes the nascent literature related to network effects of DBS measured by cerebral blood flow and metabolic imaging, functional imaging, and electrophysiology (scalp and intracranial electroencephalography and magnetoencephalography) in order to establish a framework for future studies.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael M McDowell
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael J Randazzo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Witold J Lipski
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Beck
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Avniel S Ghuman
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
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Cortical plasticity in episodic and chronic cluster headache. NEUROIMAGE-CLINICAL 2014; 6:415-23. [PMID: 25379455 PMCID: PMC4218933 DOI: 10.1016/j.nicl.2014.10.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 01/05/2023]
Abstract
Cluster headache (CH) is characterized by recurrent episodes of excruciatingly painful, unilateral headache attacks typically accompanied by trigeminal autonomic symptoms. Due to its rhythm with alternating episodes of pain and no-pain, it is an excellent model to investigate whether structural brain changes detected by magnetic resonance based voxel-based-morphometry (VBM) reflect the cause of the disease, may be a consequence of the underlying disease other than pain, or may simply be caused by the sensation of pain itself. We investigated 91 patients with CH in different stages of their disease using VBM and compared them to 78 age- and gender-matched healthy controls. We detected distinct regional gray matter (GM) changes in different brain regions including the temporal lobe, the hippocampus, the insular cortex and the cerebellum. The extent, location and direction of observed GM alterations depended on the state of disease and appeared dynamic in relation to pain state (i.e., pain vs. no-pain). No hypothalamic changes were detected in CH patients compared to healthy controls. The GM changes observed in this study are highly dynamic and thereby reflect the cortical plasticity of the brain in regard to pain. This observed dynamic may provide an explanation of the diverse results of previous VBM studies in pain. Regarding CH the results suggest that the disease is more likely to be caused by a network dysfunction rather than by a single malfunctioning structure. We identified gray matter (GM) changes in pain processing areas and beyond in patients suffering cluster headache (CH) compared to healthy controls GM changes significantly differed for different courses of the disease (chronic, episodic inside bout, episodic outside bout). GM decrease was predominantly observed in chronic CH, while episodic CH showed a more complex and partly opposite behavior. This dynamic probably reflects the brain's adaptation capacity to changing stimuli in regard to cortical plasticity and may provide an explanation of the diverse results of previous VBM studies in pain
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20
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Holle D, Obermann M. Cluster headache and the hypothalamus: causal relationship or epiphenomenon? Expert Rev Neurother 2014; 11:1255-63. [DOI: 10.1586/ern.11.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Bohgaki T, Katagiri Y, Usami M. Pain-Relief Effects of Aroma Touch Therapy with <i>Citrus junos</i> Oil Evaluated by Quantitative EEG Occipital Alpha-2 Rhythm Powers. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jbbs.2014.41002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Garcia-Larrea L, Peyron R. Pain matrices and neuropathic pain matrices: A review. Pain 2013; 154 Suppl 1:S29-S43. [PMID: 24021862 DOI: 10.1016/j.pain.2013.09.001] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 01/18/2023]
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23
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Youssef AM, Gustin SM, Nash PG, Reeves JM, Petersen ET, Peck CC, Murray GM, Henderson LA. Differential brain activity in subjects with painful trigeminal neuropathy and painful temporomandibular disorder. Pain 2013; 155:467-475. [PMID: 24269492 DOI: 10.1016/j.pain.2013.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 12/30/2022]
Abstract
Human brain imaging investigations have revealed that acute pain is associated with coactivation of numerous brain regions, including the thalamus, somatosensory, insular, and cingulate cortices. Surprisingly, a similar set of brain structures is not activated in all chronic pain conditions, particularly chronic neuropathic pain, which is associated with almost exclusively decreased thalamic activity. These inconsistencies may reflect technical issues or fundamental differences in the processing of acute compared with chronic pain. The appreciation of any differences is important because better treatment development will depend on understanding the underlying mechanisms of different forms of pain. In this investigation, we used quantitative arterial spin labeling to compare and contrast regional cerebral blood flow (CBF) patterns in individuals with chronic neuropathic orofacial pain (painful trigeminal neuropathy) and chronic nonneuropathic orofacial pain (painful temporomandibular disorder). Neuropathic pain was associated with CBF decreases in a number of regions, including the thalamus and primary somatosensory and cerebellar cortices. In contrast, chronic nonneuropathic pain was associated with significant CBF increases in regions commonly associated with higher-order cognitive and emotional functions, such as the anterior cingulate and dorsolateral prefrontal cortices and the precuneus. Furthermore, in subjects with nonneuropathic pain, blood flow increased in motor-related regions as well as within the spinal trigeminal nucleus.
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Affiliation(s)
- Andrew M Youssef
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia Departments of Radiology and Radiotherapy, University Medical Center Utrecht, The Netherlands Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Westmead Hospital, Westmead, NSW 2006, Australia
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Fukui S, Shigemori S, Komoda Y, Yamada N, Nosaka S. Phantom pain with beneficial response to electroconvulsive therapy (ECT) and regional cerebral blood flow (rCBF) studied with Xenon-CT. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/15685690260138992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Damasio A, Damasio H, Tranel D. Persistence of feelings and sentience after bilateral damage of the insula. Cereb Cortex 2013; 23:833-46. [PMID: 22473895 PMCID: PMC3657385 DOI: 10.1093/cercor/bhs077] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It has been convincingly established, over the past decade, that the human insular cortices are involved in processing both body feelings (such as pain) and feelings of emotion. Recently, however, an interpretation of this finding has emerged suggesting that the insular cortices are the necessary and sufficient platform for human feelings, in effect, the sole neural source of feeling experiences. In this study, we investigate this proposal in a patient whose insular cortices were destroyed bilaterally as a result of Herpes simplex encephalitis. The fact that all aspects of feeling were intact indicates that the proposal is problematic. The signals used to assemble the neural substrates of feelings hail from different sectors of the body and are conveyed by neural and humoral pathways to complex and topographically organized nuclei of the brain stem, prior to being conveyed again to cerebral cortices in the somatosensory, insular, and cingulate regions. We suggest that the neural substrate of feeling states is to be found first subcortically and then secondarily repeated at cortical level. The subcortical level would ensure basic feeling states while the cortical level would largely relate feeling states to cognitive processes such as decision-making and imagination.
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Affiliation(s)
- Antonio Damasio
- Brain and Creativity Institute and Dornsife Center for Cognitive Neuroimaging, University of Southern California, Los Angeles, CA 90089, USA.
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Saghaei E, Abbaszadeh F, Naseri K, Ghorbanpoor S, Afhami M, Haeri A, Rahimi F, Jorjani M. Estradiol attenuates spinal cord injury-induced pain by suppressing microglial activation in thalamic VPL nuclei of rats. Neurosci Res 2013; 75:316-23. [PMID: 23419864 DOI: 10.1016/j.neures.2013.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 01/21/2013] [Accepted: 01/29/2013] [Indexed: 12/22/2022]
Abstract
In our previous study we showed that central pain syndrome (CPS) induced by electrolytic injury caused in the unilateral spinothalamic tract (STT) is a concomitant of glial alteration at the site of injury. Here, we investigated the activity of glial cells in thalamic ventral posterolateral nuclei (VPL) and their contribution to CPS. We also examined whether post-injury administration of a pharmacological dose of estradiol can attenuate CPS and associated molecular changes. Based on the results,in the ipsilateral VPL the microglial phenotype switched o hyperactive mode and Iba1 expression was increased significantly on days 21 and 28 post-injury. The same feature was observed in contralateral VPL on day 28 (P<.05). These changes were strongly correlated with the onset of CPS (r(2)=0.670). STT injury did not induce significant astroglial response in both ipsilateral and contralateral VPL. Estradiol attenuated bilateral mechanical hypersensitivity 14 days after STT lesion (P<.05). Estradiol also suppressed microglial activation in the VPL. Taken together, these findings indicate that selective STT lesion induces bilateral microglia activation in VPL which might contribute to mechanical hypersensitivity. Furthermore, a pharmacological dose of estradiol reduces central pain possibly via suppression of glial activity in VPL region.
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Affiliation(s)
- Elham Saghaei
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran.
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Jin C, Yuan K, Zhao L, Zhao L, Yu D, von Deneen KM, Zhang M, Qin W, Sun W, Tian J. Structural and functional abnormalities in migraine patients without aura. NMR IN BIOMEDICINE 2013; 26:58-64. [PMID: 22674568 DOI: 10.1002/nbm.2819] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 06/01/2023]
Abstract
Migraine is a primary headache disorder characterized by recurrent attacks of throbbing pain associated with neurological, gastrointestinal and autonomic symptoms. Previous studies have detected structural deficits and functional impairments in migraine patients. However, researchers have failed to investigate the functional connectivity alterations of regions with structural deficits during the resting state. Twenty-one migraine patients without aura and 21 age- and gender-matched healthy controls participated in our study. Voxel-based morphometric (VBM) analysis and functional connectivity were employed to investigate the abnormal structural and resting-state properties, respectively, in migraine patients without aura. Relative to healthy comparison subjects, migraine patients showed significantly decreased gray matter volume in five brain regions: the left medial prefrontal cortex (MPFC), dorsal anterior cingulate cortex (dACC), right occipital lobe, cerebellum and brainstem. The gray matter volume of the dACC was correlated with the duration of disease in migraine patients, and thus we chose this region as the seeding area for resting-state analysis. We found that migraine patients showed increased functional connectivity between several regions and the left dACC, i.e. the bilateral middle temporal lobe, orbitofrontal cortex (OFC) and left dorsolateral prefrontal cortex (DLPFC). Furthermore, the functional connectivity between the dACC and two regions (i.e. DLPFC and OFC) was correlated with the duration of disease in migraine patients. We suggest that frequent nociceptive input has modified the structural and functional patterns of the frontal cortex, and these changes may explain the functional impairments in migraine patients.
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Affiliation(s)
- Chenwang Jin
- Department of Medical Imaging, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
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Yu D, Yuan K, Zhao L, Zhao L, Dong M, Liu P, Wang G, Liu J, Sun J, Zhou G, von Deneen KM, Liang F, Qin W, Tian J. Regional homogeneity abnormalities in patients with interictal migraine without aura: a resting-state study. NMR IN BIOMEDICINE 2012; 25:806-812. [PMID: 22020869 DOI: 10.1002/nbm.1796] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/27/2011] [Accepted: 09/09/2011] [Indexed: 05/31/2023]
Abstract
Previous studies have provided evidence of structural and task-related functional changes in the brains of patients with migraine without aura. Resting-state brain activity in patients with migraine provides clues to the pathophysiology of the disease. However, few studies have focused on the resting-state abnormalities in patients with migraine without aura. In the current study, we employed a data-driven method, regional homogeneity (ReHo), to analyze the local features of spontaneous brain activity in patients with migraine without aura during the resting state. Twenty-six patients with migraine without aura and 26 age-, education- and gender-matched healthy volunteers participated in this study. Compared with healthy controls, patients with migraine without aura showed a significant decrease in ReHo values in the right rostral anterior cingulate cortex (rACC), the prefrontal cortex (PFC), the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). In addition, we found that ReHo values were negatively correlated with the duration of disease in the right rACC and PFC. Our results suggest that the resting-state abnormalities of these regions may be associated with functional impairments in pain processing in patients with migraine without aura. We hope that our results will improve the understanding of migraine.
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Affiliation(s)
- Dahua Yu
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi, China
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Kupersl R, Van Laerel K, Van Calenberghl F, Gybelsl J, Dupontl P, Baeckl A, Plaghkil L. Multimodal therapeutic assessment of peripheral nerve stimulation in neuropathic pain: Five case reports with a 20-year follow-up. Eur J Pain 2012; 15:161.e1-9. [DOI: 10.1016/j.ejpain.2010.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/23/2010] [Accepted: 06/16/2010] [Indexed: 01/12/2023]
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Garcia-Larrea L, Maarrawi J, Peyron R, Costes N, Mertens P, Magnin M, Laurent B. On the relation between sensory deafferentation, pain and thalamic activity in Wallenberg's syndrome: A PET-scan study before and after motor cortex stimulation. Eur J Pain 2012; 10:677-88. [PMID: 16338151 DOI: 10.1016/j.ejpain.2005.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 10/14/2005] [Accepted: 10/21/2005] [Indexed: 11/22/2022]
Abstract
Decrease of thalamic blood flow contralateral to neuropathic pain has been described by several groups, but its relation with sensory deafferentation remains unclear. Here we report one instance where the thalamic effects of sensory deafferentation could be dissociated from those of neuropathic pain. A 50-year-old patient underwent a left medullary infarct leading to right-sided thermal and pain hypaesthesia up to the third right trigeminal division, as well as in the left face. During the following months the patient developed neuropathic pain limited to the left side of the face. Although the territory with sensory loss was much wider in the right (non painful) than in the left (painful) side of the body, PET-scan demonstrated significant reduction of blood flow in the right thalamus (contralateral to the small painful area) relative to its homologous region. After 3 months of right motor cortex stimulation the patient reported 60% relief of his left facial pain, and a new PET-scan showed correction of the thalamic asymmetry. We conclude that thalamic PET-scan hypoactivity contralateral to neuropathic pain does not merely reflect deafferentation, but appears related to the pain pathophysiology, and may be normalized in parallel with pain relief. The possible mechanisms linking thalamic hypoactivity and pain are discussed in relation with findings in epileptic patients, possible compensation phenomena and bursting thalamic discharges described in animals and humans. Restoration of thalamic activity in neuropathic pain might represent one important condition to obtain successful relief by analgesic procedures, including cortical neurostimulation.
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Affiliation(s)
- Luis Garcia-Larrea
- INSERM E342, Central Integration of Human Pain, Hopital Neurologique, 59 Bd Pinel, 69003 Lyon, France; Université Claude Bernard Lyon1, France.
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Meissner K, Wittmann M. Body signals, cardiac awareness, and the perception of time. Biol Psychol 2011; 86:289-97. [PMID: 21262314 DOI: 10.1016/j.biopsycho.2011.01.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 01/17/2011] [Accepted: 01/17/2011] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE This study aimed to test the hypothesis that sacral nerve stimulation affects afferent vagal projections to the central nervous system associated with frontal cortex activation in patients with fecal incontinence. PATIENTS Nine women and one man received temporary sacral nerve stimulation with permanent electrodes as a treatment for fecal incontinence. INTERVENTIONS We used positron emission tomography to record indices of regional cerebral blood flow before and after 30 minutes of continuous stimulation. We repeated this procedure after 2 weeks of continued stimulation, before and 30 minutes after arrest of the stimulation. RESULTS The initial stimulation activated a region of the contralateral frontal cortex that normally is active during focused attention. After 2 weeks of stimulation, this activation had been replaced by activity in parts of the ipsilateral caudate nucleus, a region of the brain thought to be specifically involved in learning and reward processing. CONCLUSIONS Sacral nerve stimulation induces changes in cerebral activity consistent with an effect on afferent projections of the vagus. The initial activation of the frontal cortex may reflect focused attention, whereas the subsequent activation of the caudate nucleus may reflect recruitment of mechanisms involved in learning and reward processing. These changes may contribute to the improved continence, which is an acquired result of the stimulation.
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Magis D, Bruno MA, Fumal A, Gérardy PY, Hustinx R, Laureys S, Schoenen J. Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study. BMC Neurol 2011; 11:25. [PMID: 21349186 PMCID: PMC3056751 DOI: 10.1186/1471-2377-11-25] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occipital nerve stimulation (ONS) has raised new hope for drug-resistant chronic cluster headache (drCCH), a devastating condition. However its mode of action remains elusive. Since the long delay to meaningful effect suggests that ONS induces slow neuromodulation, we have searched for changes in central pain-control areas using metabolic neuroimaging. METHODS Ten drCCH patients underwent an 18FDG-PET scan after ONS, at delays varying between 0 and 30 months. All were scanned with ongoing ONS (ON) and with the stimulator switched OFF. RESULTS After 6-30 months of ONS, 3 patients were pain free and 4 had a ≥ 90% reduction of attack frequency (responders). In all patients compared to controls, several areas of the pain matrix showed hypermetabolism: ipsilateral hypothalamus, midbrain and ipsilateral lower pons. All normalized after ONS, except for the hypothalamus. Switching the stimulator ON or OFF had little influence on brain glucose metabolism. The perigenual anterior cingulate cortex (PACC) was hyperactive in ONS responders compared to non-responders. CONCLUSIONS Metabolic normalization in the pain neuromatrix and lack of short-term changes induced by the stimulation might support the hypothesis that ONS acts in drCCH through slow neuromodulatory processes. Selective activation in responders of PACC, a pivotal structure in the endogenous opioid system, suggests that ONS could restore balance within dysfunctioning pain control centres. That ONS is nothing but a symptomatic treatment might be illustrated by the persistent hypothalamic hypermetabolism, which could explain why autonomic attacks may persist despite pain relief and why cluster attacks recur shortly after stimulator arrest. PET studies on larger samples are warranted to confirm these first results.
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Esfahani DR, Pisansky MT, Dafer RM, Anderson DE. Motor cortex stimulation: functional magnetic resonance imaging–localized treatment for three sources of intractable facial pain. J Neurosurg 2011; 114:189-95. [DOI: 10.3171/2010.5.jns091696] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain.
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Affiliation(s)
| | - Marc T. Pisansky
- 3Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Rima M. Dafer
- 1Stritch School of Medicine; and
- 2Departments of Neurology and
- 3Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Douglas E. Anderson
- 1Stritch School of Medicine; and
- 3Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
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Holle D, Katsarava Z, Obermann M. The Hypothalamus: Specific or Nonspecific Role in the Pathophysiology of Trigeminal Autonomic Cephalalgias? Curr Pain Headache Rep 2010; 15:101-7. [DOI: 10.1007/s11916-010-0166-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alonso AA, Koutlas IG, Leuthold AC, Lewis SM, Georgopoulos AP. Cortical processing of facial tactile stimuli in temporomandibular disorder as revealed by magnetoencephalography. Exp Brain Res 2010; 204:33-45. [DOI: 10.1007/s00221-010-2291-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 05/04/2010] [Indexed: 11/28/2022]
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Borsook D, Upadhyay J, Chudler EH, Becerra L. A key role of the basal ganglia in pain and analgesia--insights gained through human functional imaging. Mol Pain 2010; 6:27. [PMID: 20465845 PMCID: PMC2883978 DOI: 10.1186/1744-8069-6-27] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/13/2010] [Indexed: 01/18/2023] Open
Abstract
The basal ganglia (BG) are composed of several nuclei involved in neural processing related to the execution of motor, cognitive and emotional activities. Preclinical and clinical data have implicated a role for these structures in pain processing. Recently neuroimaging has added important information on BG activation in conditions of acute pain, chronic pain and as a result of drug effects. Our current understanding of alterations in cortical and sub-cortical regions in pain suggests that the BG are uniquely involved in thalamo-cortico-BG loops to integrate many aspects of pain. These include the integration of motor, emotional, autonomic and cognitive responses to pain.
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Affiliation(s)
- David Borsook
- PAIN Group, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.
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Berg JWMT, Dupont P, Schoenen J. Glossopharyngeal Neuralgia Triggered by Non-Noxious Stimuli at Multiple Cephalic and Extracephalic Sites. Cephalalgia 2009; 29:1174-9. [DOI: 10.1111/j.1468-2982.2009.01851.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Glossopharyngeal neuralgia (GN) triggered by non-noxious stimuli at multiple cephalic and extracephalic sites with positron emission tomography (PET) evidence for involvement of the upper brainstem has never been reported. We present such a patient, a 73-year-old man who since the age of 50 had suffered from GN with a high recurrence rate and very severe unilateral, non-familial GN episodes with very easy trigger zones widely extending beyond the n IX territory. Extensive neuroimaging and neurophysiological tests detected no precise underlying cause. PET scan revealed activation in the upper brainstem on extracephalic triggers. Single-fibre electromyography data will be discussed. We hypothesize that deficient inhibition as seen in trigeminal nociceptive reflexes on the level of brainstem interneurons, a functional lesion in the primary somatosensory cortex-sensory thalamic nuclei circuit and the dorsal column-thalamic pathway both activated by light touch may in part be involved in the extra- cephalic triggering.
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Affiliation(s)
- JWM ter Berg
- Orbis Medical Centre, Dr. H. van der Hoffplein 1,6130 MB, Sittard-Geleen, The Netherlands
| | - P Dupont
- Centre for PET, Department of Nuclear Medicine, KU Leuven, Leuven
| | - J Schoenen
- Department of Neurology, Headache Research Unit, University of Liège, Liège, Belgium [Correction added after online publication 9 April 2009: JWM ter Berg's affiliation address has been changed]
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Reed KL, Black SB, Banta CJ, Will KR. Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: Initial experience. Cephalalgia 2009; 30:260-71. [DOI: 10.1111/j.1468-2982.2009.01996.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A novel approach to the treatment of chronic migraine headaches based on neurostimulation of both occipital and supraorbital nerves was developed and reduced to clinical practice in a series of patients with headaches unresponsive to currently available therapies. Following positive trials, seven patients with chronic migraine and refractory chronic migraine headaches had permanent combined occipital nerve–supraorbital nerve neurostimulation systems implanted. The relative responses to two stimulation programs were evaluated: one that stimulated only the occipital leads and one that stimulated both the occipital and supraorbital leads together. With follow-up ranging from 1 to 35 months all patients reported a full therapeutic response but only to combined supraorbital–occipital neurostimulation. Occipital nerve stimulation alone provided a markedly inferior and inadequate response. Combined occipital nerve–supraorbital nerve neurostimulation systems may provide effective treatment for patients with chronic migraine and refractory chronic migraine headaches. For patients with chronic migraine headaches the response to combined systems appears to be substantially better than occipital nerve stimulation alone.
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Affiliation(s)
- KL Reed
- Department of Anesthesiology, Presbyterian Hospital of Dallas, TX, USA
| | - SB Black
- Medical Director of Neurology, Baylor University Medical Center of Dallas, TX, USA
| | - CJ Banta
- Department of Orthopedic Surgery, Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - KR Will
- Department of Anesthesiology, Presbyterian Hospital of Dallas, TX, USA
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Abstract
Neuroimaging makes it possible to study pain processing beyond the peripheral nervous system, at the supraspinal level, in a safe, noninvasive way, without interfering with neurophysiological processes. In recent years, studies using brain imaging methods have contributed to our understanding of the mechanisms responsible for the development and maintenance of chronic pain. Moreover, neuroimaging shows promising results for analgesic drug development and in characterizing different types of pain, bringing us closer to development of mechanism-based diagnoses and treatments for the chronic pain patient.
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Affiliation(s)
- Karolina Wartolowska
- grid.4991.50000000419368948Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, and Nuffield Department of Anaesthetics, University of Oxford, Oxford, England, OX3 9DU, UK
| | - Irene Tracey
- grid.4991.50000000419368948Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, and Nuffield Department of Anaesthetics, University of Oxford, Oxford, England, OX3 9DU, UK
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Cha MH, Kim DS, Cho ZH, Sohn JH, Chung MA, Lee HJ, Nam TS, Lee BH. Modification of cortical excitability in neuropathic rats: A voltage-sensitive dye study. Neurosci Lett 2009; 464:117-21. [DOI: 10.1016/j.neulet.2009.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/07/2009] [Accepted: 08/07/2009] [Indexed: 01/14/2023]
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Harrison NA, Brydon L, Walker C, Gray MA, Steptoe A, Dolan RJ, Critchley HD. Neural origins of human sickness in interoceptive responses to inflammation. Biol Psychiatry 2009; 66:415-22. [PMID: 19409533 PMCID: PMC2885492 DOI: 10.1016/j.biopsych.2009.03.007] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 01/26/2009] [Accepted: 02/23/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inflammation is associated with psychological, emotional, and behavioral disturbance, known as sickness behavior. Inflammatory cytokines are implicated in coordinating this central motivational reorientation accompanying peripheral immunologic responses to pathogens. Studies in rodents suggest an afferent interoceptive neural mechanism, although comparable data in humans are lacking. METHODS In a double-blind, randomized crossover study, 16 healthy male volunteers received typhoid vaccination or saline (placebo) injection in two experimental sessions. Profile of Mood State questionnaires were completed at baseline and at 2 and 3 hours. Two hours after injection, participants performed a high-demand color word Stroop task during functional magnetic resonance imaging. Blood samples were performed at baseline and immediately after scanning. RESULTS Typhoid but not placebo injection produced a robust inflammatory response indexed by increased circulating interleukin-6 accompanied by a significant increase in fatigue, confusion, and impaired concentration at 3 hours. Performance of the Stroop task under inflammation activated brain regions encoding representations of internal bodily state. Spatial and temporal characteristics of this response are consistent with interoceptive information flow via afferent autonomic fibers. During performance of this task, activity within interoceptive brain regions also predicted individual differences in inflammation-associated but not placebo-associated fatigue and confusion. Maintenance of cognitive performance, despite inflammation-associated fatigue, led to recruitment of additional prefrontal cortical regions. CONCLUSIONS These findings suggest that peripheral infection selectively influences central nervous system function to generate core symptoms of sickness and reorient basic motivational states.
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Affiliation(s)
- Neil A. Harrison
- Wellcome Trust, Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom,Institute of Cognitive Neuroscience, University College London, London, United Kingdom,Address correspondence to Neil Harrison, M.B.B.S., Ph.D., UCL Institute of Cognitive Neuroscience, Alexandra House, University College London, 17 Queen Square, London WC1N 3AR, UK
| | - Lena Brydon
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cicely Walker
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Marcus A. Gray
- Brighton and Sussex Medical School, University of Sussex Campus, Falmer, Brighton, United Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Raymond J. Dolan
- Wellcome Trust, Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - Hugo D. Critchley
- Brighton and Sussex Medical School, University of Sussex Campus, Falmer, Brighton, United Kingdom
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Brain glucose metabolic changes associated with chronic spontaneous pain due to brachial plexus avulsion: a preliminary positron emission tomography study. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200806020-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Denuelle M, Fabre N, Payoux P, Chollet F, Geraud G. Hypothalamic activation in spontaneous migraine attacks. Headache 2008; 47:1418-26. [PMID: 18052951 DOI: 10.1111/j.1526-4610.2007.00776.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Migraine sufferers experience premonitory symptoms which suggest that primary hypothalamic dysfunction is a likely trigger of the attacks. Neuroendocrine and laboratory data also support this hypothesis. To date, positron emission tomography (PET) scans of migraine sufferers have demonstrated activation of brainstem nuclei, but not of the hypothalamus. OBJECTIVE To record cerebral activations withH2 15OPET during spontaneous migraine without aura attacks. METHODS We scanned 7 patients with migraine without aura (6 females and 1 male) in each of 3 situations: within 4 hours of headache onset, after headache relief by sumatriptan injection (between the fourth and the sixth hour after headache onset), and during an attack-free period. RESULTS During the headache we found not only significant activations in the midbrain and pons, but also in the hypothalamus, all persisting after headache relief by sumatriptan. CONCLUSION Hypothalamic activity, long suspected by clinical and experimental arguments as a possible trigger for migraine, is demonstrated for the first time during spontaneous attacks.
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Affiliation(s)
- Marie Denuelle
- Neurology Service, Rangueil Hospital, Toulouse Cedex 9, France
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Garcia-Larrea L, Magnin M. Physiopathologie de la douleur neuropathique : revue des modèles expérimentaux et des mécanismes proposés. Presse Med 2008; 37:315-40. [DOI: 10.1016/j.lpm.2007.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/02/2007] [Indexed: 01/22/2023] Open
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Abstract
Currently the clinical needs for pain and headache management are not met. Despite the numerous and exciting recent advances in understanding the molecular and cellular mechanisms that originate pain, we cannot yet fully explain the mechanism underlying the biology of chronic pain. Pain is a natural mechanism preserving our species survival; however, when the protective quality is lost, physiologic changes to the peripheral and central nervous systems result in the formation of chronic pain states. Once we understand how this chronic pain state is created, either through genetic, environmental, therapeutic, or other triggers we may be able to enhance our species existence, limiting maladaptive pain and suffering. The future therapeutic targets will need to address the genetics, neurophysiologic changes of the neurons and brain as well as help control immune systems including the glia. The key to successful headache and pain therapy is research aimed at prevention and minimizing the plastic changes triggering chronic pain.
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Buvanendran A, Ali A, Stoub TR, Berger RA, Kroin JS. The use of brain positron emission tomography to identify sites of postoperative pain processing with and without epidural analgesia. Anesth Analg 2007; 105:1784-6, table of contents. [PMID: 18042883 DOI: 10.1213/01.ane.0000270206.30333.cb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is not known how different analgesic regimes affect the brain when reducing postoperative pain. We performed positron emission tomography (PET) scans on a 69-yr-old woman in the presence of moderate postoperative pain and then with epidural analgesia producing complete analgesia, during the first 2 days after total knee arthroplasty. Day 2 postsurgery PET scan data (no pain with epidural analgesia) were subtracted from Day 1 postsurgery PET scan data (time of moderate pain without epidural analgesia) to determine the brain regions activated. Postsurgical pain was associated with increased activity in the contralateral primary somatosensory cortex. Other brain regions showing increased postsurgical activity were the contralateral parietal cortex, bilateral pulvinar and ipsilateral medial dorsal nucleus of the thalamus, contralateral putamen, contralateral superior temporal gyrus, ipsilateral fusiform gyrus, ipsilateral posterior lobe, and contralateral anterior cerebellar lobe. This study demonstrates the feasibility of evaluating the central processing of acute postoperative pain using PET.
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Affiliation(s)
- Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois 60612, USA.
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Affiliation(s)
- Li Min Chen
- Vanderbilt University, Nashville, Tennessee 37232-2310, USA.
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