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Shraim MA, Massé-Alarie H, Farrell MJ, Cavaleri R, Loggia ML, Hodges PW. Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study. Eur J Pain 2024. [PMID: 39007713 DOI: 10.1002/ejp.2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Chronic pain involves communication between neural and immune systems. Recent data suggest localization of glial (brain immune cells) activation to the sensorimotor regions of the brain cortex (S1/M1) in chronic low back pain (LBP). As glia perform diverse functions that impact neural function, activation might contribute to sensorimotor changes, particularly in LBP maintained by increased nervous system sensitivity (i.e., nociplastic pain). This preliminary proof-of-concept study aimed to: (i) compare evidence of neuroinflammatory activation in S1/M1 between individuals with and without LBP (and between nociceptive and nociplastic LBP phenotypes), and (ii) evaluate relationships between neuroinflammatory activation and sensorimotor function. METHODS Simultaneous PET-fMRI measured neuroinflammatory activation in functionally defined S1/M1 in pain-free individuals (n = 8) and individuals with chronic LBP (n = 9; nociceptive: n = 4, nociplastic: n = 5). Regions of S1/M1 related to the back were identified using fMRI during motor tasks and thermal stimuli. Sensorimotor measures included single and paired-pulse transcranial magnetic stimulation (TMS) and quantitative sensory testing (QST). Sleep, depression, disability and pain questionnaires were administered. RESULTS Neuroinflammatory activation was greater in the lower back cortical representation of S1/M1 of the nociplastic LBP group than both nociceptive LBP and pain-free groups. Neuroinflammatory activation in S1/M1 was positively correlated with sensitivity to hot (r = 0.52) and cold (r = 0.55) pain stimuli, poor sleep, depression, disability and BMI, and negatively correlated with intracortical facilitation (r = -0.41). CONCLUSION This preliminary proof-of-concept study suggests that neuroinflammation in back regions of S1/M1 in individuals with nociplastic LBP could plausibly explain some characteristic features of this LBP phenotype. SIGNIFICANCE STATEMENT Neuroinflammatory activation localized to sensorimotor areas of the brain in individuals with nociplastic pain might contribute to changes in sensory and motor function and aspects of central sensitization. If cause-effect relationships are established in longitudinal studies, this may direct development of therapies that target neuroinflammatory activation.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
- Centre Interdisciplinaire de Recherche en réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Michael J Farrell
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, School of Health Sciences, Sydney, New South Wales, Australia
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul W Hodges
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
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Zhu H, Tao Y, Wang S, Zhu X, Lin K, Zheng N, Chen LM, Xu F, Wu R. fMRI, LFP, and anatomical evidence for hierarchical nociceptive routing pathway between somatosensory and insular cortices. Neuroimage 2024; 289:120549. [PMID: 38382864 DOI: 10.1016/j.neuroimage.2024.120549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
The directional organization of multiple nociceptive regions, particularly within obscure operculoinsular areas, underlying multidimensional pain processing remains elusive. This study aims to establish the fundamental organization between somatosensory and insular cortices in routing nociceptive information. By employing an integrated multimodal approach of high-field fMRI, intracranial electrophysiology, and transsynaptic viral tracing in rats, we observed a hierarchically organized connection of S1/S2 → posterior insula → anterior insula in routing nociceptive information. The directional nociceptive pathway determined by early fMRI responses was consistent with that examined by early evoked LFP, intrinsic effective connectivity, and anatomical projection, suggesting fMRI could provide a valuable facility to discern directional neural circuits in animals and humans non-invasively. Moreover, our knowledge of the nociceptive hierarchical organization of somatosensory and insular cortices and the interface role of the posterior insula may have implications for the development of targeted pain therapies.
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Affiliation(s)
- Hongyan Zhu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Yan Tao
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Siqi Wang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Xutao Zhu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Kunzhang Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Ning Zheng
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science and Department of Psychology, Vanderbilt University, Nashville, TN 37232, USA.
| | - Fuqiang Xu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan 430071, China.
| | - Ruiqi Wu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China; Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai 200031, China.
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3
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Batista NP, de Oliveira Silva D, Mochizuki L, Norte GE, Bazett-Jones DM. Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map. Gait Posture 2024; 109:189-200. [PMID: 38341930 DOI: 10.1016/j.gaitpost.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. RESEARCH QUESTION This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. METHODS We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. RESULTS Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. SIGNIFICANCE Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.
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Affiliation(s)
- Natanael P Batista
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Shulman Y, Finkelstein L, Levi Y, Kovalchuk D, Weksler A, Reichstein A, Kigel-Tsur K, Davidi M, Levi I, Schauder A, Rubin K, Achituv E, Castel D, Meilin S. A Novel Sensory Wave (P25) in Myelin Oligodendrocyte Glycoprotein-induced Experimental Autoimmune Encephalomyelitis Murine Model. THE JOURNAL OF PAIN 2024; 25:73-87. [PMID: 37524220 DOI: 10.1016/j.jpain.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/09/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
Myelin oligodendrocyte glycoprotein (MOG)-induced experimental autoimmune encephalomyelitis (EAE) is a murine model for multiple sclerosis. This model is characterized by chronic and progressive demyelination, leading to impairment of motor function and paralysis. While the outcomes of the disease, including impaired motor function and immunological changes, are well-characterized, little is known about the impact of EAE on the electrophysiology of the motor and sensory systems. In this study, we assessed evoked potentials as a quantitative marker for in vivo monitoring of nervous system damage. Motor-evoked potentials (MEPs) and sensory-evoked potentials (SEPs) were first standardized in naïve C57BL mice and studied thoroughly in EAE mice. The duration of MEPs and the number of connotative potentials increased significantly alongside an increase in temporal SEP amplitudes. Moreover, a new SEP wave was identified in naïve animals, which significantly increased in MOG-induced EAE animals with no or mild symptoms (clinical score 0-2, 0-5 scale). This wave occurred ∼25 milliseconds poststimulation, thus named p25. P25 was correlated with increased vocalization and was also reduced in amplitude following treatment with morphine. As the EAE score progressed (clinical score 3-4, 0-5 scale), the amplitude of MEPs and SEPs decreased drastically. Our results demonstrate that desynchronized neural motor activity, along with hypersensitivity in the early stages of EAE, leads to a complete loss of motor and sensory functions in the late stages of the disease. The findings also suggest an increase in p25 amplitude before motor deficits appear, indicating SEP as a predictive marker for disease progression. PERSPECTIVE: This article assesses p25, a new sensory electrophysiology wave that correlates with pain-related behavior in MOG-induced EAE mice and appears prior to the clinical symptoms. Motor electrophysiology correlates with traditional motor behavior scoring and histology.
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Affiliation(s)
- Yoav Shulman
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Lena Finkelstein
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Yakir Levi
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | | | - Ayelet Weksler
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | | | - Keren Kigel-Tsur
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Mazal Davidi
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Isaac Levi
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Avital Schauder
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Keren Rubin
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - Elhanan Achituv
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
| | - David Castel
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel; The Neufeld Cardiac Research Institute and Department of Physiology and Pharmacology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sigal Meilin
- Neurology Division, MD Biosciences Innovalora, Ltd, Rehovot, Israel
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Shrivastava M, Ye L. Neuroimaging and artificial intelligence for assessment of chronic painful temporomandibular disorders-a comprehensive review. Int J Oral Sci 2023; 15:58. [PMID: 38155153 PMCID: PMC10754947 DOI: 10.1038/s41368-023-00254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic Painful Temporomandibular Disorders (TMD) are challenging to diagnose and manage due to their complexity and lack of understanding of brain mechanism. In the past few decades' neural mechanisms of pain regulation and perception have been clarified by neuroimaging research. Advances in the neuroimaging have bridged the gap between brain activity and the subjective experience of pain. Neuroimaging has also made strides toward separating the neural mechanisms underlying the chronic painful TMD. Recently, Artificial Intelligence (AI) is transforming various sectors by automating tasks that previously required humans' intelligence to complete. AI has started to contribute to the recognition, assessment, and understanding of painful TMD. The application of AI and neuroimaging in understanding the pathophysiology and diagnosis of chronic painful TMD are still in its early stages. The objective of the present review is to identify the contemporary neuroimaging approaches such as structural, functional, and molecular techniques that have been used to investigate the brain of chronic painful TMD individuals. Furthermore, this review guides practitioners on relevant aspects of AI and how AI and neuroimaging methods can revolutionize our understanding on the mechanisms of painful TMD and aid in both diagnosis and management to enhance patient outcomes.
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Affiliation(s)
- Mayank Shrivastava
- Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Liang Ye
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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6
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Mishra A, Yang PF, Manuel TJ, Newton AT, Phipps MA, Luo H, Sigona MK, Reed JL, Gore JC, Grissom WA, Caskey CF, Chen LM. Disrupting nociceptive information processing flow through transcranial focused ultrasound neuromodulation of thalamic nuclei. Brain Stimul 2023; 16:1430-1444. [PMID: 37741439 PMCID: PMC10702144 DOI: 10.1016/j.brs.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND MRI-guided transcranial focused ultrasound (MRgFUS) as a next-generation neuromodulation tool can precisely target and stimulate deep brain regions with high spatial selectivity. Combined with MR-ARFI (acoustic radiation force imaging) and using fMRI BOLD signal as functional readouts, our previous studies have shown that low-intensity FUS can excite or suppress neural activity in the somatosensory cortex. OBJECTIVE To investigate whether low-intensity FUS can suppress nociceptive heat stimulation-induced responses in thalamic nuclei during hand stimulation, and to determine how this suppression influences the information processing flow within nociception networks. FINDINGS BOLD fMRI activations evoked by 47.5 °C heat stimulation of hand were detected in 24 cortical regions, which belong to sensory, affective, and cognitive nociceptive networks. Concurrent delivery of low-intensity FUS pulses (650 kHz, 550 kPa) to the predefined heat nociceptive stimulus-responsive thalamic centromedial_parafascicular (CM_para), mediodorsal (MD), ventral_lateral (VL_ and ventral_lateral_posteroventral (VLpv) nuclei suppressed their heat responses. Off-target cortical areas exhibited reduced, enhanced, or no significant fMRI signal changes, depending on the specific areas. Differentiable thalamocortical information flow during the processing of nociceptive heat input was observed, as indicated by the time to reach 10% or 30% of the heat-evoked BOLD signal peak. Suppression of thalamic heat responses significantly altered nociceptive processing flow and direction between the thalamus and cortical areas. Modulation of contralateral versus ipsilateral areas by unilateral thalamic activity differed. Signals detected in high-order cortical areas, such as dorsal frontal (DFC) and ventrolateral prefrontal (vlPFC) cortices, exhibited faster response latencies than sensory areas. CONCLUSIONS The concurrent delivery of FUS suppressed nociceptive heat response in thalamic nuclei and disrupted the nociceptive network. This study offers new insights into the causal functional connections within the thalamocortical networks and demonstrates the modulatory effects of low-intensity FUS on nociceptive information processing.
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Affiliation(s)
- Arabinda Mishra
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pai-Feng Yang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas J Manuel
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Allen T Newton
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Anthony Phipps
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Huiwen Luo
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Michelle K Sigona
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Jamie L Reed
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - William A Grissom
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Charles F Caskey
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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7
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Smith JA, Ji Y, Lorsung R, Breault MS, Koenig J, Cramer N, Masri R, Keller A. Parabrachial Nucleus Activity in Nociception and Pain in Awake Mice. J Neurosci 2023; 43:5656-5667. [PMID: 37451980 PMCID: PMC10401640 DOI: 10.1523/jneurosci.0587-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
The parabrachial nuclear complex (PBN) is a nexus for aversion and for the sensory and affective components of pain perception. We have previously shown that during chronic pain PBN neurons in anesthetized rodents have amplified activity. We report a method to record from PBN neurons of behaving, head-restrained mice while applying reproducible noxious stimuli. We find that both spontaneous and evoked activity are higher in awake animals compared with urethane anesthetized mice. Fiber photometry of calcium responses from calcitonin-gene-related peptide-expressing PBN neurons demonstrates that these neurons respond to noxious stimuli. In both males and females with neuropathic or inflammatory pain, responses of PBN neurons remain amplified for at least 5 weeks, in parallel with increased pain metrics. We also show that PBN neurons can be rapidly conditioned to respond to innocuous stimuli after pairing with noxious stimuli. Finally, we demonstrate that changes in PBN neuronal activity are correlated with changes in arousal, measured as changes in pupil area.SIGNIFICANCE STATEMENT The parabrachial complex is a nexus of aversion, including pain. We report a method to record from parabrachial nucleus neurons of behaving mice while applying reproducible noxious stimuli. This allowed us to track parabrachial activity over time in animals with neuropathic or inflammatory pain. It also allowed us to show that the activity of these neurons correlates with arousal states and that these neurons can be conditioned to respond to innocuous stimuli.
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Affiliation(s)
- Jesse A Smith
- Program in Neuroscience, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
| | - Yadong Ji
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland 21201-1786
| | - Rebecca Lorsung
- Program in Neuroscience, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
| | - Macauley S Breault
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Jeffrey Koenig
- Program in Molecular Medicine, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
| | - Nathan Cramer
- Program in Neuroscience, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
| | - Radi Masri
- Program in Neuroscience, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland 21201-1786
| | - Asaf Keller
- Program in Neuroscience, Department of Neurobiology, School of Medicine, University of Maryland, Baltimore, Maryland 21201
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8
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Smith JA, Ji Y, Lorsung R, Breault MS, Koenig J, Cramer N, Masri R, Keller A. Sex differences in the role of parabrachial in nociception and pain in awake mice.. [PMID: 36993729 PMCID: PMC10055376 DOI: 10.1101/2023.03.22.533230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
SummaryThe parabrachial nucleus is a nexus for aversion, and for the sensory and affective components of pain. In anesthetized rodents with chronic pain, parabrachial neurons have amplified activity. Both spontaneous and evoked activity are considerably higher in awake, compared to anesthetized animals. Parabrachial neurons are rapidly conditioned to respond to innocuous stimuli, after pairing with nociceptive stimuli. In neuropathic or inflammatory pain, parabrachial responses remain amplified for at least 6 weeks, in parallel with increased pain metrics. Calcium responses from CGRP- expressing parabrachial neurons in males demonstrate responses to nociceptive stimuli, and amplified activity in inflammatory pain. In females these neurons evoke smaller responses at baseline, and only small increases in neuropathic pain. This sex difference may relate to our finding that, in females, a small percentage of neurons expresses CGRP RNA. Finally, we show that changes in parabrachial activity are correlated with in arousal, measured as changes in pupil size.
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9
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Robayo LE, Govind V, Salan T, Cherup NP, Sheriff S, Maudsley AA, Widerström-Noga E. Neurometabolite alterations in traumatic brain injury and associations with chronic pain. Front Neurosci 2023; 17:1125128. [PMID: 36908781 PMCID: PMC9997848 DOI: 10.3389/fnins.2023.1125128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) can lead to a variety of comorbidities, including chronic pain. Although brain tissue metabolite alterations have been extensively examined in several chronic pain populations, it has received less attention in people with TBI. Thus, the primary aim of this study was to compare brain tissue metabolite levels in people with TBI and chronic pain (n = 16), TBI without chronic pain (n = 17), and pain-free healthy controls (n = 31). The metabolite data were obtained from participants using whole-brain proton magnetic resonance spectroscopic imaging (1H-MRSI) at 3 Tesla. The metabolite data included N-acetylaspartate, myo-inositol, total choline, glutamate plus glutamine, and total creatine. Associations between N-acetylaspartate levels and pain severity, neuropathic pain symptom severity, and psychological variables, including anxiety, depression, post-traumatic stress disorder (PTSD), and post-concussive symptoms, were also explored. Our results demonstrate N-acetylaspartate, myo-inositol, total choline, and total creatine alterations in pain-related brain regions such as the frontal region, cingulum, postcentral gyrus, and thalamus in individuals with TBI with and without chronic pain. Additionally, NAA levels in the left and right frontal lobe regions were positively correlated with post-concussive symptoms; and NAA levels within the left frontal region were also positively correlated with neuropathic pain symptom severity, depression, and PTSD symptoms in the TBI with chronic pain group. These results suggest that neuronal integrity or density in the prefrontal cortex, a critical region for nociception and pain modulation, is associated with the severity of neuropathic pain symptoms and psychological comorbidities following TBI. Our data suggest that a combination of neuronal loss or dysfunction and maladaptive neuroplasticity may contribute to the development of persistent pain following TBI, although no causal relationship can be determined based on these data.
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Affiliation(s)
- Linda E Robayo
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Teddy Salan
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Nicholas P Cherup
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Andrew A Maudsley
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States.,Department of Neurological Surgery, University of Miami, Miami, FL, United States
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10
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Triccas LT, Camilleri KP, Tracey C, Mansoureh FH, Benjamin W, Francesca M, Leonardo B, Dante M, Geert V. Reliability of Upper Limb Pin-Prick Stimulation With Electroencephalography: Evoked Potentials, Spectra and Source Localization. Front Hum Neurosci 2022; 16:881291. [PMID: 35937675 PMCID: PMC9351050 DOI: 10.3389/fnhum.2022.881291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
In order for electroencephalography (EEG) with sensory stimuli measures to be used in research and neurological clinical practice, demonstration of reliability is needed. However, this is rarely examined. Here we studied the test-retest reliability of the EEG latency and amplitude of evoked potentials and spectra as well as identifying the sources during pin-prick stimulation. We recorded EEG in 23 healthy older adults who underwent a protocol of pin-prick stimulation on the dominant and non-dominant hand. EEG was recorded in a second session with rest intervals of 1 week. For EEG electrodes Fz, Cz, and Pz peak amplitude, latency and frequency spectra for pin-prick evoked potentials was determined and test-retest reliability was assessed. Substantial reliability ICC scores (0.76-0.79) were identified for evoked potential negative-positive amplitude from the left hand at C4 channel and positive peak latency when stimulating the right hand at Cz channel. Frequency spectra showed consistent increase of low-frequency band activity (< 5 Hz) and also in theta and alpha bands in first 0.25 s. Almost perfect reliability scores were found for activity at both low-frequency and theta bands (ICC scores: 0.81-0.98). Sources were identified in the primary somatosensory and motor cortices in relation to the positive peak using s-LORETA analysis. Measuring the frequency response from the pin-prick evoked potentials may allow the reliable assessment of central somatosensory impairment in the clinical setting.
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Affiliation(s)
- Lisa Tedesco Triccas
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Kenneth P. Camilleri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Camilleri Tracey
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Fahimi Hnazaee Mansoureh
- Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
- The Wellcome Trust Centre for Neuroimaging, University College London Institute of Neurology, London, United Kingdom
| | | | - Muscat Francesca
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Boccuni Leonardo
- Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mantini Dante
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Verheyden Geert
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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11
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Viseux FJF, Simoneau M, Billot M. A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060812. [PMID: 35744075 PMCID: PMC9230450 DOI: 10.3390/medicina58060812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.
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Affiliation(s)
- Frédéric J. F. Viseux
- Centre d’Evaluation et de Traitement de la Douleur (CETD), Hôpital Jean Bernard, Centre Hospitalier de Valenciennes, F-59322 Valenciennes, France
- Département Sciences de l’Homme et du Vivant (SHV), Université Polytechnique Hauts-de-France (UPHF), LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
- Correspondence:
| | - Martin Simoneau
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS) du CIUSSS de la Capitale Nationale, Québec, QC G1M 2S8, Canada
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, F-86000 Poitiers, France;
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12
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Ojala J, Vanhanen J, Harno H, Lioumis P, Vaalto S, Kaunisto MA, Putaala J, Kangasniemi M, Kirveskari E, Mäkelä JP, Kalso E. A Randomized, Sham-Controlled Trial of Repetitive Transcranial Magnetic Stimulation Targeting M1 and S2 in Central Poststroke Pain: A Pilot Trial. Neuromodulation 2022; 25:538-548. [PMID: 35670063 DOI: 10.1111/ner.13496] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Central poststroke pain (CPSP), a neuropathic pain condition, is difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) targeted to the primary motor cortex (M1) can alleviate the condition, but not all patients respond. We aimed to assess a promising alternative rTMS target, the secondary somatosensory cortex (S2), for CPSP treatment. MATERIALS AND METHODS This prospective, randomized, double-blind, sham-controlled three-arm crossover trial assessed navigated rTMS (nrTMS) targeted to M1 and S2 (10 sessions, 5050 pulses per session at 10 Hz). Participants were evaluated for pain, depression, anxiety, health-related quality of life, upper limb function, and three plasticity-related gene polymorphisms including Dopamine D2 Receptor (DRD2). We monitored pain intensity and interference before and during stimulations and at one month. A conditioned pain modulation test was performed using the cold pressor test. This assessed the efficacy of the descending inhibitory system, which may transmit TMS effects in pain control. RESULTS We prescreened 73 patients, screened 29, and included 21, of whom 17 completed the trial. NrTMS targeted to S2 resulted in long-term (from baseline to one-month follow-up) pain intensity reduction of ≥30% in 18% (3/17) of participants. All stimulations showed a short-term effect on pain (17-20% pain relief), with no difference between M1, S2, or sham stimulations, indicating a strong placebo effect. Only nrTMS targeted to S2 resulted in a significant long-term pain intensity reduction (15% pain relief). The cold pressor test reduced CPSP pain intensity significantly (p = 0.001), indicating functioning descending inhibitory controls. The homozygous DRD2 T/T genotype is associated with the M1 stimulation response. CONCLUSIONS S2 is a promising nrTMS target in the treatment of CPSP. The DRD2 T/T genotype might be a biomarker for M1 nrTMS response, but this needs confirmation from a larger study.
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Affiliation(s)
- Juhani Ojala
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jukka Vanhanen
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Harno
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pantelis Lioumis
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Selja Vaalto
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Kangasniemi
- HUS Diagnostic Center, Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erika Kirveskari
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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13
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Basedau H, Peng KP, May A, Mehnert J. High-Density Electroencephalography-Informed Multiband Functional Magnetic Resonance Imaging Reveals Rhythm-Specific Activations Within the Trigeminal Nociceptive Network. Front Neurosci 2022; 16:802239. [PMID: 35651631 PMCID: PMC9149083 DOI: 10.3389/fnins.2022.802239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
The interest in exploring trigeminal pain processing has grown in recent years, mainly due to various pathologies (such as migraine) related to this system. However, research efforts have mainly focused on understanding molecular mechanisms or studying pathological states. On the contrary, non-invasive imaging studies are limited by either spatial or temporal resolution depending on the modality used. This can be overcome by using multimodal imaging techniques such as simultaneous functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Although this technique has already been applied to neuroscientific research areas and consequently gained insights into diverse sensory systems and pathologies, only a few studies have applied EEG-fMRI in the field of pain processing and none in the trigeminal system. Focusing on trigeminal nociception, we used a trigeminal pain paradigm, which has been well-studied in either modality. For validation, we first acquired stand-alone measures with each imaging modality before fusing them in a simultaneous session. Furthermore, we introduced a new, yet simple, non-parametric correlation technique, which exploits trial-to-trial variance of both measurement techniques with Spearman’s correlations, to consolidate the results gained by the two modalities. This new technique does not presume a linear relationship and needs a few repetitions per subject. We also showed cross-validation by analyzing visual stimulations. Using these techniques, we showed that EEG power changes in the theta-band induced by trigeminal pain correlate with fMRI activation within the brainstem, whereas those of gamma-band oscillations correlate with BOLD signals in higher cortical areas.
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14
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Trevarrow MP, Reelfs A, Ott LR, Penhale SH, Lew BJ, Goeller J, Wilson TW, Kurz MJ. Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy. Brain Commun 2022; 4:fcac087. [PMID: 35441137 PMCID: PMC9014448 DOI: 10.1093/braincomms/fcac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/13/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all pFWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.
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Affiliation(s)
- Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brandon J. Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jessica Goeller
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J. Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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15
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Paul K, Tik M, Hahn A, Sladky R, Geissberger N, Wirth EM, Kranz GS, Pfabigan DM, Kraus C, Lanzenberger R, Lamm C, Windischberger C. Give me a pain that I am used to: distinct habituation patterns to painful and non-painful stimulation. Sci Rep 2021; 11:22929. [PMID: 34824311 PMCID: PMC8617189 DOI: 10.1038/s41598-021-01881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/18/2021] [Indexed: 11/08/2022] Open
Abstract
Pain habituation is associated with a decrease of activation in brain areas related to pain perception. However, little is known about the specificity of these decreases to pain, as habituation has also been described for other responses like spinal reflexes and other sensory responses. Thus, it might be hypothesized that previously reported reductions in activation are not specifically related to pain habituation. For this reason, we performed a 3 T fMRI study using either painful or non-painful electrical stimulation via an electrode attached to the back of the left hand. Contrasting painful vs. non-painful stimulation revealed significant activation clusters in regions well-known to be related to pain processing, such as bilateral anterior and posterior insula, primary/secondary sensory cortices (S1/S2) and anterior midcingulate cortex (aMCC). Importantly, our results show distinct habituation patterns for painful (in aMCC) and non-painful (contralateral claustrum) stimulation, while similar habituation for both types of stimulation was identified in bilateral inferior frontal gyrus (IFG) and contralateral S2. Our findings thus distinguish a general habituation in somatosensory processing (S2) and reduced attention (IFG) from specific pain and non-pain related habituation effects where pain-specific habituation effects within the aMCC highlight a change in affective pain perception.
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Affiliation(s)
- Katharina Paul
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Martin Tik
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ronald Sladky
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Nicole Geissberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva-Maria Wirth
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Daniela M Pfabigan
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christoph Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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16
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Ye X, Yang PF, Liu Q, Dillenburger BD, Friedman RM, Chen LM. A thermal nociceptive patch in the S2 cortex of nonhuman primates: a combined functional magnetic resonance imaging and electrophysiology study. Pain 2021; 162:2705-2716. [PMID: 33945242 PMCID: PMC8380756 DOI: 10.1097/j.pain.0000000000002247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Human functional magnetic resonance imaging (fMRI) and behavioral studies have established the roles of cortical areas along the Sylvian fissure in sensing subjective pain. Yet, little is known about how sensory aspects of painful information are represented and processed by neurons in these regions and how their electrophysiological activities are related to fMRI signals. The current study aims to partially address this critical knowledge gap by performing fMRI-guided microelectrode mapping and recording studies in the homologous region of the parietal operculum in squirrel monkeys under light anesthesia. In each animal studied (n = 8), we detected mesoscale mini-networks for heat nociception in cortical regions around the lateral sulcus. Within the network, we discovered a ∼1.5 × 1.5-mm2-sized cortical patch that solely contained heat nociceptive neurons that aligned with the heat fMRI activation locus. These neurons responded slowly to thermal (heat and cold) nociceptive stimuli exclusively, continued firing for several seconds after the succession of stimulation, and exhibited multidigit receptive fields and high spontaneous firing rates. Similar to the fMRI responses, increasing temperatures in the nociceptive range led to a nonlinear increase in firing rates. The finding of a clustering of heat nociceptive neurons provides novel insights into the unique functional organization of thermal nociception in the S2 subregion of the primate brain. With fMRI, it supports the existence of a modality-preferred heat nociceptive patch that is spatially separated and intermingled with touch patches containing neurons with comparable receptive fields and the presence of functionally distinct mini-networks in primate opercular cortex.
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Affiliation(s)
- Xiang Ye
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Pai-Feng Yang
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Qing Liu
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Barbara D Dillenburger
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robert M Friedman
- Department of Psychology, Vanderbilt University, Nashville, TN 37232, USA
| | - Li Min Chen
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Psychology, Vanderbilt University, Nashville, TN 37232, USA
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17
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Martin L, Rosales JH, Jaime K, Ramos F. Affective Episodic Memory System for Virtual Creatures: The First Step of Emotion-Oriented Memory. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:7954140. [PMID: 34721565 PMCID: PMC8550857 DOI: 10.1155/2021/7954140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Episodic memory and emotions are considered essential functions in human cognition. Both allow us to acquire new knowledge from the environment, ranging from the objects around us to how we feel towards them. These qualities make them crucial functions for systems trying to create human-like behaviour. In the field of cognitive architectures (CAs), there are multiple studies covering memory and emotions. However, most of them treat these subjects in an isolated manner, considering emotions only as a reward signal unrelated to a retrieved experience. To address this lack of direct interaction, we propose a computational model that covers the common processes that are related to memory and emotions. Specifically, this proposal focuses on affective evaluations of episodic memories. Neurosciences and psychology are the bases of this model. That is, the model's components and the processes that they carry out on the information they receive are designed based on evidence from these cognitive sciences. The proposed model is a part of Cuáyóllótl, a cognitive architecture for cybernetic entities such as virtual creatures and robots. Case studies validate our proposal. They show the relevance of the integration of emotions and memory in a virtual creature. The virtual creature endowed with our emotional episodic model improves its learning and modifies its behaviour according to planning and decision-making processes.
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Affiliation(s)
- Luis Martin
- Department of Computer Science, Center for Research and Advanced Studies of the National Polytechnic Institute, Zapopan 45019, Mexico
| | - Jonathan H. Rosales
- Faculty of Science and Technology, Autonomous University of Guadalajara, Zapopan 45129, Mexico
| | - Karina Jaime
- Department of Computer Science, Center for Research and Advanced Studies of the National Polytechnic Institute, Zapopan 45019, Mexico
| | - Felix Ramos
- Department of Computer Science, Center for Research and Advanced Studies of the National Polytechnic Institute, Zapopan 45019, Mexico
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18
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Enhanced Temporal Coupling between Thalamus and Dorsolateral Prefrontal Cortex Mediates Chronic Low Back Pain and Depression. Neural Plast 2021; 2021:7498714. [PMID: 34659398 PMCID: PMC8519723 DOI: 10.1155/2021/7498714] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Numerous neuroimaging studies have demonstrated that the brain plasticity is associated with chronic low back pain (cLBP). However, there is a lack of knowledge regarding the underlying mechanisms of thalamic pathways for chronic pain and psychological effects in cLBP caused by lumbar disc herniation (LDH). Combining psychophysics and magnetic resonance imaging (MRI), we investigated the structural and functional brain plasticity in 36 patients with LDH compared with 38 age- and gender-matched healthy controls. We found that (1) LDH patients had increased psychophysical disturbs (i.e., depression and anxiety), and depression (Beck-Depression Inventory, BDI) was found to be an outstanding significant factor to predict chronic pain (short form of the McGill Pain Questionnaire, SF-MPQ); (2) the LDH group showed significantly smaller fractional anisotropy values in the region of posterior corona radiate while gray matter volumes were comparable in both groups; (3) resting state functional connectivity analysis revealed that LDH patients exhibited increased temporal coupling between the thalamus and dorsolateral prefrontal cortex (DLPFC), which further mediate the relationship from chronic pain to depression. Our results emphasized that thalamic pathways underlying prefrontal cortex might play a key role in regulating chronic pain and depression of the pathophysiology of LDH.
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19
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Boezaart AP, Smith CR, Chembrovich S, Zasimovich Y, Server A, Morgan G, Theron A, Booysen K, Reina MA. Visceral versus somatic pain: an educational review of anatomy and clinical implications. Reg Anesth Pain Med 2021; 46:629-636. [PMID: 34145074 DOI: 10.1136/rapm-2020-102084] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
Somatic and visceral nociceptive signals travel via different pathways to reach the spinal cord. Additionally, signals regulating visceral blood flow and gastrointestinal tract (GIT) motility travel via efferent sympathetic nerves. To offer optimal pain relief and increase GIT motility and blood flow, we should interfere with all these pathways. These include the afferent nerves that travel with the sympathetic trunks, the somatic fibers that innervate the abdominal wall and part of the parietal peritoneum, and the sympathetic efferent fibers. All somatic and visceral afferent neural and sympathetic efferent pathways are effectively blocked by appropriately placed segmental thoracic epidural blocks (TEBs), whereas well-placed truncal fascial plane blocks evidently do not consistently block the afferent visceral neural pathways nor the sympathetic efferent nerves. It is generally accepted that it would be beneficial to counter the effects of the stress response on the GIT, therefore most enhanced recovery after surgery protocols involve TEB. The TEB failure rate, however, can be high, enticing practitioners to resort to truncal fascial plane blocks. In this educational article, we discuss the differences between visceral and somatic pain, their management and the clinical implications of these differences.
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Affiliation(s)
- Andre P Boezaart
- Anesthesiology, University of Florida, Gainesville, Florida, USA .,Lumina Pain Medicine Collaborative, Surrey, UK
| | - Cameron R Smith
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | | | - Yury Zasimovich
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Anna Server
- Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Gwen Morgan
- Syncerus Care, George, Western Cape, South Africa
| | - Andre Theron
- Syncerus Care, George, Western Cape, South Africa
| | - Karin Booysen
- Private Anesthesiology Practice, Pretoria, Gauteng, South Africa
| | - Miguel A Reina
- Anesthesiology, University of Florida, Gainesville, Florida, USA.,Department of Anesthesiology, CEU San Pablo University Faculty of Medicine, Alcorcon, Madrid, Spain
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20
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Abstract
BACKGROUND Pain and depression have a high impact on caring for the people who need palliative care, but both of these are neglected compared with the approach for other symptoms encountered by these patients. AREAS OF UNCERTAINTY There are few studies in humans that support the existence of common neural circuits between depression and pain that also explore the use of drugs with effects in both conditions. More knowledge is needed about the relationship of these clinical entities that will lead to the optimization of the treatment and improvement of quality of life. DATA SOURCES We conducted a search in PubMed to identify relevant articles and reviews that have been published in the last 5 years, concerning the topic of common pathways between depression and pain (2014-April 2019). THERAPEUTIC ADVANCES The connections between the 2 clinical entities start at the level of the cortical regions. The hippocampus is the main site of neural changes, modification of the immune system, neuromodulators, neurotransmitters, and signaling pathways implicated in both conditions. Increased levels of peripheral proinflammatory cytokines and neuroinflammatory changes are related to the physiopathology of these entities. Inflammation links depression and pain by altering neural circuits and changes in their common cortical regions. Antidepressants are used to treat depression and chronic, pain but more experimental studies are needed to determine which antidepressant drugs are the most effective in treating the 2 entities. CONCLUSIONS Pharmacological and nonpharmacological interventions targeting cortical changes in pain and depression are promising, but more clinical studies are needed to validate their usefulness.
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21
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Alshami AM, Alrammah TA. Standing and Walking Balance in Patients with Chronic Shoulder Pain: A Case-control Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:152-158. [PMID: 34084106 PMCID: PMC8152385 DOI: 10.4103/sjmms.sjmms_401_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Background: Patients with shoulder pain may have proprioceptive and balance deficits. However, studies on balance in patients with shoulder pain are scarce. Objective: This study aims to investigate if patients with chronic shoulder pain demonstrate deficits in standing and walking balance and to study the relationship between outcome measures of balance and age and body mass index (BMI). Materials and Methods: This case–control study was conducted at Dammam Medical Complex, Dammam, Saudi Arabia, between March and November 2018. The study recruited patients (n = 15) with chronic shoulder pain (>4 months) and healthy controls (n = 15) matched for age, gender and BMI. Standing balance was tested using a Challenge Disc test, the Romberg test and timed unipedal stance test (UPST). Walking balance was assessed using the timed up and go (TUG) test, stance phase duration and center of pressure (COP) deviation. Independent t-tests were used to investigate the differences between the two groups in demographic data and all the outcome measurements. Pearson correlation coefficients were used for correlation analysis. Results: No statistically significant differences were found between the two groups in any outcome of the standing balance (P ≥ 0.095) or walking balance (P ≥ 0.160). However, medium effect sizes were found for the UPST (η2: ≥0.06), Challenge Disc (η2: 0.06), TUG (Cohen's d: 0.54) and COP deviation (Cohen's d: 0.53). There was a moderate correlation between BMI and Challenge Disc (P = 0.025) and between age and Challenge Disc (P = 0.012) in both the groups. Conclusion: Patients with chronic shoulder pain had lower balance measurements compared with healthy people, although this difference was not statistically significant.
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Affiliation(s)
- Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Talal A Alrammah
- Rehabilitation Centre (Building 2), Dammam Medical Complex, Dammam, Saudi Arabia
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22
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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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23
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van der Watt ASJ, Spies G, Roos A, Lesch E, Seedat S. Functional Neuroimaging of Adult-to-Adult Romantic Attachment Separation, Rejection, and Loss: A Systematic Review. J Clin Psychol Med Settings 2021; 28:637-648. [PMID: 33392890 DOI: 10.1007/s10880-020-09757-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Romantic attachment rejection (RAR) is a highly prevalent phenomenon among young adults. Rejection by a romantic attachment figure can be a painful and incapacitating experience with lasting negative mental health sequelae, yet the underlying neurobiology of RAR is not well characterized. We systematically reviewed functional neuroimaging studies of adult RAR. Four functional magnetic resonance imaging (fMRI) studies that measured participants' responses to real or imagined RAR and met inclusion criteria were evaluated. These included studies were published between 2004 and 2018. Brain activity in adult participants with an RAR appears to be influenced by the stimulus used to elicit a reaction as well as by attachment styles. Brain regions that show a significant change in activation following a rejection stimulus include cortical regions (cingulate, insular, orbitofrontal, and prefrontal), and subcortical regions (angular gyrus, hippocampus, striatum, tegmental area, and temporal pole) and correspond to (i) pain, distress, and memory retrieval; (ii) reward, romantic love, and dopaminergic circuits; and (iii) emotion regulation and behavioural adaptation. Further neuroimaging studies of adult RAR, as moderated by stimulus and attachment style, are needed to better understand the underlying neurobiology of RAR.
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Affiliation(s)
- A S J van der Watt
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa.
| | - G Spies
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - A Roos
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - E Lesch
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
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24
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Nielsen SS, Alvarez J, Bicout DJ, Calistri P, Depner K, Drewe JA, Garin-Bastuji B, Gonzales Rojas JL, Schmidt CG, Michel V, Miranda Chueca MÁ, Roberts HC, Sihvonen LH, Spoolder H, Stahl K, Velarde A, Viltrop A, Candiani D, Van der Stede Y, Winckler C. Welfare of cattle at slaughter. EFSA J 2020; 18:e06275. [PMID: 33163113 PMCID: PMC7607414 DOI: 10.2903/j.efsa.2020.6275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The killing of cattle for human consumption (slaughtering) can take place in a slaughterhouse or on farm. The processes of slaughtering that were assessed for welfare, from the arrival of cattle until their death (including slaughtering without stunning), were grouped into three main phases: pre-stunning (including arrival, unloading from the truck, lairage, handling and moving of cattle); stunning (including restraint); and bleeding. Stunning methods were grouped into two categories: mechanical and electrical. Twelve welfare consequences that cattle may be exposed to during slaughter were identified: heat stress, cold stress, fatigue, prolonged thirst, prolonged hunger, impeded movement, restriction of movements, resting problems (inability to rest or discomfort during resting), social stress, pain, fear and distress. Welfare consequences and their relevant animal-based measures are described. In total, 40 welfare hazards that could occur during slaughter were identified and characterised, most of them related to stunning and bleeding. Staff were identified as the origin of 39 hazards, which were attributed to the lack of appropriate skill sets needed to perform tasks or to fatigue. Measures to prevent and correct hazards were identified, and structural and managerial measures were identified as those with a crucial role in prevention. Outcome tables linking hazards, welfare consequences, animal-based measures, origin of hazards, and preventive and corrective measures were developed for each process. Mitigation measures to minimise welfare consequences are proposed.
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25
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Yin Y, He S, Xu J, You W, Li Q, Long J, Luo L, Kemp GJ, Sweeney JA, Li F, Chen S, Gong Q. The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies. J Headache Pain 2020; 21:78. [PMID: 32560622 PMCID: PMC7304152 DOI: 10.1186/s10194-020-01131-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD.
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Affiliation(s)
- Yuanyuan Yin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shushu He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingchen Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wanfang You
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingyi Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lekai Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Song Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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26
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Russo A, Silvestro M, Trojsi F, Bisecco A, De Micco R, Caiazzo G, Di Nardo F, Esposito F, Tessitore A, Tedeschi G. Cognitive Networks Disarrangement in Patients With Migraine Predicts Cutaneous Allodynia. Headache 2020; 60:1228-1243. [DOI: 10.1111/head.13860] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Russo
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
- Institute for Diagnosis and Care “Hermitage‐Capodimonte” Naples Italy
| | - Marcello Silvestro
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Francesca Trojsi
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Alvino Bisecco
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Rosa De Micco
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Giuseppina Caiazzo
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Federica Di Nardo
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana University of Salerno Baronissi Italy
| | - Alessandro Tessitore
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Gioacchino Tedeschi
- Headache Center Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Centre SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
- Institute for Diagnosis and Care “Hermitage‐Capodimonte” Naples Italy
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27
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Volkers R, Giesen E, van der Heiden M, Kerperien M, Lange S, Kurt E, van Dongen R, Schutter D, Vissers KCP, Henssen D. Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data. Neuromodulation 2020; 23:436-443. [PMID: 32030854 PMCID: PMC7317964 DOI: 10.1111/ner.13119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
Objective Invasive motor cortex stimulation (iMCS) has been proposed as a treatment for intractable neuropathic pain syndromes. Although the mechanisms underlying the analgesic effect of iMCS remain largely elusive, several studies found iMCS‐related changes in regional cerebral blood flow (rCBF) in neuropathic pain patients. The aim of this study was to meta‐analyze the findings of neuroimaging studies on rCBF changes to iMCS. Methods PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were systematically searched for retrieval of relevant scientific papers. After initial assessment of relevancy by screening title and abstract by two investigators, independently, predefined inclusion and exclusion criteria were used for final inclusion of papers. Descriptive results were statistically assessed, whereas coordinates were pooled and meta‐analyzed in accordance with the activation likelihood estimation (ALE) methodology. Results Six studies were included in the systematic narrative analysis, suggesting rCBF increases in the cingulate gyrus, thalamus, insula, and putamen after switching the MCS device “ON” as compared to the “OFF” situation. Decreases in rCBF were found in for example the precentral gyrus and different occipital regions. Two studies did not report stereotactic coordinates and were excluded from further analysis. ALE meta‐analysis showed that, after switching the iMCS electrode “ON,” increased rCBF occurred in the (1) anterior cingulate gyrus; (2) putamen; (3) cerebral peduncle; (4) precentral gyrus; (5) superior frontal gyrus; (6) red nucleus; (7) internal part of the globus pallidus; (8) ventral lateral nucleus of the thalamus; (9) medial frontal gyrus; (10) inferior frontal gyrus; and (11) claustrum, as compared to the “OFF” situation. Reductions in rCBF were found in the posterior cingulate gyrus when the iMCS electrode was turned “OFF.” Conclusions These findings suggested that iMCS induces changes in principal components of the default mode‐, the salience‐, and sensorimotor network.
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Affiliation(s)
- Ruben Volkers
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmay Giesen
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maudy van der Heiden
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijke Kerperien
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sibylle Lange
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert van Dongen
- Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis Schutter
- Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Helmholtz Institute, Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain, and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan Henssen
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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28
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Henssen D, Giesen E, van der Heiden M, Kerperien M, Lange S, van Cappellen van Walsum AM, Kurt E, van Dongen R, Schutter D, Vissers K. A systematic review of the proposed mechanisms underpinning pain relief by primary motor cortex stimulation in animals. Neurosci Lett 2020; 719:134489. [DOI: 10.1016/j.neulet.2019.134489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/28/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023]
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29
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Zheng W, Woo CW, Yao Z, Goldstein P, Atlas LY, Roy M, Schmidt L, Krishnan A, Jepma M, Hu B, Wager TD. Pain-Evoked Reorganization in Functional Brain Networks. Cereb Cortex 2019; 30:2804-2822. [PMID: 31813959 DOI: 10.1093/cercor/bhz276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 12/18/2022] Open
Abstract
Recent studies indicate that a significant reorganization of cerebral networks may occur in patients with chronic pain, but how immediate pain experience influences the organization of large-scale functional networks is not yet well characterized. To investigate this question, we used functional magnetic resonance imaging in 106 participants experiencing both noxious and innocuous heat. Painful stimulation caused network-level reorganization of cerebral connectivity that differed substantially from organization during innocuous stimulation and standard resting-state networks. Noxious stimuli increased somatosensory network connectivity with (a) frontoparietal networks involved in context representation, (b) "ventral attention network" regions involved in motivated action selection, and (c) basal ganglia and brainstem regions. This resulted in reduced "small-worldness," modularity (fewer networks), and global network efficiency and in the emergence of an integrated "pain supersystem" (PS) whose activity predicted individual differences in pain sensitivity across 5 participant cohorts. Network hubs were reorganized ("hub disruption") so that more hubs were localized in PS, and there was a shift from "connector" hubs linking disparate networks to "provincial" hubs connecting regions within PS. Our findings suggest that pain reorganizes the network structure of large-scale brain systems. These changes may prioritize responses to painful events and provide nociceptive systems privileged access to central control of cognition and action during pain.
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Affiliation(s)
- Weihao Zheng
- School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, P. R. China.,Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Zhijun Yao
- School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Pavel Goldstein
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO 80309, USA.,Institute of Cognitive Science, University of Colorado, Boulder, CO 80309, USA.,The School of Public Health, University of Haifa, Haifa, 3498838, Israel
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA.,National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.,National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA
| | - Mathieu Roy
- Department of Psychology, McGill University, Montréal, Quebec H3A 0G4, Canada
| | - Liane Schmidt
- Control-Interoception-Attention (CIA) team, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University / CNRS / INSERM, 75013 Paris, France
| | - Anjali Krishnan
- Department of Psychology, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA
| | - Marieke Jepma
- Department of Psychology, University of Amsterdam, Amsterdam, 1018 WS, The Netherlands
| | - Bin Hu
- School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO 80309, USA.,Institute of Cognitive Science, University of Colorado, Boulder, CO 80309, USA.,Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA
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30
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Kul A, Bilen A, Bilge N, Sarıhan K, Uzkeser H, Dayanan R, Baygutalp F. Balance disorders and hypothyroidism: A rare cause worth remembering. ENT UPDATES 2019. [DOI: 10.32448/entupdates.633311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Functional connectivity of the amygdala is linked to individual differences in emotional pain facilitation. Pain 2019; 161:300-307. [DOI: 10.1097/j.pain.0000000000001714] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ahmadian-Moghadam H, Akbarabadi A, Toolee H, Sadat-Shirazi MS, Khalifeh S, Niknamfar S, Zarrindast MR. Correlation among the Behavioral Features in the Offspring of Morphine-Abstinent Rats. ADDICTION & HEALTH 2019; 11:262-275. [PMID: 32206219 PMCID: PMC7073814 DOI: 10.22122/ahj.v11i4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/03/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Critical analysis of new evidence in medical sciences relies on statistics in terms of correlation. The aim of the present study was to evaluate the correlation coefficients among the behavioral features in the offspring of morphine-abstinent parent(s). METHODS The offspring of rats with various parental morphine-exposure were divided into four groups including offspring with healthy parents (CTL), offspring with paternal morphine-abstinent (PMA) parent, offspring with maternal morphine-abstinent (MMA) parent, and offspring with both morphine-abstinent (BMA) parents. Pain perception, depression-like behavior and avoidance-memory in the offspring were quantified. The association between variables was measured using Pearson correlation analysis. FINDINGS A strong correlation was observed between pain and depressive-like behavior in female and male offspring of healthy parents. Moreover, in the male and female offspring of healthy parents and BMA, no significant correlation was observed between avoidance memory and pain behavior or depressive-like behavior. However, in the offspring of MMA, a strong correlation was observed between avoidance memory and depressive-like behavior. CONCLUSION The results revealed that in comparison with the offspring with CTL, the correlation among the behavioral futures in the offspring with MMA or PMA parents is significantly different.
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Affiliation(s)
- Hamid Ahmadian-Moghadam
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Akbarabadi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Heidar Toolee
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Solmaz Khalifeh
- Cognitive and Neuroscience Research Center, Amir Al-Momenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Saba Niknamfar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zarrindast
- Iranian National Center for Addiction Studies AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Ibrahim NM, Abdelhameed KM, Kamal SMM, Khedr EMH, Kotb HIM. Effect of Transcranial Direct Current Stimulation of the Motor Cortex on Visceral Pain in Patients with Hepatocellular Carcinoma. PAIN MEDICINE 2019; 19:550-560. [PMID: 28605527 DOI: 10.1093/pm/pnx087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Hepatocellular carcinoma (HCC) is frequently associated with visceral pain. Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain; however, its effectiveness in malignant visceral pain is unknown. This study aimed to investigate the effects of tDCS in patients with visceral pain due to HCC. Design This is a randomized, sham-controlled, double-blind, prospective study. Forty patients with visceral pain due to HCC were enrolled and randomly assigned into two groups: a real and a sham group; tDCS was applied over the primary motor area (M1) for 10 consecutive days (2 mA, 30 minutes). Patient's pain was evaluated by visual analog scale (VAS) and verbal descriptor scale (VDS) and for depression by Hamilton rating scale (HAM-D). Evaluation was done at prestimulation, after the first, fifth, and 10th sessions, and one month after the end of stimulation sessions. Results Real tDCS showed a reduction of VDS (P = 0.001, F = 4.01) and VAS (P = 0.001, F = 6.817) for HAM-D (P = 0.012, F = 5,077); the effect started from the fifth session and continued to one month after stimulation, while in the sham group the effect persisted for five days only. Percentage reduction in all scales in the real group after the 10th session was as follows: VDS P = 0.008, VAS P = 0.001, HAM-D = 0.001; for one month after the end of stimulation, it was as follows: VDS P = 0.001, VAS P = 0.037, HAM-D = 0.002. Conclusions tDCS proved to be an effective and clinically relevant therapeutic strategy for visceral pain due to HCC.
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Affiliation(s)
- Nagwa Mostafa Ibrahim
- Faculty of Medicine, Anesthesia, Intensive Care and Pain Management, Assiut Universiy, Assiut, Egypt
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Chang WJ, Buscemi V, Liston MB, McAuley JH, Hodges PW, Schabrun SM. Sensorimotor Cortical Activity in Acute Low Back Pain: A Cross-Sectional Study. THE JOURNAL OF PAIN 2019; 20:819-829. [PMID: 30660764 DOI: 10.1016/j.jpain.2019.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Sensorimotor cortical activity is altered in both the immediate acute and chronic stages of musculoskeletal pain. However, these changes are opposite, with decreased cortical activity reported in experimentally induced acute pain (lasting minutes to hours), and increased cortical activity in chronic, clinical pain (lasting >6 months). It is unknown whether sensorimotor cortical activity is altered in acute, clinical musculoskeletal pain (lasting <4 weeks). In 36 individuals with acute, nonspecific, clinical low back pain (LBP) and 36 age- and sex-matched, pain-free controls, we investigated the processing of non-noxious afferent inputs using sensory evoked potentials (SEPs), as well as corticomotor excitability and organization of the primary motor cortex using transcranial magnetic stimulation. Processing of non-noxious sensory inputs was lower (smaller area of the N80-N150-P260 SEP complex) in acute LBP (F1,70 = 45.28, P < .01). The examination of specific SEP components revealed a smaller area of the N150 and P260 SEP components in acute LBP, although interindividual variability was high. Motor cortical map volume was lower in acute LBP (F1,70 = 5.61, P = .02). These findings demonstrate that acute LBP is characterized by lower sensorimotor cortical activity at the group level. However, individual variation was high, suggesting individual adaptation of cortical plasticity in acute pain. PERSPECTIVE: This is the first study to examine sensorimotor cortical activity in the acute stage of clinical LBP. This information is critical for understanding the neurophysiology of acute LBP.
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Affiliation(s)
- Wei-Ju Chang
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Valentina Buscemi
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew B Liston
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, Shepherd's House, King's College London, UK
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia..
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Azevedo-Santos IF, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res 2018; 11:2969-2980. [PMID: 30538536 PMCID: PMC6255280 DOI: 10.2147/jpr.s151169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Procedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional’s routine, and studies have been developed to show the relevance of measuring pain in critically ill patients. Objective This review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published. Method Systematic literature search was performed on PubMed and Google Scholar. Keywords “pain”, “pain measurement”, “intensive care units” and “respiration, artificial” were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review. Results Objective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods. Conclusion This review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals’ knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.
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Affiliation(s)
- Isabela Freire Azevedo-Santos
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
| | - Josimari Melo DeSantana
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
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Lenoir C, Algoet M, Mouraux A. Deep continuous theta burst stimulation of the operculo-insular cortex selectively affects Aδ-fibre heat pain. J Physiol 2018; 596:4767-4787. [PMID: 30085357 PMCID: PMC6166055 DOI: 10.1113/jp276359] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022] Open
Abstract
KEY POINTS Deep continuous theta burst stimulation (cTBS) of the right operculo-insular cortex delivered with a double cone coil selectively impairs the ability to perceive thermonociceptive input conveyed by Aδ-fibre thermonociceptors without concomitantly affecting the ability to perceive innocuous warm, cold or vibrotactile sensations. Unlike deep cTBS, superficial cTBS of the right operculum delivered with a figure-of-eight coil does not affect the ability to perceive thermonociceptive input conveyed by Aδ-fibre thermonociceptors. The effect of deep operculo-insular cTBS on the perception of Aδ-fibre input was present at both the contralateral and the ipsilateral hand. The magnitude of the increase in Aδ-heat detection threshold induced by the deep cTBS was significantly correlated with the intensity of the cTBS pulses. Deep cTBS delivered over the operculo-insular cortex is associated with a risk of transcranial magnetic stimulation-induced seizure. ABSTRACT Previous studies have suggested a pivotal role of the insular cortex in nociception and pain perception. Using a double-cone coil designed for deep transcranial magnetic stimulation, our objective was to assess (1) whether continuous theta burst stimulation (cTBS) of the operculo-insular cortex affects differentially the perception of different types of thermal and mechanical somatosensory inputs, (2) whether the induced after-effects are lateralized relative to the stimulated hemisphere, and (3) whether the after-effects are due to neuromodulation of the insula or neuromodulation of the more superficial opercular cortex. Seventeen participants took part in two experiments. In Experiment 1, thresholds and perceived intensity of Aδ- and C-fibre heat pain elicited by laser stimulation, non-painful cool sensations elicited by contact cold stimulation and mechanical vibrotactile sensations were assessed at the left hand before, immediately after and 20 min after deep cTBS delivered over the right operculo-insular cortex. In Experiment 2, Aδ-fibre heat pain and vibrotactile sensations elicited by stimulating the contralateral and ipsilateral hands were evaluated before and after deep cTBS or superficial cTBS delivered using a flat figure-of-eight coil. Only the threshold to detect Aδ-fibre heat pain was significantly increased 20 min after deep cTBS. This effect was present at both hands. No effect was observed after superficial cTBS. Neuromodulation of the operculo-insular cortex using deep cTBS induces a bilateral reduction of the ability to perceive Aδ-fibre heat pain, without concomitantly affecting the ability to perceive innocuous warm, cold or vibrotactile sensations.
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Affiliation(s)
- Cédric Lenoir
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL)BrusselsBelgium
| | - Maxime Algoet
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL)BrusselsBelgium
| | - André Mouraux
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL)BrusselsBelgium
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Rosenow JM. Anatomy of the Nervous System. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Pain was considered to be integrated subcortically during most of the 20th century, and it was not until 1956 that focal injury to the parietal opercular-insular cortex was shown to produce selective loss of pain senses. The parietal operculum and adjacent posterior insula are the main recipients of spinothalamic afferents in primates. The innermost operculum appears functionally associated with the posterior insula and can be segregated histologically, somatotopically and neurochemically from the more lateral S2 areas. The Posterior Insula and Medial Operculum (PIMO) encompass functional networks essential to initiate cortical nociceptive processing. Destruction of this region selectively abates pain sensations; direct stimulation generates acute pain, and epileptic foci trigger painful seizures. Lesions of the PIMO have also high potential to develop central pain with dissociated loss of pain and temperature. The PIMO region behaves as a somatosensory area on its own, which handles phylogenetically old somesthetic capabilities based on thinly myelinated or unmyelinated inputs. It integrates spinothalamic-driven information - not only nociceptive but also innocuous heat and cold, crude touch, itch, and possibly viscero-somatic interoception. Conversely, proprioception, graphesthesia or stereognosis are not processed in this area but in S1 cortices. Given its anatomo-functional properties, thalamic connections, and tight relations with limbic and multisensory cortices, the region comprising the inner parietal operculum and posterior insula appears to contain a third somatosensory cortex contributing to the spinothalamic attributes of the final perceptual experience.
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Affiliation(s)
- Luis Garcia-Larrea
- NeuroPain Laboratory, Lyon Centre for Neuroscience, Inserm U1028 and University Claude Bernard, Lyon, France; Center for the Evaluation and Treatment of Pain, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.
| | - François Mauguière
- NeuroPain Laboratory, Lyon Centre for Neuroscience, Inserm U1028 and University Claude Bernard, Lyon, France; Functional Neurology Service, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
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Dagsdóttir LK, Bellan V, Skyt I, Vase L, Baad-Hansen L, Castrillon E, Svensson P. Multisensory modulation of experimentally evoked perceptual distortion of the face. J Oral Rehabil 2017; 45:1-8. [PMID: 29054121 DOI: 10.1111/joor.12581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic oro-facial pain patients often perceive the painful face area as "swollen" without clinical signs, that is a perceptual distortion (PD). Local anaesthetic (LA) injections in healthy participants are also associated with PD. OBJECTIVE The aim was to explore whether PD evoked by LA into the infraorbital region could be modulated by adding mechanical stimulation (MS) to the affected area. METHODS Mechanical stimulation was given with a brush and a 128-mN von Frey filament. Firstly, sixty healthy participants were randomly divided into three groups: (i) LA control, (ii) LA with MS, (iii) isotonic solution (ISO) with MS as an additional control condition. To further examine the role of a multisensory modulation, an additional experiment was conducted. Twenty participants received LA with MS (filament) in addition to visual feedback of their distorted face. The results of the two experiments are presented together. RESULTS All three LA groups experienced PD; per contra, PD was not reported in the ISO group. MS alone did not change the magnitude of PD: brush (P = .089), filament (P = .203). However, when the filament stimulation was combined with additional visual information of a distorted face, there was observable decrease in PD (P = .002). CONCLUSION The findings indicate the importance of multisensory integration for PD and represent a significant step forward in the understanding of the factors that may influence this common condition. Future studies are encouraged to investigate further the cortical processing for possible implications for PD in pain management.
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Affiliation(s)
- L K Dagsdóttir
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - V Bellan
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - I Skyt
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - L Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - L Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - E Castrillon
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
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Wu R, Wang F, Yang PF, Chen LM. High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain. Neuroimage 2017; 155:147-158. [PMID: 28461059 DOI: 10.1016/j.neuroimage.2017.04.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/21/2023] Open
Abstract
Numerous functional imaging and electrophysiological studies in humans and animals indicate that the two contiguous areas of secondary somatosensory cortex (S2) and posterior insula (pIns) are core regions in nociceptive processing and pain perception. In this study, we tested the hypothesis that the S2-pIns connection serves as a hub for connecting distinct sensory and affective nociceptive processing networks in the squirrel monkey brain. At 9.4T, we first mapped the brain regions that respond to nociceptive heat stimuli with high-resolution fMRI, and then used seed-based resting-state fMRI (rsfMRI) analysis to delineate and refine the global intrinsic functional connectivity circuits of the proximal S2 and pIns regions. In each subject, nociceptive (47.5°C) heat-evoked fMRI activations were detected in many brain regions, including primary somatosensory (S1), S2, pIns, area 7b, anterior cingulate cortex (ACC), primary motor cortex, prefrontal cortex, supplementary motor area, thalamus, and caudate. Using the heat-evoked fMRI activation foci in S2 and pIns as the seeds, voxel-wise whole-brain resting-state functional connectivity (rsFC) analysis revealed strong functional connections between contralateral S2 and pIns, as well as their corresponding regions in the ipsilateral hemisphere. Spatial similarity and overlap analysis identified each region as part of two distinct intrinsic functional networks with 7% overlap: sensory S2-S1-area 7b and affective pIns-ACC-PCC networks. Moreover, a high degree of overlap was observed between the combined rsFC maps of nociceptive S2 and pIns regions and the nociceptive heat-evoked activation map. In summary, our study provides evidence for the existence of two distinct intrinsic functional networks for S2 and pIns nociceptive regions, and these two networks are joined via the S2-pIns connection. Brain regions that are involved in processing nociceptive inputs are also highly interconnected at rest. The presence of robust and distinct S1-S2-area 7b and pIns-ACC-PCC rsFC networks under anesthesia underscores their fundamental roles in processing nociceptive information.
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Affiliation(s)
- Ruiqi Wu
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States; Wuhan Institute of Physics and Mathematics, The Chinese Academy of Sciences/State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan 430071, China
| | - Feng Wang
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Pai-Feng Yang
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Li Min Chen
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States; Department of Psychology, Vanderbilt University, Nashville, TN 37232, United States.
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Brosey EA, Woodward ND. Neuroanatomical correlates of perceptual aberrations in psychosis. Schizophr Res 2017; 179:125-131. [PMID: 27729190 DOI: 10.1016/j.schres.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Aberrations in body perception are common in psychotic disorders. The insula and temporoparietal junction (TPJ) are involved in body ownership and spatial perception suggesting that abnormal structure of these regions might be related to the expression of perceptual aberrations in psychosis. METHODS 58 individuals with a primary psychotic disorder and 40 healthy subjects completed the Chapman Perceptual Aberration Scale (PAS) and underwent structural magnetic resonance imaging (MRI). Grey matter volume was extracted from a-priori defined TPJ, whole insula, and insula sub-division regions-of-interest (ROIs) and correlated with PAS scores. Additionally, a voxel-based morphometry (VBM) analysis examining the correlation between voxel-wise grey matter volume and PAS scores was conducted. RESULTS PAS scores in psychosis patients correlated with bilateral whole insula (right: r=-0.30, p=0.026; left: r=-0.35, p=0.011) and right TPJ (r=-0.27, p=0.024) volumes. The correlation between grey matter volume and PAS was strongest for the posterior sub-division of the insula (right: r=-0.32, p=0.017; left: r=-0.37, p=0.006). VBM analyses confirmed the ROI results: negative correlations with PAS were identified in clusters within the posterior and dorsal anterior insula, and the right TPJ. An exploratory, whole-brain analysis also revealed two additional regions located in the left middle orbitofrontal gyrus and left inferior temporal gyrus that inversely correlated with PAS scores. CONCLUSIONS Perceptual aberrations in individuals with psychosis are related to lower grey matter volume in the insula and TPJ. This relationship was strongest in the posterior region of the insula and right TPJ; brain areas that have been implicated in interoception and somesthesis.
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Affiliation(s)
- Erin A Brosey
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN 37212, USA
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
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Opioid subtype- and cell-type-dependent regulation of inhibitory synaptic transmission in the rat insular cortex. Neuroscience 2016; 339:478-490. [DOI: 10.1016/j.neuroscience.2016.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/13/2016] [Accepted: 10/02/2016] [Indexed: 12/22/2022]
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Abstract
Pain can be modulated by contextual stimuli, such as emotions, social factors, or specific bodily perceptions. We presented painful laser stimuli together with body-related masochistic visual stimuli to persons with and without preferred masochistic sexual behavior and used neutral, positive, and negative pictures with and without painful stimuli as control. Masochists reported substantially reduced pain intensity and unpleasantness in the masochistic context compared with controls but had unaltered pain perception in the other conditions. Functional magnetic resonance imaging revealed that masochists activated brain areas involved in sensory-discriminative processing rather than affective pain processing when they received painful stimuli on a masochistic background. The masochists compared with the controls displayed attenuated functional connectivity of the parietal operculum with the left and right insulae, the central operculum, and the supramarginal gyrus. Masochists additionally showed negative correlations between the duration of interest in masochistic activities and activation of areas involved in motor activity and affective processing. We propose that the parietal operculum serves as an important relay station that attenuates the affective-motivational aspects of pain in masochists. This novel mechanism of pain modulation might be related to multisensory integration and has important implications for the assessment and treatment of pain.
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Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial. Pain 2016; 157:429-437. [PMID: 26469395 DOI: 10.1097/j.pain.0000000000000386] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory bowel disease (IBD) is frequently associated with chronic abdominal pain (CAP). Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain. This study aimed to investigate the effects of tDCS in patients with CAP due to IBD. This randomized, sham-controlled, double blind, parallel-designed study included 20 patients with either Crohn disease or ulcerative colitis with CAP (≥3/10 on the visual analog scale (VAS) in 3/6 months). Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days (2 mA, 20 minutes). Assessments included VAS, pressure pain threshold, inflammatory markers, and questionnaires on quality of life, functional and disease specific symptoms (Irritable Bowel Syndrome-Severity Scoring System [IBS-SSS]), disease activity, and pain catastrophizing. Follow-up data were collected 1 week after the end of the stimulation. Statistical analyses were performed using analysis of variance and t tests. There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS. This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen. In addition, 1 week after stimulation, pain reduction remained significantly decreased in the right side of the abdomen. There was also a significant reduction in scores on pain catastrophizing and on IBS-SSS when comparing both groups. Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment. Transcranial direct current stimulation proved to be an effective and clinically relevant therapeutic strategy for CAP in IBD. The analgesic effects observed are unrelated to inflammation and disease activity, which emphasizes central pain mechanisms in CAP.
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Knothe C, Oertel BG, Ultsch A, Kettner M, Schmidt PH, Wunder C, Toennes SW, Geisslinger G, Lötsch J. Pharmacoepigenetics of the role of DNA methylation in μ-opioid receptor expression in different human brain regions. Epigenomics 2016; 8:1583-1599. [PMID: 27685027 DOI: 10.2217/epi-2016-0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM Exposure to opioids has been associated with epigenetic effects. Studies in rodents suggested a role of varying degrees of DNA methylation in the differential regulation of μ-opioid receptor expression across the brain. METHODS In a translational investigation, using tissue acquired postmortem from 21 brain regions of former opiate addicts, representing a human cohort with chronic opioid exposure, μ-opioid receptor expression was analyzed at the level of DNA methylation, mRNA and protein. RESULTS & CONCLUSION While high or low μ-opioid receptor expression significantly correlated with local OPRM1 mRNA levels, there was no corresponding association with OPRM1 methylation status. Additional experiments in human cell lines showed that changes in DNA methylation associated with changes in μ-opioid expression were an order of magnitude greater than differences in brain. Hence, different degrees of DNA methylation associated with chronic opioid exposure are unlikely to exert a major role in the region-specificity of μ-opioid receptor expression in the human brain.
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Affiliation(s)
- Claudia Knothe
- Institute of Clinical Pharmacology, Goethe - University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bruno G Oertel
- Fraunhofer Institute for Molecular Biology & Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Alfred Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße, 35032 Marburg, Germany
| | - Mattias Kettner
- Institute of Legal Medicine, Goethe - University, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - Peter Harald Schmidt
- Institute of Legal Medicine, Saarland University, Building 80.2, 66421, Homburg, Saar, Germany
| | - Cora Wunder
- Institute of Legal Medicine, Goethe - University, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - Stefan W Toennes
- Institute of Legal Medicine, Goethe - University, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe - University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Fraunhofer Institute for Molecular Biology & Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe - University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Fraunhofer Institute for Molecular Biology & Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Taylor AM, Harris AD, Varnava A, Phillips R, Hughes O, Wilkes AR, Hall JE, Wise RG. Neural responses to a modified Stroop paradigm in patients with complex chronic musculoskeletal pain compared to matched controls: an experimental functional magnetic resonance imaging study. BMC Psychol 2016; 4:5. [PMID: 26833066 PMCID: PMC4736129 DOI: 10.1186/s40359-016-0109-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 01/28/2016] [Indexed: 12/25/2022] Open
Abstract
Background Chronic musculoskeletal pain (CMSKP) is attentionally demanding, complex and multi-factorial; neuroimaging research in the population seen in pain clinics is sparse. A better understanding of the neural activity underlying attentional processes to pain related information compared to healthy controls may help inform diagnosis and management in the future. Methods Blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) compared brain responses in patients with CMSKP (n = 15) and healthy controls (n = 14) while completing a modified Stroop task using pain-related, positive-emotional, and neutral control words. Results Response times in the Stroop task were no different for CMSKP patients compared with controls, but patients were less accurate in their responses to all word types. BOLD fMRI responses during presentation of pain-related words suggested increases in neural activation in patients compared to controls in regions previously reported as being involved in pain perception and emotion: the anterior cingulate cortex, insula and primary and secondary somatosensory cortex. No fMRI differences were seen between groups in response to positive or control words. Conclusions Using this modified Stroop tasks, specific differences were identified in brain activity between CMSKP patients and controls in response to pain-related information using fMRI. This provided evidence of differences in the way that pain-related information is processed in those with chronic complex musculoskeletal pain that were not detectable using the behavioural measures of speed and accuracy. The study may be helpful in gaining new insights into the impact of attention in those living with chronic pain.
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Affiliation(s)
- Ann M Taylor
- Department of Anaesthetics, Intensive Care and Pain Medicine, Institute of Infection and Immunity, Cardiff University, Cardiff, CF14 4XN, Wales, UK.
| | - Ashley D Harris
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF10 3AT, Wales, UK.,Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA.,F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alice Varnava
- Department of Psychology, Swansea University, Singleton Park, Swansea, SA2 8PP, Wales, UK.,School of Psychology, Cardiff University, Cardiff, CF10 3AT, Wales, UK
| | - Rhiannon Phillips
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, CF14 4YS, Wales, UK
| | - Owen Hughes
- Bronllys Pain and Fatigue Management Centre, Powys, Brecon, LD3 0 LU, Wales, UK
| | - Antony R Wilkes
- Department of Anaesthetics, Intensive Care and Pain Medicine, Institute of Infection and Immunity, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Judith E Hall
- Department of Anaesthetics, Intensive Care and Pain Medicine, Institute of Infection and Immunity, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF10 3AT, Wales, UK
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Zanatta P, Linassi F, Mazzarolo AP, Aricò M, Bosco E, Bendini M, Sorbara C, Ori C, Carron M, Scarpa B. Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:403. [PMID: 26573633 PMCID: PMC4647335 DOI: 10.1186/s13054-015-1119-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/28/2015] [Indexed: 11/23/2022]
Abstract
Introduction Early prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome. Methods No- and low-flow times, pupillary reflex, Glasgow motor score and biochemical data were evaluated at ICU admission. The following were considered within 72 h of cardiac arrest: highest creatinine value, hyperthermia occurrence, EEG, SSEP at low- (10 mA) and high-intensity (50 mA) stimulation, and blood pressure reactivity to 50 mA. Intensive care treatments were also considered. Data were compared to survival, consciousness recovery and 6-month CPC (Cerebral Performance Category). Results Pupillary reflex and EEG were statistically significant in predicting survival; the absence of blood pressure reactivity seems to predict brain death within 7 days of cardiac arrest. Middle- and short-latency SSEP were statistically significant in predicting consciousness recovery, and middle-latency SSEP was statistically significant in predicting 6-month CPC outcome. The prognostic capability of 50 mA middle-latency-SSEP was demonstrated to occur earlier than that of EEG reactivity. Conclusions Neurophysiological evaluation constitutes the key to early information about the neurological prognostication of postanoxic coma. In particular, the presence of 50 mA middle-latency SSEP seems to be an early and reliable predictor of good neurological outcome, and its absence constitutes a marker of poor prognosis. Moreover, the absence 50 mA blood pressure reactivity seems to identify patients evolving towards the brain death.
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Affiliation(s)
- Paolo Zanatta
- Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy.
| | - Federico Linassi
- Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy.
| | - Anna Paola Mazzarolo
- Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy.
| | - Maria Aricò
- Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy.
| | - Enrico Bosco
- Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy.
| | - Matteo Bendini
- Unit of Neuroradiology, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy.
| | - Carlo Sorbara
- Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy.
| | - Carlo Ori
- Department of Anesthesia and Intensive Care, Padova University Hospital, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy.
| | - Michele Carron
- Department of Anesthesia and Intensive Care, Padova University Hospital, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy.
| | - Bruno Scarpa
- Department of Statistical Sciences, Padova University, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy.
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