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Ekhtiari H, Zare-Bidoky M, Sangchooli A, Valyan A, Abi-Dargham A, Cannon DM, Carter CS, Garavan H, George TP, Ghobadi-Azbari P, Juchem C, Krystal JH, Nichols TE, Öngür D, Pernet CR, Poldrack RA, Thompson PM, Paulus MP. Reporting checklists in neuroimaging: promoting transparency, replicability, and reproducibility. Neuropsychopharmacology 2024:10.1038/s41386-024-01973-5. [PMID: 39242922 DOI: 10.1038/s41386-024-01973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/09/2024]
Abstract
Neuroimaging plays a crucial role in understanding brain structure and function, but the lack of transparency, reproducibility, and reliability of findings is a significant obstacle for the field. To address these challenges, there are ongoing efforts to develop reporting checklists for neuroimaging studies to improve the reporting of fundamental aspects of study design and execution. In this review, we first define what we mean by a neuroimaging reporting checklist and then discuss how a reporting checklist can be developed and implemented. We consider the core values that should inform checklist design, including transparency, repeatability, data sharing, diversity, and supporting innovations. We then share experiences with currently available neuroimaging checklists. We review the motivation for creating checklists and whether checklists achieve their intended objectives, before proposing a development cycle for neuroimaging reporting checklists and describing each implementation step. We emphasize the importance of reporting checklists in enhancing the quality of data repositories and consortia, how they can support education and best practices, and how emerging computational methods, like artificial intelligence, can help checklist development and adherence. We also highlight the role that funding agencies and global collaborations can play in supporting the adoption of neuroimaging reporting checklists. We hope this review will encourage better adherence to available checklists and promote the development of new ones, and ultimately increase the quality, transparency, and reproducibility of neuroimaging research.
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Affiliation(s)
- Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
- Laureate Institute for Brain Research, Tulsa, OK, USA.
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arshiya Sangchooli
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alireza Valyan
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
- Department of Psychiatry, Columbia University Vagelos School of Medicine and New York State Psychiatric Institute, New York, NY, USA
| | - Dara M Cannon
- Clinical Neuroimaging Laboratory, Center for Neuroimaging, Cognition & Genomics, College of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland
| | - Cameron S Carter
- Department of Psychiatry and Human Behavior, University of California at Irvine, Irvine, CA, USA
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, USA
| | - Tony P George
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Peyman Ghobadi-Azbari
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University Fu Foundation, School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Thomas E Nichols
- Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Dost Öngür
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cyril R Pernet
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
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2
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Lemos MD, Barbosa LM, Andrade DCD, Lucato LT. Contributions of neuroimaging in central poststroke pain: a review. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-11. [PMID: 39216489 DOI: 10.1055/s-0044-1789225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Central neuropathic poststroke pain (CNPSP) affects up to 12% of patients with stroke in general and up to 18% of patients with sensory deficits. This pain syndrome is often incapacitating and refractory to treatment. Brain computed tomography and magnetic resonance imaging (MRI) are widely used methods in the evaluation of CNPSP. OBJECTIVE The present study aims to review the role of neuroimaging methods in CNPSP. METHODS We performed a literature review of the main clinical aspects of CNPSP and the contribution of neuroimaging methods to study its pathophysiology, commonly damaged brain sites, and possible differential diagnoses. Lastly, we briefly mention how neuroimaging can contribute to the non-pharmacological CNPSP treatment. Additionally, we used a series of MRI from our institution to illustrate this review. RESULTS Imaging has been used to explain CNPSP pathogenesis based on spinothalamic pathway damage and connectome dysfunction. Imaging locations associated with CNPSP include the brainstem (mainly the dorsolateral medulla), thalamus (especially the ventral posterolateral/ventral posteromedial nuclei), cortical areas such as the posterior insula and the parietal operculum, and, more recently, the thalamocortical white matter in the posterior limb of the internal capsule. Imaging also brings the prospect of helping search for new targets for non-pharmacological treatments for CNPSP. Other neuropathic pain causes identified by imaging include syringomyelia, multiple sclerosis, and herniated intervertebral disc. CONCLUSION Imaging is a valuable tool in the complimentary evaluation of CNPSP patients in clinical and research scenarios.
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Affiliation(s)
- Marcelo Delboni Lemos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo SP, Brazil
| | - Luciana Mendonça Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Leandro Tavares Lucato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo SP, Brazil
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3
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Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2024; 49:581-601. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [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: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
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Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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4
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Gozzi N, Preatoni G, Ciotti F, Hubli M, Schweinhardt P, Curt A, Raspopovic S. Unraveling the physiological and psychosocial signatures of pain by machine learning. MED 2024:S2666-6340(24)00298-8. [PMID: 39116869 DOI: 10.1016/j.medj.2024.07.016] [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: 02/23/2024] [Revised: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pain is a complex subjective experience, strongly impacting health and quality of life. Despite many attempts to find effective solutions, present treatments are generic, often unsuccessful, and present significant side effects. Designing individualized therapies requires understanding of multidimensional pain experience, considering physical and emotional aspects. Current clinical pain assessments, relying on subjective one-dimensional numeric self-reports, fail to capture this complexity. METHODS To this aim, we exploited machine learning to disentangle physiological and psychosocial components shaping the pain experience. Clinical, psychosocial, and physiological data were collected from 118 chronic pain and healthy participants undergoing 40 pain trials (4,697 trials). FINDINGS To understand the objective response to nociception, we classified pain from the physiological signals (accuracy >0.87), extracting the most important biomarkers. Then, using multilevel mixed-effects models, we predicted the reported pain, quantifying the mismatch between subjective level and measured physiological response. From these models, we introduced two metrics: TIP (subjective index of pain) and Φ (physiological index). These represent possible added value in the clinical process, capturing psychosocial and physiological pain dimensions, respectively. Patients with high TIP are characterized by frequent sick leave from work and increased clinical depression and anxiety, factors associated with long-term disability and poor recovery, and are indicated for alternative treatments, such as psychological ones. By contrast, patients with high Φ show strong nociceptive pain components and could benefit more from pharmacotherapy. CONCLUSIONS TIP and Φ, explaining the multidimensionality of pain, might provide a new tool potentially leading to targeted treatments, thereby reducing the costs of inefficient generic therapies. FUNDING RESC-PainSense, SNSF-MOVE-IT197271.
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Affiliation(s)
- Noemi Gozzi
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Federico Ciotti
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria.
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5
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Clarke S, Rogers R, Wanigasekera V, Fardo F, Pia H, Nochi Z, Macian N, Leray V, Finnerup NB, Pickering G, Mouraux A, Truini A, Treede RD, Garcia-Larrea L, Tracey I. Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization. Eur J Pain 2024; 28:1069-1094. [PMID: 38381488 DOI: 10.1002/ejp.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Functional magnetic resonance imaging, in conjunction with models of peripheral and/or central sensitization, has been used to assess analgesic efficacy in healthy humans. This review aims to summarize the use of these techniques to characterize brain mechanisms of hyperalgesia/allodynia and to evaluate the efficacy of analgesics. DATABASES AND DATA TREATMENT Searches were performed (PubMed-Medline, Cochrane, Web of Science and Clinicaltrials.gov) to identify and review studies. A co-ordinate based meta-analysis (CBMA) was conducted to quantify neural activity that was reported across multiple independent studies in the hyperalgesic condition compared to control, using GingerALE software. RESULTS Of 217 publications, 30 studies met the inclusion criteria. They studied nine different models of hyperalgesia/allodynia assessed in the primary (14) or secondary hyperalgesia zone (16). Twenty-three studies focused on neural correlates of hyperalgesic conditions and showed consistent changes in the somatosensory cortex, prefrontal cortices, insular cortex, anterior cingulate cortex, thalamus and brainstem. The CBMA on 12 studies that reported activation coordinates for a contrast comparing the hyperalgesic state to control produced six activation clusters (significant at false discovery rate of 0.05) with more peaks for secondary (17.7) than primary zones (7.3). Seven studies showed modulation of brain activity by analgesics in five of the clusters but also in four additional regions. CONCLUSIONS This meta-analysis revealed substantial but incomplete overlap between brain areas related to neural mechanisms of hyperalgesia and those reflecting the efficacy of analgesic drugs. Studies testing in the secondary zone were more sensitive to evaluate analgesic efficacy on central sensitization at brainstem or thalamocortical levels. SIGNIFICANCE Experimental pain models that provide a surrogate for features of pathological pain conditions in healthy humans and functional imaging techniques are both highly valuable research tools. This review shows that when used together, they provide a wealth of information about brain activity during pain states and analgesia. These tools are promising candidates to help bridge the gap between animal and human studies, to improve translatability and provide opportunities for identification of new targets for back-translation to animal studies.
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Affiliation(s)
- Sophie Clarke
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Richard Rogers
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Vishvarani Wanigasekera
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Francesca Fardo
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Hossein Pia
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Zahra Nochi
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Nicolas Macian
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Leray
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Nanna Brix Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Gisèle Pickering
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
- Inserm 1107, University Clermont Auvergne, Clermont-Ferrand, France
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Luis Garcia-Larrea
- NeuroPain Lab, Lyon Centre for Neuroscience Inserm U1028 and University Claude Bernard, Lyon, France
- Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
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Chen Y, Shen P, He Y, Zeng D, Li Y, Zhang Y, Chen M, Liu C. Bibliometric analysis of functional magnetic resonance imaging studies on chronic pain over the past 20 years. Acta Neurochir (Wien) 2024; 166:307. [PMID: 39060813 DOI: 10.1007/s00701-024-06204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE The utilization of functional magnetic resonance imaging (fMRI) in studying the mechanisms and treatment of chronic pain has gained significant popularity. However, there is currently a dearth of literature conducting bibliometric analysis on fMRI studies focused on chronic pain. METHODS All the literature included in this study was obtained from the Science Citation Index Expanded of Web of Science Core Collection. We used CiteSpace and VOSviewer to analyze publications, authors, countries or regions, institutions, journals, references and keywords. Additionally, we evaluated the timeline and burst analysis of keywords, as well as the timeline and burst analysis of references. The search was conducted from 2004 to 2023 and completed within a single day on October 4th, 2023. RESULTS A total of 1,327 articles were retrieved. The annual publication shows an overall increasing trend. The United States has the highest number of publications and the main contributing institution is Harvard University. The journal PAIN produces the most articles. In recent years, resting-state fMRI, the prefrontal cortex, nucleus accumbens, thalamus, and migraines have been researched hotspots of fMRI studies on chronic pain. CONCLUSIONS This study provides an in-depth perspective on fMRI for chronic pain research, revealing key points, research hotspots and research trends, which offers valuable ideas for future research activities. It concludes with a summary of advances in clinical practice in this area, pointing out the need for critical evaluation of these findings in the light of guidelines and expert recommendations. It is anticipated that further high-quality research outputs will be generated in the future, which will facilitate the utilization of fMRI in clinical decision-making for chronic pain.
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Affiliation(s)
- Yiming Chen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peifeng Shen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanan He
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Deyi Zeng
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), 688 West Yushan Road Shatou Street, Panyu District, Guangzhou, China
| | - Yuanchao Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuting Zhang
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengtong Chen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunlong Liu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Meng L, Zheng X, Xie K, Li Y, Liu D, Xu Y, Zhang J, Wu F, Guo G. Hyperexcitation of the glutamatergic neurons in lateral hypothalamus induced by chronic pain contributes to depression-like behavior and learning and memory impairment in male mice. Neurobiol Stress 2024; 31:100654. [PMID: 38948390 PMCID: PMC11214532 DOI: 10.1016/j.ynstr.2024.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Chronic pain can induce mood disorders and cognitive dysfunctions, such as anxiety, depression, and learning and memory impairment in humans. However, the specific neural network involved in anxiety- and depression-like behaviors and learning and memory impairment caused by chronic pain remains poorly understood. In this study, behavioral test results showed that chronic pain induced anxiety- and depression-like behaviors, and learning and memory impairment in male mice. c-Fos immunofluorescence and fiber photometry recording showed that glutamatergic neurons in the LH of mice with chronic pain were selectively activated. Next, the glutamatergic neurons of LH in normal mice were activated using optogenetic and chemogenetic methods, which recapitulates some of the depressive-like behaviors, as well as memory impairment, but not anxiety-like behavior. Finally, inhibition of glutamatergic neurons in the LH of mice with chronic pain, effectively relieved anxiety- and depression-like behaviors and learning and memory impairment. Taken together, our findings suggest that hyperexcitation of glutamatergic neurons in the LH is involved in depression-like behavior and learning and memory impairment induced by chronic pain.
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Affiliation(s)
| | | | - Keman Xie
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Yifei Li
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Danlei Liu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Yuanyuan Xu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Jifeng Zhang
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Fengming Wu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
| | - Guoqing Guo
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou, 510630, China
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Viellard J, Bouali-Benazzouz R, Benazzouz A, Fossat P. Modulating Neural Circuits of Pain in Preclinical Models: Recent Insights for Future Therapeutics. Cells 2024; 13:997. [PMID: 38920628 PMCID: PMC11202162 DOI: 10.3390/cells13120997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Chronic pain is a pathological state defined as daily pain sensation over three consecutive months. It affects up to 30% of the general population. Although significant research efforts have been made in the past 30 years, only a few and relatively low effective molecules have emerged to treat chronic pain, with a considerable translational failure rate. Most preclinical models have focused on sensory neurotransmission, with particular emphasis on the dorsal horn of the spinal cord as the first relay of nociceptive information. Beyond impaired nociceptive transmission, chronic pain is also accompanied by numerous comorbidities, such as anxiety-depressive disorders, anhedonia and motor and cognitive deficits gathered under the term "pain matrix". The emergence of cutting-edge techniques assessing specific neuronal circuits allow in-depth studies of the connections between "pain matrix" circuits and behavioural outputs. Pain behaviours are assessed not only by reflex-induced responses but also by various or more complex behaviours in order to obtain the most complete picture of an animal's pain state. This review summarises the latest findings on pain modulation by brain component of the pain matrix and proposes new opportunities to unravel the mechanisms of chronic pain.
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Affiliation(s)
- Juliette Viellard
- Université de Bordeaux, UMR 5293, F-33076 Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
| | - Rabia Bouali-Benazzouz
- Université de Bordeaux, UMR 5293, F-33076 Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
| | - Abdelhamid Benazzouz
- Université de Bordeaux, UMR 5293, F-33076 Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
| | - Pascal Fossat
- Université de Bordeaux, UMR 5293, F-33076 Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
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9
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Barakat A, Munro G, Heegaard AM. Finding new analgesics: Computational pharmacology faces drug discovery challenges. Biochem Pharmacol 2024; 222:116091. [PMID: 38412924 DOI: 10.1016/j.bcp.2024.116091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/10/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
Despite the worldwide prevalence and huge burden of pain, pain is an undertreated phenomenon. Currently used analgesics have several limitations regarding their efficacy and safety. The discovery of analgesics possessing a novel mechanism of action has faced multiple challenges, including a limited understanding of biological processes underpinning pain and analgesia and poor animal-to-human translation. Computational pharmacology is currently employed to face these challenges. In this review, we discuss the theory, methods, and applications of computational pharmacology in pain research. Computational pharmacology encompasses a wide variety of theoretical concepts and practical methodological approaches, with the overall aim of gaining biological insight through data acquisition and analysis. Data are acquired from patients or animal models with pain or analgesic treatment, at different levels of biological organization (molecular, cellular, physiological, and behavioral). Distinct methodological algorithms can then be used to analyze and integrate data. This helps to facilitate the identification of biological molecules and processes associated with pain phenotype, build quantitative models of pain signaling, and extract translatable features between humans and animals. However, computational pharmacology has several limitations, and its predictions can provide false positive and negative findings. Therefore, computational predictions are required to be validated experimentally before drawing solid conclusions. In this review, we discuss several case study examples of combining and integrating computational tools with experimental pain research tools to meet drug discovery challenges.
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Affiliation(s)
- Ahmed Barakat
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
| | | | - Anne-Marie Heegaard
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bhatt RR, Haddad E, Zhu AH, Thompson PM, Gupta A, Mayer EA, Jahanshad N. Mapping Brain Structure Variability in Chronic Pain: The Role of Widespreadness and Pain Type and Its Mediating Relationship With Suicide Attempt. Biol Psychiatry 2024; 95:473-481. [PMID: 37543299 PMCID: PMC10838358 DOI: 10.1016/j.biopsych.2023.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Chronic pain affects nearly 20% of the U.S. POPULATION It is a leading cause of disability globally and is associated with a heightened risk for suicide. The role of the central nervous system in the perception and maintenance of chronic pain has recently been accepted, but specific brain circuitries involved have yet to be mapped across pain types in a large-scale study. METHODS We used data from the UK Biobank (N = 21,968) to investigate brain structural alterations in individuals reporting chronic pain compared with pain-free control participants and their mediating effect on history of suicide attempt. RESULTS Chronic pain and, more notably, chronic multisite pain was associated with, on average, lower surface area throughout the cortex after adjusting for demographic, clinical, and neuropsychiatric confounds. Only participants with abdominal pain showed lower subcortical volumes, including the amygdala and brainstem, and lower cerebellum volumes. Participants with chronic headaches showed a widespread thicker cortex compared with control participants. Mediation analyses revealed that precuneus thickness mediated the relationship of chronic multisite pain and history of suicide attempt. Mediating effects were also identified specific to localized pain, with the strongest effect being amygdala volume in individuals with chronic abdominal pain. CONCLUSIONS Results support a widespread effect of chronic pain on brain structure and distinct brain structures underlying chronic musculoskeletal pain, visceral pain, and headaches. Mediation effects of regions in the extended ventromedial prefrontal cortex subsystem suggest that exacerbated negative internal states, negative self-referencing, and impairments in future planning may underlie suicidal behaviors in individuals with chronic pain.
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Affiliation(s)
- Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
| | - Elizabeth Haddad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Arpana Gupta
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
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11
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Kaptan M, Pfyffer D, Konstantopoulos CG, Law CS, Weber II KA, Glover GH, Mackey S. Recent developments and future avenues for human corticospinal neuroimaging. Front Hum Neurosci 2024; 18:1339881. [PMID: 38332933 PMCID: PMC10850311 DOI: 10.3389/fnhum.2024.1339881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Non-invasive neuroimaging serves as a valuable tool for investigating the mechanisms within the central nervous system (CNS) related to somatosensory and motor processing, emotions, memory, cognition, and other functions. Despite the extensive use of brain imaging, spinal cord imaging has received relatively less attention, regardless of its potential to study peripheral communications with the brain and the descending corticospinal systems. To comprehensively understand the neural mechanisms underlying human sensory and motor functions, particularly in pathological conditions, simultaneous examination of neuronal activity in both the brain and spinal cord becomes imperative. Although technically demanding in terms of data acquisition and analysis, a growing but limited number of studies have successfully utilized specialized acquisition protocols for corticospinal imaging. These studies have effectively assessed sensorimotor, autonomic, and interneuronal signaling within the spinal cord, revealing interactions with cortical processes in the brain. In this mini-review, we aim to examine the expanding body of literature that employs cutting-edge corticospinal imaging to investigate the flow of sensorimotor information between the brain and spinal cord. Additionally, we will provide a concise overview of recent advancements in functional magnetic resonance imaging (fMRI) techniques. Furthermore, we will discuss potential future perspectives aimed at enhancing our comprehension of large-scale neuronal networks in the CNS and their disruptions in clinical disorders. This collective knowledge will aid in refining combined corticospinal fMRI methodologies, leading to the development of clinically relevant biomarkers for conditions affecting sensorimotor processing in the CNS.
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Affiliation(s)
- Merve Kaptan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dario Pfyffer
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christiane G. Konstantopoulos
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christine S.W. Law
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kenneth A. Weber II
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gary H. Glover
- Radiological Sciences Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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12
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Gunsilius CZ, Heffner J, Bruinsma S, Corinha M, Cortinez M, Dalton H, Duong E, Lu J, Omar A, Owen LLW, Roarr BN, Tang K, Petzschner FH. SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment. JMIR Mhealth Uhealth 2024; 12:e47177. [PMID: 38214952 PMCID: PMC10818247 DOI: 10.2196/47177] [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: 03/13/2023] [Revised: 10/03/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users' self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain.
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Affiliation(s)
- Chloe Zimmerman Gunsilius
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, RI, United States
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Joseph Heffner
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
| | - Sienna Bruinsma
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Madison Corinha
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Maria Cortinez
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Hadley Dalton
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Ellen Duong
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Joshua Lu
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Aisulu Omar
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Lucy Long Whittington Owen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Bradford Nazario Roarr
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Kevin Tang
- Industrial Design, Rhode Island School of Design, Providence, RI, United States
| | - Frederike H Petzschner
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
- Center for Digital Health, Brown University, Lifespan, Providence, RI, United States
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13
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Liaghat A, Konsman JP. Methodological advice for the young at heart investigator: Triangulation to build better foundations. Brain Behav Immun 2024; 115:737-746. [PMID: 37972881 DOI: 10.1016/j.bbi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
In medicine and science, one is typically taught the main theories in a discipline or field along with standard models before receiving more instructions on how to apply certain methods. The aim of this work is not to address one method, but rather methodology, the study and evaluation of methods, by taking a philosophy of science detour. In this, a critique of biomedicine will be used as a starting point to address some positions regarding reductionism, specifying notions such as systems and mechanisms, as well as regarding the mind-body problem discussing psychosomatic medicine and psychoneuroimmunology. Some recommendations to make science more pluralistic, robust and translationally-relevant will then be made as a way to foster constructive debates on reductionism and the mind-body problem and, in turn, favor more interdisciplinary research.
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Affiliation(s)
- Amirreza Liaghat
- IMMUNOlogy from CONcepts and ExPeriments to Translation, CNRS UMR 5164, University of Bordeaux, 33076 Bordeaux, France
| | - Jan Pieter Konsman
- IMMUNOlogy from CONcepts and ExPeriments to Translation, CNRS UMR 5164, University of Bordeaux, 33076 Bordeaux, France.
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14
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Zhu J, Gu R, Shi L, Su Y. Altered intrinsic brain activity in patients with neuropathic pain after brachial plexus avulsion. Brain Res Bull 2024; 206:110831. [PMID: 38056510 DOI: 10.1016/j.brainresbull.2023.110831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE This study aimed to investigate brain activity changes in patients suffering from neuropathic pain (NP) following brachial plexus avulsion (BPA). METHODS Fifteen patients with NP following BPA and eight healthy participants (HP) were recruited for this study. All participants underwent examination using resting-state functional MRI. The amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) were calculated and compared between the BPA group, left-BPA subgroup, right-BPA subgroup, and the HP group using independent samples t-tests. RESULTS In the BPA group, there were notable increases in ALFF/ReHo observed in the left rolandic operculum, insula, and supramarginal gyrus, while decreases were observed in the left paracentral lobule, fusiform gyrus, calcarine fissure and surrounding cortex, lingual gyrus, precuneus, as well as the bilateral anterior/median cingulate and paracingulate gyri, supplementary motor area, and cerebellum. In the left-BPA subgroup, elevated ALFF/ReHo levels were identified in the left middle/inferior frontal gyri, rolandic operculum, and supramarginal gyrus, with corresponding decreases in the left calcarine fissure and surrounding cortex, inferior occipital gyrus, fusiform gyrus, lingual gyrus, as well as the bilateral anterior/median cingulate and paracingulate gyri, postcentral gyri, supplementary motor area, paracentral lobules, and cerebellum. The right-BPA subgroup displayed increased ALFF/ReHo in the left frontal lobe, rolandic operculum, insula, fusiform gyrus, and lingual gyrus, as well as the right cerebellum. Conversely, decreases in ALFF/ReHo were observed in the bilateral anterior/median cingulate and paracingulate gyri, calcarine fissure and surrounding cortex, cuneus, and occipital lobes. CONCLUSIONS The NP after BPA caused spontaneous activity changes in brain regions associated with linguistic, visual, somatosensory, and motor coordination and processing function. The majority of these abnormal areas were situated in the left cerebral hemisphere, while the effect of cingulate gyri and cerebellum seemed to be bilateral.
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Affiliation(s)
- Jin Zhu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Rui Gu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
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15
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Leng J, Zhu J, Yan Y, Yu X, Liu M, Lou Y, Liu Y, Gao L, Sun Y, He T, Yang Q, Feng C, Wang D, Zhang Y, Xu Q, Xu F. Multilevel Laser-Induced Pain Measurement with Wasserstein Generative Adversarial Network - Gradient Penalty Model. Int J Neural Syst 2024; 34:2350067. [PMID: 38149912 DOI: 10.1142/s0129065723500673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Pain is an experience of unpleasant sensations and emotions associated with actual or potential tissue damage. In the global context, billions of people are affected by pain disorders. There are particular challenges in the measurement and assessment of pain, and the commonly used pain measuring tools include traditional subjective scoring methods and biomarker-based measures. The main tools for biomarker-based analysis are electroencephalography (EEG), electrocardiography and functional magnetic resonance. The EEG-based quantitative pain measurements are of immense value in clinical pain management and can provide objective assessments of pain intensity. The assessment of pain is now primarily limited to the identification of the presence or absence of pain, with less research on multilevel pain. High power laser stimulation pain experimental paradigm and five pain level classification methods based on EEG data augmentation are presented. First, the EEG features are extracted using modified S-transform, and the time-frequency information of the features is retained. Based on the pain recognition effect, the 20-40[Formula: see text]Hz frequency band features are optimized. Afterwards the Wasserstein generative adversarial network with gradient penalty is used for feature data augmentation. It can be inferred from the good classification performance of features in the parietal region of the brain that the sensory function of the parietal lobe region is effectively activated during the occurrence of pain. By comparing the latest data augmentation methods and classification algorithms, the proposed method has significant advantages for the five-level pain dataset. This research provides new ways of thinking and research methods related to pain recognition, which is essential for the study of neural mechanisms and regulatory mechanisms of pain.
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Affiliation(s)
- Jiancai Leng
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Jianqun Zhu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Yihao Yan
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Xin Yu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Ming Liu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Yitai Lou
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Yanbing Liu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Licai Gao
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Yuan Sun
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Tianzheng He
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Qingbo Yang
- School of Mathematics and Statistics, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Chao Feng
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
| | - Dezheng Wang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan 250012, P. R. China
| | - Yang Zhang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan 250012, P. R. China
| | - Qing Xu
- Shandong Institute of Scientific and Technical Information, Jinan 250101, P. R. China
| | - Fangzhou Xu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, P. R. China
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16
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Sommer C, Rittner H. Pain research in 2023: towards understanding chronic pain. Lancet Neurol 2024; 23:27-28. [PMID: 38101893 DOI: 10.1016/s1474-4422(23)00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Claudia Sommer
- Department of Neurology, University Hospital Würzburg, 97080 Würzburg, Germany; Clinical Research Group Resolve PAIN, University Hospital Würzburg, 97080 Würzburg, Germany.
| | - Heike Rittner
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Würzburg, 97080 Würzburg, Germany; Clinical Research Group Resolve PAIN, University Hospital Würzburg, 97080 Würzburg, Germany
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17
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Rosner J, de Andrade DC, Davis KD, Gustin SM, Kramer JLK, Seal RP, Finnerup NB. Central neuropathic pain. Nat Rev Dis Primers 2023; 9:73. [PMID: 38129427 PMCID: PMC11329872 DOI: 10.1038/s41572-023-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.
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Affiliation(s)
- Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - John L K Kramer
- International Collaboration on Repair Discoveries, ICORD, University of British Columbia, Vancouver, Canada
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca P Seal
- Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Departments of Neurobiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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18
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Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [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: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
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Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
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19
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Basbaum AI, Jensen TS, Keefe FJ. Fifty years of pain research and clinical advances: highlights and key trends. Pain 2023; 164:S11-S15. [PMID: 37831954 PMCID: PMC10787538 DOI: 10.1097/j.pain.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 10/15/2023]
Abstract
ABSTRACT This article highlights advances in basic science preclinical pain research, clinical research, and psychological research occurring over the 50 years since the International Association for the Study of Pain was founded. It presents important findings and key trends in these 3 areas of pain science: basic science preclinical research, clinical research, and psychological research.
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Affiliation(s)
- Allan I. Basbaum
- Department of Anatomy, University California San Francisco, San Francisco, CA USA 94158
| | - Troels. S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hosital, DK, 8200 Aarhus N, Denmark
| | - Francis J. Keefe
- Duke Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27705
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20
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Flor H, Noguchi K, Treede RD, Turk DC. The role of evolving concepts and new technologies and approaches in advancing pain research, management, and education since the establishment of the International Association for the Study of Pain. Pain 2023; 164:S16-S21. [PMID: 37831955 DOI: 10.1097/j.pain.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 10/15/2023]
Abstract
ABSTRACT The decades since the inauguration of the International Association for the Study of Pain have witnessed major advances in scientific concepts (such as the biopsychosocial model and chronic primary pain as a disease in its own right) and in new technologies and approaches (from molecular biology to brain imaging) that have inspired innovations in pain research. These have guided progress in pain management and education about pain for healthcare professionals, the general public, and administrative agencies.
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Affiliation(s)
- Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Koichi Noguchi
- Laboratory of Pain Mechanism Research, Hyogo Medical University, Hyogo, Japan
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
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21
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Chen Y, Yang Y, Gong Z, Kang Y, Zhang Y, Chen H, Zeng K, Men X, Wang J, Huang Y, Wang H, Zhan S, Tan W, Wang W. Altered effective connectivity from cerebellum to motor cortex in chronic low back pain: A multivariate pattern analysis and spectral dynamic causal modeling study. Brain Res Bull 2023; 204:110794. [PMID: 37871687 DOI: 10.1016/j.brainresbull.2023.110794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
To explore the central processing mechanism of pain perception in chronic low back pain (cLBP) using multi-voxel pattern analysis (MVPA) based on the static and dynamic fractional amplitude of low-frequency fluctuations (fALFF) analysis, and spectral dynamic causal modeling (spDCM). Thirty-two patients with cLBP and 29 matched healthy controls (HCs) for the first cohort and 24 patients with cLBP and 22 HCs for the validation cohort underwent resting-state fMRI scan. The alterations in static and dynamic fALFF were as classification features to distinguish patients with cLBP from HCs. The brain regions gotten from the MVPA results were used for further spDCM analysis. We found that the most discriminative brain regions that contributed to the classification were the right supplementary motor area (SMA.R), left paracentral lobule (PCL.L), and bilateral cerebellar Crus II. The spDCM results displayed decreased excitatory influence from the bilateral cerebellar Crus II to PCL.L in patients with cLBP compared with HCs. Moreover, the conversion of effective connectivity from the bilateral cerebellar Crus II to SMA.R from excitatory influence to inhibitive influence, and the effective connectivity strength exhibited partially mediated effects on Chinese Short Form Oswestry Disability Index Questionnaire (C-SFODI) scores. Our findings suggest that the cerebellum and its weakened or inhibited connections to the motor cortex may be one of the underlying feedback pathways for pain perception in cLBP, and partially mediate the degree of dysfunction.
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Affiliation(s)
- Yilei Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuchan Yang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhigang Gong
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingjie Kang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zeng
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiubo Men
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianwei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanwen Huang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenli Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Wei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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22
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Li J, Tian C, Yuan S, Yin Z, Wei L, Chen F, Dong X, Liu A, Wang Z, Wu T, Tian C, Niu L, Wang L, Wang P, Xie W, Cao F, Shen H. Neuropathic pain following spinal cord hemisection induced by the reorganization in primary somatosensory cortex and regulated by neuronal activity of lateral parabrachial nucleus. CNS Neurosci Ther 2023; 29:3269-3289. [PMID: 37170721 PMCID: PMC10580357 DOI: 10.1111/cns.14258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
AIMS Neuropathic pain after spinal cord injury (SCI) remains a common and thorny problem, influencing the life quality severely. This study aimed to elucidate the reorganization of the primary sensory cortex (S1) and the regulatory mechanism of the lateral parabrachial nucleus (lPBN) in the presence of allodynia or hyperalgesia after left spinal cord hemisection injury (LHS). METHODS Through behavioral tests, we first identified mechanical allodynia and thermal hyperalgesia following LHS. We then applied two-photon microscopy to observe calcium activity in S1 during mechanical or thermal stimulation and long-term spontaneous calcium activity after LHS. By slice patch clamp recording, the electrophysiological characteristics of neurons in lPBN were explored. Finally, exploiting chemogenetic activation or inhibition of the neurons in lPBN, allodynia or hyperalgesia was regulated. RESULTS The calcium activity in left S1 was increased during mechanical stimulation of right hind limb and thermal stimulation of tail, whereas in right S1 it was increased only with thermal stimulation of tail. The spontaneous calcium activity in right S1 changed more dramatically than that in left S1 after LHS. The lPBN was also activated after LHS, and exploiting chemogenetic activation or inhibition of the neurons in lPBN could induce or alleviate allodynia and hyperalgesia in central neuropathic pain. CONCLUSION The neuronal activity changes in S1 are closely related to limb pain, which has accurate anatomical correspondence. After LHS, the spontaneously increased functional connectivity of calcium transient in left S1 is likely causing the mechanical allodynia in right hind limb and increased neuronal activity in bilateral S1 may induce thermal hyperalgesia in tail. This state of allodynia and hyperalgesia can be regulated by lPBN.
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Affiliation(s)
- Jing Li
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Chao Tian
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Shiyang Yuan
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Zhenyu Yin
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Liangpeng Wei
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Feng Chen
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Xi Dong
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Aili Liu
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
| | - Zhenhuan Wang
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Tongrui Wu
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Chunxiao Tian
- School of Biomedical EngineeringTianjin Medical UniversityTianjinChina
| | - Lin Niu
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
| | - Lei Wang
- Department of PhysiologyZhuhai Campus of Zunyi Medical UniversityZhuhaiChina
| | - Pu Wang
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Wanyu Xie
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Fujiang Cao
- Department of OrthopedicsTianjin Medical University General HospitalTianjinChina
| | - Hui Shen
- Department of Cellular Biology, School of Basic ScienceTianjin Medical UniversityTianjinChina
- Innovation Research Institute of Traditional Chinese MedicineShandong University of Traditional Chinese MedicineJinanChina
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23
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Hector MS, Cheng JC, Hemington KS, Rogachov A, Kim JA, Osborne NR, Bosma RL, Fauchon C, Ayoub LJ, Inman R, Oh J, Anastakis DJ, Davis KD. Resilience is associated with cortical gray matter of the antinociceptive pathway in people with chronic pain. Biol Psychol 2023; 183:108658. [PMID: 37567549 DOI: 10.1016/j.biopsycho.2023.108658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
Resilience is an important personal characteristic that influences health and recovery. Previous studies of chronic pain suggest that highly resilient people may be more effective at modulating their pain. Since brain gray matter in the antinociceptive pathway has also been shown to be abnormal in people with chronic pain, we examined whether resilience is related to gray matter in regions of interest (ROIs) of the antinociceptive pathway (rostral and subgenual anterior cingulate cortex (rACC, sgACC), anterior insula (aINS), dorsolateral prefrontal cortex (dlPFC)) normally and in people who are experiencing chronic pain. We extracted gray matter volume (GMV) and cortical thickness (CT) from 3T MRIs of 88 people with chronic pain (half males/females) and 86 healthy controls (HCs), who completed The Resilience Scale and Brief Pain Inventory. We found that resilience scores were significantly lower in people with chronic pain compared to HCs, whereas ROI GMV and CT were not different between groups. Resilience negatively correlated with average pain scores and positively correlated with GMV in the bilateral rACC, sgACC, and left dlPFC of people with chronic pain. Mediation analyses revealed that GMV in the right rACC and left sgACC partially co-mediated the relationship between resilience and average pain in people with chronic pain. The resilience-pain and some resilience-GMV relationships were sex-dependent. These findings suggest that the antinociceptive pathway may play a role in the impact of resilience on one's ability to modulate chronic pain. A better understanding of the brain-resilience relationship may help advance evidence-based approaches to pain management.
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Affiliation(s)
- Melinda S Hector
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua C Cheng
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kasey S Hemington
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anton Rogachov
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Junseok A Kim
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Natalie R Osborne
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rachael L Bosma
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Camille Fauchon
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Lizbeth J Ayoub
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; Division of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Robert Inman
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Division of Immunology, University of Toronto, Toronto, ON, Canada
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Dimitri J Anastakis
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Karen D Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
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24
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Neogi T, Colloca L. Placebo effects in osteoarthritis: implications for treatment and drug development. Nat Rev Rheumatol 2023; 19:613-626. [PMID: 37697077 PMCID: PMC10615856 DOI: 10.1038/s41584-023-01021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/13/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting ~500 million people, yet there are no effective treatments to halt its progression. Without any structure-modifying agents, management of OA focuses on ameliorating pain and improving function. Treatment approaches typically have modest efficacy, and many patients have contraindications to recommended pharmacological treatments. Drug development for OA is hindered by the gradual and progressive nature of the disease and the targeting of established disease in clinical trials. Additionally, new medications for OA cannot receive regulatory approval without demonstrating improvements in both structure (pathological features of OA) and symptoms (reduced pain and/or improved function). In clinical trials, people with OA show high 'placebo responses', which hamper the ability to identify new effective treatments. Placebo responses refer to the individual variability in response to placebos given in the context of clinical trials and other settings. Placebo effects refer specifically to short-lasting improvements in symptoms that occur because of physiological changes. To mitigate the effects of the placebo phenomenon, we must first understand what it is, how it manifests, how to identify placebo responders in OA trials and how these insights can be used to improve clinical trials in OA. Leveraging placebo responses and effects in clinical practice might provide additional avenues to augment symptom management of OA.
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Affiliation(s)
- Tuhina Neogi
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Luana Colloca
- Department of Pain and Translation Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA.
- Placebo Beyond Opinions Center, School of Nursing, University of Maryland, Baltimore, MD, USA.
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25
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Cao X, Jiao B, Wen D, Duan G, Zhang M, Zhang C, Wu G, Zhang X. Evaluation of the correlation of dorsal root ganglia and spinal nerves with clinical symptoms in patients with postherpetic neuralgia using magnetic resonance neurography. PeerJ 2023; 11:e15998. [PMID: 37667753 PMCID: PMC10475274 DOI: 10.7717/peerj.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
Purpose To assess changes of dorsal root ganglia (DRG) and spinal nerves in patients with postherpetic neuralgia (PHN), and investigate the correlation between DRG morphology and clinical symptoms in PHN patients using magnetic resonance neurography (MRN). Methods In this case-control study, forty-nine lesioned DRG in 30 patients and 49 normal DRG in 30 well-matched (age, sex, height, weight) healthy controls were assessed. Clinical symptoms of patients (pain, allodynia, itching, and numbness) were assessed. MRN features (DRG volume (VDRG), the largest diameter (Dmax) of spinal nerves, signal intensity of DRG and spinal nerves (M-value)) were measured in all participants. Multilinear regression analysis was used to evaluate the relationship between the DRG morphology and clinical symptoms in patients. Results The volume and relative M-value of lesioned DRG in patients were significantly higher than those on the same side of healthy controls (p = 0.013, p < 0.001, respectively). The mean Dmax and relative M-value of spinal nerves on the lesioned side were significantly higher than those on the contralateral and same side of healthy controls (p < 0.0001, p = 0.0001, p = 0.0011, p = 0.0053, respectively). No difference was found between the mean VDRG of the lesioned and contralateral sides. Multiple linear regression analysis revealed that disease duration was independent risk factor for the maximum rate of VDRG differences (p = 0.013). Conclusions DRG and spinal nerves on the lesioned side are swollen during PHN. Disease duration is an independent risk factor for morphological differences in the lesioned DRG of PHN patients. This study provides important guidance for individualized treatments of PHN.
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Affiliation(s)
- Xueqin Cao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Jiao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Donglin Wen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Wuhan, Hubei, China
| | - Mi Zhang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Caixia Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gang Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianwei Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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26
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Zhi HW, Jia YZ, Bo HQ, Li HT, Zhang SS, Wang YH, Yang J, Hu MZ, Wu HY, Cui WQ, Xu XD. Curcumin alleviates orofacial allodynia and improves cognitive impairment via regulating hippocampal synaptic plasticity in a mouse model of trigeminal neuralgia. Aging (Albany NY) 2023; 15:8458-8470. [PMID: 37632838 PMCID: PMC10496987 DOI: 10.18632/aging.204984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/24/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Cognitive impairment, one of the most prevalent complications of trigeminal neuralgia, is troubling for patients and clinicians due to limited therapeutic options. Curcumin shows antinociception and neuroprotection pharmacologically, suggesting that it may have therapeutic effect on this complication. This study aimed to investigate whether curcumin alleviates orofacial allodynia and improves cognitive impairment by regulating hippocampal CA1 region synaptic plasticity in trigeminal neuralgia. METHODS A mouse model of trigeminal neuralgia was established by partially transecting the infraorbital nerve (pT-ION). Curcumin was administered by gavage twice daily for 14 days. Nociceptive thresholds were measured using the von Frey and acetone test, and the cognitive functions were evaluated using the Morris water maze test. Dendritic spines and synaptic ultrastructures in the hippocampal CA1 area were observed by Golgi staining and transmission electron microscopy. RESULTS Curcumin intervention increased the mechanical and cold pain thresholds of models. It decreased the escape latency and distance to the platform and increased the number of platform crossings and dwell time in the target quadrant of models, and improved spatial learning and memory deficits. Furthermore, it partially restored the disorder of the density and proportion of dendritic spines and the abnormal density and structure of synapses in the hippocampal CA1 region of models. CONCLUSION Curcumin alleviates abnormal orofacial pain and cognitive impairment in pT-ION mice by a mechanism that may be related to the synaptic plasticity of hippocampal CA1, suggesting that curcumin is a potential strategy for repairing cognitive dysfunction under long-term neuropathic pain conditions.
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Affiliation(s)
- Hong-Wei Zhi
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Yu-Zhi Jia
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Huai-Qian Bo
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hai-Tao Li
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Si-Shuo Zhang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Ya-Han Wang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Jie Yang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Ming-Zhe Hu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hong-Yun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Wen-Qiang Cui
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Xiang-Dong Xu
- Experimental Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
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27
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Hucho T. [Lipedema pain-the neglected symptom]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:575-579. [PMID: 37438647 DOI: 10.1007/s00105-023-05189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
Pain, which is a central characteristic of lipedema, allows differentiation from other fat tissue diseases. The analysis of the multiple aspects of pain beyond a quantification of pain scale scores could make molecular disease and therapy mechanisms accessible. Lipedema pain is causally linked to lipedema fat. First robust data show peripheral sensory changes. Tissue weight and systemic inflammation are becoming less likely as causes for the experianced pain. Furthermore, genetics and hormonal influences need to be investigated. Lipedema pain cannot currently be treated with drugs. Physical therapy shows transient relief. Liposuction has been shown to have a long-term effect on pain. The potential of modulating the perception of pain with psychotherapeutic approaches is emerging as a potentially effective new therapeutic approach.
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Affiliation(s)
- Tim Hucho
- Translationale Schmerzforschung, Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln (AöR), Universität zu Köln, Joseph-Stelzmann Str. 9, Geb. 35, 50931, Köln, Deutschland.
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28
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Das D, Choy E. Non-inflammatory pain in inflammatory arthritis. Rheumatology (Oxford) 2023; 62:2360-2365. [PMID: 36478185 PMCID: PMC10321089 DOI: 10.1093/rheumatology/keac671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
'Non-inflammatory' pain, pain that is not associated with measures of inflammation, is common in patients with inflammatory arthritis including RA. One important cause of non-inflammatory pain is concomitant fibromyalgia. Systematic review has shown that fibromyalgia is common in inflammatory arthritis including RA affecting 1 in 5 patients and is associated with higher disease activity scores due to inflated tender joint count and patient global assessment. Consequently, many patients with RA and concomitant fibromyalgia may fail to reach treatment target and switch to alternate disease modifying drugs frequently. European Alliance of Association for Rheumatology has highlighted that concomitant fibromyalgia is an important consideration in assessing difficult-to-treat RA. The incidence and prevalence of fibromyalgia are higher in RA than the general population, raising the possibility that fibromyalgia may be 'secondary' to RA rather than a concomitant disease. The precise mechanisms whereby patients with RA develop fibromyalgia are unknown. In this review, we discussed fibromyalgia in RA, its clinical impact and epidemiology as well as data suggesting fibromyalgia might be 'secondary'. Lastly, we reviewed potential pathogenic mechanisms which included inflammatory cytokines sensitizing nociceptive neurones, temporal summation, also known as windup, from chronic pain and impaired coping from poor quality sleep and mental well-being. Deciphering the exact mechanisms may lead to treatment strategies that prevent development of secondary fibromyalgia and will address a common factor associated with difficult-to-treat RA.
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Affiliation(s)
- Dhivya Das
- Consultant Rheumatologist, Northern Care Alliance NHS Foundation Trust, University School of Medicine (Formerly with Cardiff), Cardiff, UK
| | - Ernest Choy
- Correspondence to: Ernest Choy, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Tenovus Building, Heath Park Campus, Cardiff CF14 4XN, UK. E-mail:
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29
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Hranilovich JA, Legget KT, Dodd KC, Wylie KP, Tregellas JR. Functional magnetic resonance imaging of headache: Issues, best-practices, and new directions, a narrative review. Headache 2023; 63:309-321. [PMID: 36942411 PMCID: PMC10089616 DOI: 10.1111/head.14487] [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: 11/14/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To ensure readers are informed consumers of functional magnetic resonance imaging (fMRI) research in headache, to outline ongoing challenges in this area of research, and to describe potential considerations when asked to collaborate on fMRI research in headache, as well as to suggest future directions for improvement in the field. BACKGROUND Functional MRI has played a key role in understanding headache pathophysiology, and mapping networks involved with headache-related brain activity have the potential to identify intervention targets. Some investigators have also begun to explore its use for diagnosis. METHODS/RESULTS The manuscript is a narrative review of the current best practices in fMRI in headache research, including guidelines on transparency and reproducibility. It also contains an outline of the fundamentals of MRI theory, task-related study design, resting-state functional connectivity, relevant statistics and power analysis, image preprocessing, and other considerations essential to the field. CONCLUSION Best practices to increase reproducibility include methods transparency, eliminating error, using a priori hypotheses and power calculations, using standardized instruments and diagnostic criteria, and developing large-scale, publicly available datasets.
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Affiliation(s)
- Jennifer A Hranilovich
- Division of Child Neurology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristina T Legget
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Research Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Keith C Dodd
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korey P Wylie
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Research Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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30
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Yessick LR, Tanguay J, Gandhi W, Harrison R, Dinu R, Chakrabarti B, Borg E, Salomons TV. Investigating the relationship between pain indicators and observers' judgements of pain. Eur J Pain 2023; 27:223-233. [PMID: 36377314 DOI: 10.1002/ejp.2053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the inherent subjectivity of pain, it is difficult to make accurate judgements of pain in others. Research has found discrepancies between the ways in which perceived "objective" (e.g., medical evidence of injury) and "subjective" information (e.g., self-report) influence judgements of pain. This study aims to explore which potential cues (depictions of sensory input, brain activation, self-reported pain and facial expressions) participants are most influenced by when evaluating pain in others. METHODS First, 60 participants (23 women, 36 ± 10 years old) judged who was in more pain between two different pain indicators representing two different patients. These trials revealed which congruent indicator (i.e., two high pain indicators) would most influence participant decisions. Second, participants prescribed quantities of analgesia for one patient's pain based on two different pain indicators. These trials revealed which incongruent indicators (i.e., one high and one low indicator) would most influence participant decisions. RESULTS As predicted, facial expressions were perceived as subjective and were the least likely, among all pain indicators, to influence observer's judgements of pain. Participants relied upon indicators they perceived as objective. Self-report pain ratings had the greatest influence on participants judgements about how much analgesic cream to prescribe and was perceived as objective by half of the participants. CONCLUSIONS We found that in situations where incongruent information was presented about an individual's pain, participants relied on pain indicators that they perceived to be objective. The current study provides important insights about biases that people hold when making judgements of pain in others. SIGNIFICANCE Interpretation and assessment of pain remains one of the largest barriers to pain management and involves complex, idiosyncratic processing. This study provides insights into what information participants view as critical in making attributions of pain when presented with multiple, seemingly incongruent sources of information.
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Affiliation(s)
- Lindsey R Yessick
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Justine Tanguay
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
| | - Wiebke Gandhi
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Richard Harrison
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Ruxandra Dinu
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Bhismadev Chakrabarti
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Emma Borg
- Department of Philosophy, University of Reading, Reading, UK
| | - Tim V Salomons
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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31
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Henn AT, Larsen B, Frahm L, Xu A, Adebimpe A, Scott JC, Linguiti S, Sharma V, Basbaum AI, Corder G, Dworkin RH, Edwards RR, Woolf CJ, Habel U, Eickhoff SB, Eickhoff CR, Wagels L, Satterthwaite TD. Structural imaging studies of patients with chronic pain: an anatomical likelihood estimate meta-analysis. Pain 2023; 164:e10-e24. [PMID: 35560117 PMCID: PMC9653511 DOI: 10.1097/j.pain.0000000000002681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/09/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Neuroimaging is a powerful tool to investigate potential associations between chronic pain and brain structure. However, the proliferation of studies across diverse chronic pain syndromes and heterogeneous results challenges data integration and interpretation. We conducted a preregistered anatomical likelihood estimate meta-analysis on structural magnetic imaging studies comparing patients with chronic pain and healthy controls. Specifically, we investigated a broad range of measures of brain structure as well as specific alterations in gray matter and cortical thickness. A total of 7849 abstracts of experiments published between January 1, 1990, and April 26, 2021, were identified from 8 databases and evaluated by 2 independent reviewers. Overall, 103 experiments with a total of 5075 participants met the preregistered inclusion criteria. After correction for multiple comparisons using the gold-standard family-wise error correction ( P < 0.05), no significant differences associated with chronic pain were found. However, exploratory analyses using threshold-free cluster enhancement revealed several spatially distributed clusters showing structural alterations in chronic pain. Most of the clusters coincided with regions implicated in nociceptive processing including the amygdala, thalamus, hippocampus, insula, anterior cingulate cortex, and inferior frontal gyrus. Taken together, these results suggest that chronic pain is associated with subtle, spatially distributed alterations of brain structure.
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Affiliation(s)
- Alina T. Henn
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Bart Larsen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Lennart Frahm
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
| | - Anna Xu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
- Department of Psychology, Stanford University, Stanford, Carlifornia, US
| | - Azeez Adebimpe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA (Veterans Affairs) Medical Center, Philadelphia, Pennsylvania, US
| | - Sophia Linguiti
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Vaishnavi Sharma
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Allan I. Basbaum
- Department of Anatomy, University of California, San Francisco, US
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, US
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, Massachusetts, US
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, US
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Claudia R. Eickhoff
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Institute of Neuroscience and Medicine (INM1), Forschungszentrum Jülich, Jülich, Germany
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
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32
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Catley P, Claydon L. Why neuroscience changes some things but not everything for the law. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:251-264. [PMID: 37633714 DOI: 10.1016/b978-0-12-821375-9.00016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Neuroenthusiasts and neuroskeptics both exaggerate the strength of their positions. Neuroscience is already having a significant impact in the courts in many jurisdictions and as knowledge from the cognitive sciences expands, that knowledge, wherever relevant, should continue to inform legal systems. However, neuroscience will only ever be one influence among many. In certain areas, for example, our understanding of fear responses or the reliability of memory evidence, the cognitive sciences may help challenge errors of folk psychology and assist the law to adopt better approaches. In other areas such as juvenile responsibility, developmental neuroscience may prove decisive in reinforcing messages from educational psychology and the behavioral sciences both in persuading legislators and judges but also importantly in altering public attitudes. Drawing on examples from a range of countries including Argentina, Australia, Canada, England, the Netherlands, Scotland, Slovenia, and the United States, we argue that legal systems must be open to and learn from science and must not be afraid to engage with science even where there is no clear scientific consensus.
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Affiliation(s)
- Paul Catley
- The Open University Law School, The Open University, Milton Keynes, United Kingdom. //
| | - Lisa Claydon
- The Open University Law School, The Open University, Milton Keynes, United Kingdom
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33
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FDG PET Imaging of the Pain Matrix in Neuropathic Pain Model Rats. Biomedicines 2022; 11:biomedicines11010063. [PMID: 36672571 PMCID: PMC9855331 DOI: 10.3390/biomedicines11010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Pain is an unpleasant subjective experience that is usually modified by complex multidimensional neuropsychological processes. Increasing numbers of neuroimaging studies in humans have characterized the hierarchical brain areas forming a pain matrix, which is involved in the different dimensions of pain components. Although mechanistic investigations have been performed extensively in rodents, the homologous brain regions involved in the multidimensional pain components have not been fully understood in the rodent brain. Herein, we successfully identified several brain regions activated in response to mechanical allodynia in neuropathic pain rat models using an alternative neuroimaging method based on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography (FDG PET) scanning. Regions such as the medial prefrontal cortex, primary somatosensory cortex hindlimb region, and the centrolateral thalamic nucleus were identified. Moreover, brain activity in these regions was positively correlated with mechanical allodynia-related behavioral changes. These results suggest that FDG PET imaging in neuropathic pain model rats enables the evaluation of regional brain activity encoding the multidimensional pain aspect. It could thus be a fascinating tool to bridge the gap between preclinical and clinical investigations.
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Chao CC, Hsieh PC, Janice Lin CH, Huang SL, Hsieh ST, Chiang MC. Limbic Connectivity Underlies Pain Treatment Response in Small-Fiber Neuropathy. Ann Neurol 2022; 93:655-667. [PMID: 36511844 DOI: 10.1002/ana.26577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Small-fiber neuropathy (SFN) is characterized by neuropathic pain due to degeneration of small-diameter nerves in the skin. Given that brain reorganization occurs following chronic neuropathic pain, this study investigated the structural and functional basis of pain-related brain changes after skin nerve degeneration. METHODS Diffusion-weighted and resting-state functional MRI data were acquired from 53 pathologically confirmed SFN patients, and the structural and functional connectivity of the pain-related network was assessed using network-based statistic (NBS) analysis. RESULTS Compared with age- and sex-matched controls, the SFN patients exhibited a robust and global reduction of functional connectivity, mainly across the limbic and somatosensory systems. Furthermore, lower functional connectivity was associated with skin nerve degeneration measured by reduced intraepidermal nerve fiber density and better therapeutic response to anti-neuralgia medications, particularly for the connectivity between the insula and the limbic areas including the anterior and middle cingulate cortices. Similar to the patterns of functional connectivity changes, the structural connectivity was robustly reduced among the limbic and somatosensory areas, and the cognition-integration areas including the inferior parietal lobule. There was shared reduction of structural and functional connectivity among the limbic, somatosensory, striatal, and cognition-integration systems: (1) between the middle cingulate cortex and inferior parietal lobule and (2) between the thalamus and putamen. These observations indicate the structural basis underlying altered functional connectivity in SFN. INTERPRETATION Our findings provide imaging evidence linking structural and functional brain dysconnectivity to sensory deafferentation caused by peripheral nerve degeneration and therapeutic responses for neuropathic pain in SFN. ANN NEUROL 2022.
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Affiliation(s)
- Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Paul-Chen Hsieh
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dermatology, NTU BioMedical Park Hospital, Hsinchu, Taiwan
| | - Chien-Ho Janice Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Yeong-An Orthopedic and Physical Therapy Clinic, Taipei, Taiwan
| | - Shin-Leh Huang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan.,Center of Precision Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
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35
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Chen YL, Feng XL, Cheung CW, Liu JA. Mode of action of astrocytes in pain: From the spinal cord to the brain. Prog Neurobiol 2022; 219:102365. [DOI: 10.1016/j.pneurobio.2022.102365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
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36
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Multidimensional Pain Modulation by Acupuncture Analgesia: The Reward Effect of Acupuncture on Pain Relief. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3759181. [PMID: 36408345 PMCID: PMC9671730 DOI: 10.1155/2022/3759181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022]
Abstract
Pain is an intrinsically unpleasant experience with features that protect an organism by promoting motivation and learning. Pain relief, a negative reinforcement of pain, is considered a reward and activates the brain's reward system. The reward circuit in the brain involves reward and pain. Acupuncture has a multidimensional and comprehensive regulating effect on chronic pain. However, the reward effect of acupuncture in relieving chronic pain and the mechanism of the brain reward circuit involved in acupuncture analgesia are not thoroughly studied. In this article, we have reviewed the definition of pain abnormalities and negative emotions in patients with chronic pain, the conceptual characteristics of analgesic reward, and the new progress in studying brain reward circuits and functions. Moreover, we have expounded on the critical clinical and scientific significance of studying the reward effect of acupuncture analgesia and related brain reward circuits, the pain mechanism obtained from human neuroimaging studies, and the survey results on the effects of acupuncture on reward/motivation circuits. Some viewpoints and suggestions on the reward effect of acupuncture analgesia and related reward circuits have been put forward to clarify the multidimensional characteristics and benign regulation of acupuncture analgesia. Studies on the reward effect of acupuncture in relieving chronic pain and the regulating effect of the brain reward loop on acupuncture analgesia help to deepen the clinical understanding of acupuncture analgesia, innovate the research concept of acupuncture analgesia, and provide help for further studies on the central mechanism of acupuncture in improving chronic pain in the future.
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37
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Salomons TV, Iannetti GD. Fetal pain and its relevance to abortion policy. Nat Neurosci 2022; 25:1396-1398. [PMID: 36303072 DOI: 10.1038/s41593-022-01188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- T V Salomons
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.
| | - G D Iannetti
- Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome, Italy. .,Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.
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38
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Preliminary study: quantification of chronic pain from physiological data. Pain Rep 2022; 7:e1039. [PMID: 36213596 PMCID: PMC9534370 DOI: 10.1097/pr9.0000000000001039] [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: 05/09/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Preliminary evidence suggests that physiological variables collected with our low-cost pain meter are correlated with chronic pain, both for individuals and populations. Introduction: It is unknown if physiological changes associated with chronic pain could be measured with inexpensive physiological sensors. Recently, acute pain and laboratory-induced pain have been quantified with physiological sensors. Objectives: To investigate the extent to which chronic pain can be quantified with physiological sensors. Methods: Data were collected from chronic pain sufferers who subjectively rated their pain on a 0 to 10 visual analogue scale, using our recently developed pain meter. Physiological variables, including pulse, temperature, and motion signals, were measured at head, neck, wrist, and finger with multiple sensors. To quantify pain, features were first extracted from 10-second windows. Linear models with recursive feature elimination were fit for each subject. A random forest regression model was used for pain score prediction for the population-level model. Results: Predictive performance was assessed using leave-one-recording-out cross-validation and nonparametric permutation testing. For individual-level models, 5 of 12 subjects yielded intraclass correlation coefficients between actual and predicted pain scores of 0.46 to 0.75. For the population-level model, the random forest method yielded an intraclass correlation coefficient of 0.58. Bland–Altman analysis shows that our model tends to overestimate the lower end of the pain scores and underestimate the higher end. Conclusion: This is the first demonstration that physiological data can be correlated with chronic pain, both for individuals and populations. Further research and more extensive data will be required to assess whether this approach could be used as a “chronic pain meter” to assess the level of chronic pain in patients.
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Anderson AR, Monroe TB, Dietrich MS, Bruehl SP, Iversen WL, Cowan RL, Failla MD. Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease. FRONTIERS IN PAIN RESEARCH 2022; 3:914473. [PMID: 36387417 PMCID: PMC9650512 DOI: 10.3389/fpain.2022.914473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Background Pain continues to be underrecognized and undertreated in people with Alzheimer's disease (AD). The periaqueductal gray (PAG) is essential to pain processing and modulation yet is damaged by AD. While evidence exists of altered neural processing of pain in AD, there has not been a focused investigation of the PAG during pain in people with AD. Purpose To investigate the role of the PAG in sensory and affective pain processing for people living with AD. Methods Participants from a larger study completed pain psychophysics assessments and then a perceptually-matched heat pain task (warmth, mild, and moderate pain) during a functional MRI scan. In this cross-sectional study, we examined blood oxygenation level-dependent (BOLD) responses in the PAG and other pain-related regions in participants with AD (n = 18) and cognitively intact older adults (age- and sex-matched, n = 18). Associations of BOLD percent signal change and psychophysics were also examined. Results There were significant main effects of AD status on the temperature needed to reach each perception of warmth or pain, where people with AD reached higher temperatures. Furthermore, participants with AD rated mild and moderate pain as more unpleasant than controls. PAG BOLD activation was greater in AD relative to controls during warmth and mild pain percepts. No significant differences were found for moderate pain or in other regions of interest. Greater PAG activation during mild pain was associated with higher affective/unpleasantness ratings of mild pain in participants with AD but not in controls. Conclusion Results suggest a role for the PAG in altered pain responses in people with AD. The PAG is the primary source of endogenous opioid pain inhibition in the neuroaxis, thus, altered PAG function in AD suggests possible changes in descending pain inhibitory circuits. People with AD may have a greater risk of suffering from pain compared to cognitively intact older adults.
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Affiliation(s)
- Alison R. Anderson
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
| | - Todd B. Monroe
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephen P. Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - W. Larkin Iversen
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
| | - Ronald L. Cowan
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
- Departments of Psychiatry and Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michelle D. Failla
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Gillespie A, Harmer CJ. Can You Feel the Burn? Using Neuroimaging to Illuminate the Mechanisms of Mindfulness Interventions for Pain. Am J Psychiatry 2022; 179:705-707. [PMID: 36181328 DOI: 10.1176/appi.ajp.20220712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amy Gillespie
- Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, U.K
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, U.K
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Abstract
Pain is an unpleasant sensory and emotional experience. Understanding the neural mechanisms of acute and chronic pain and the brain changes affecting pain factors is important for finding pain treatment methods. The emergence and progress of non-invasive neuroimaging technology can help us better understand pain at the neural level. Recent developments in identifying brain-based biomarkers of pain through advances in advanced imaging can provide some foundations for predicting and detecting pain. For example, a neurologic pain signature (involving brain regions that receive nociceptive afferents) and a stimulus intensity-independent pain signature (involving brain regions that do not show increased activity in proportion to noxious stimulus intensity) were developed based on multivariate modeling to identify processes related to the pain experience. However, an accurate and comprehensive review of common neuroimaging techniques for evaluating pain is lacking. This paper reviews the mechanism, clinical application, reliability, strengths, and limitations of common neuroimaging techniques for assessing pain to promote our further understanding of pain.
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Affiliation(s)
- Jing Luo
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hui-Qi Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Bo Gou
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China.
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
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42
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Identifying the Presence of Ethics Concepts in Chronic Pain Research: A Scoping Review of Neuroscience Journals. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Verriotis M, Sorger C, Peters J, Ayoub LJ, Seunarine KK, Clark CA, Walker SM, Moayedi M. Amygdalar Functional Connectivity Differences Associated With Reduced Pain Intensity in Pediatric Peripheral Neuropathic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:918766. [PMID: 35692562 PMCID: PMC9184677 DOI: 10.3389/fpain.2022.918766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is evidence of altered corticolimbic circuitry in adults with chronic pain, but relatively little is known of functional brain mechanisms in adolescents with neuropathic pain (NeuP). Pediatric NeuP is etiologically and phenotypically different from NeuP in adults, highlighting the need for pediatric-focused research. The amygdala is a key limbic region with important roles in the emotional-affective dimension of pain and in pain modulation. Objective To investigate amygdalar resting state functional connectivity (rsFC) in adolescents with NeuP. Methods This cross-sectional observational cohort study compared resting state functional MRI scans in adolescents aged 11–18 years with clinical features of chronic peripheral NeuP (n = 17), recruited from a tertiary clinic, relative to healthy adolescents (n = 17). We performed seed-to-voxel whole-brain rsFC analysis of the bilateral amygdalae. Next, we performed post hoc exploratory correlations with clinical variables to further explain rsFC differences. Results Adolescents with NeuP had stronger negative rsFC between right amygdala and right dorsolateral prefrontal cortex (dlPFC) and stronger positive rsFC between right amygdala and left angular gyrus (AG), compared to controls (PFDR<0.025). Furthermore, lower pain intensity correlated with stronger negative amygdala-dlPFC rsFC in males (r = 0.67, P = 0.034, n = 10), and with stronger positive amygdala-AG rsFC in females (r = −0.90, P = 0.006, n = 7). These amygdalar rsFC differences may thus be pain inhibitory. Conclusions Consistent with the considerable affective and cognitive factors reported in a larger cohort, there are rsFC differences in limbic pain modulatory circuits in adolescents with NeuP. Findings also highlight the need for assessing sex-dependent brain mechanisms in future studies, where possible.
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Affiliation(s)
- Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Madeleine Verriotis
| | - Clarissa Sorger
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Lizbeth J. Ayoub
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, Toronto, ON, Canada
- Division of Clinical and Computational Neuroscience, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Chris A. Clark
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suellen M. Walker
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, Toronto, ON, Canada
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Abstract
Deep, dreamless sleep is considered the only “normal” state under which consciousness is lost. The main reason for the voluntary, external induction of an unconscious state, via general anesthesia, is to silence the brain circuitry of nociception. In this article, I describe the perception of pain as a neural and behavioral correlate of consciousness. I briefly mention the brain areas and parameters that are connected to the presence of consciousness, mainly by virtue of their absence under deep anesthesia, and parallel those to brain areas responsible for the perception of pain. Activity in certain parts of the cortex and thalamus, and the interaction between them, will be the main focus of discussion as they represent a common ground that connects our general conscious state and our ability to sense the environment around us, including the painful stimuli. A plethora of correlative and causal evidence has been described thus far to explain the brain’s involvement in consciousness and nociception. Despite the great advancement in our current knowledge, the manifestation and true nature of the perception of pain, or any conscious experience, are far from being fully understood.
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Lee JY, You T, Lee CH, Im GH, Seo H, Woo CW, Kim SG. Role of anterior cingulate cortex inputs to periaqueductal gray for pain avoidance. Curr Biol 2022; 32:2834-2847.e5. [PMID: 35609604 DOI: 10.1016/j.cub.2022.04.090] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 12/13/2022]
Abstract
Although pain-related excessive fear is known to be a key factor in chronic pain disability, which involves the anterior cingulate cortex (ACC), little is known about the downstream circuits of the ACC for fear avoidance in pain processing. Using behavioral experiments and functional magnetic resonance imaging with optogenetics at 15.2 T, we demonstrate that the ACC is a part of the abnormal circuit changes in chronic pain and its downstream circuits are closely related to modulating sensorimotor integration and generating active movement rather than carrying sensory information. The projection from the ACC to the dorsolateral and lateral parts of the periaqueductal gray (dl/lPAG) especially enhances both reflexive and active avoidance behavior toward pain. Collectively, our results indicate that increased signals from the ACC to the dl/lPAG might be critical for excessive fear avoidance in chronic pain disability.
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Affiliation(s)
- Jeong-Yun Lee
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea.
| | - Taeyi You
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Choong-Hee Lee
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea
| | - Geun Ho Im
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea
| | - Heewon Seo
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Chemistry and Biochemistry, Oberlin College, Oberlin, OH 44704, USA
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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46
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Xu J, Xie H, Liu L, Shen Z, Yang L, Wei W, Guo X, Liang F, Yu S, Yang J. Brain Mechanism of Acupuncture Treatment of Chronic Pain: An Individual-Level Positron Emission Tomography Study. Front Neurol 2022; 13:884770. [PMID: 35585847 PMCID: PMC9108276 DOI: 10.3389/fneur.2022.884770] [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: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAcupuncture has been shown to be effective in the treatment of chronic pain. However, their neural mechanism underlying the effective acupuncture response to chronic pain is still unclear. We investigated whether metabolic patterns in the pain matrix network might predict acupuncture therapy responses in patients with primary dysmenorrhea (PDM) using a machine-learning-based multivariate pattern analysis (MVPA) on positron emission tomography data (PET).MethodsForty-two patients with PDM were selected and randomized into two groups: real acupuncture and sham acupuncture (three menstrual cycles). Brain metabolic data from the three special brain networks (the sensorimotor network (SMN), default mode network (DMN), and salience network (SN)) were extracted at the individual level by using PETSurfer in fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) data. MVPA analysis based on metabolic network features was employed to predict the pain relief after treatment in the pooled group and real acupuncture treatment, separately.ResultsPaired t-tests revealed significant alterations in pain intensity after real but not sham acupuncture treatment. Traditional mass-univariate correlations between brain metabolic and alterations in pain intensity were not significant. The MVPA results showed that the brain metabolic pattern in the DMN and SMN did predict the pain relief in the pooled group of patients with PDM (R2 = 0.25, p = 0.005). In addition, the metabolic pattern in the DMN could predict the pain relief after treatment in the real acupuncture treatment group (R2 = 0.40, p = 0.01).ConclusionThis study indicates that the individual-level metabolic patterns in DMN is associated with real acupuncture treatment response in chronic pain. The present findings advanced the knowledge of the brain mechanism of the acupuncture treatment in chronic pain.
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Affiliation(s)
- Jin Xu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongjun Xie
- Department of Nuclear Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Liying Liu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhifu Shen
- Department of Traditional Chinese and Western Medicine, North Sichuan Medical College, Nanchong, China
| | - Lu Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Wei
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Guo
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyi Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Siyi Yu
| | - Jie Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jie Yang
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47
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Stilwell P, Hudon A, Meldrum K, Pagé MG, Wideman TH. What is Pain-Related Suffering? Conceptual Critiques, Key Attributes, and Outstanding Questions. THE JOURNAL OF PAIN 2022; 23:729-738. [PMID: 34852304 DOI: 10.1016/j.jpain.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering - with and without self-reflection - are discussed. PERSPECTIVE: This article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.
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Affiliation(s)
- Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Ethics Research Center (CRÉ), Montreal, Quebec, Canada
| | | | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Universite de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.
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48
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Sieberg CB, Karunakaran KD, Kussman B, Borsook D. Preventing pediatric chronic postsurgical pain: Time for increased rigor. Can J Pain 2022; 6:73-84. [PMID: 35528039 PMCID: PMC9067470 DOI: 10.1080/24740527.2021.2019576] [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: 09/08/2021] [Revised: 11/12/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous systems following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient's risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the perisurgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an eight-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.
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Affiliation(s)
- Christine B. Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Keerthana Deepti Karunakaran
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Barry Kussman
- Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, United States
| | - David Borsook
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Lan L, Yin T, Tian Z, Lan Y, Sun R, Li Z, Jing M, Wen Q, Li S, Liang F, Zeng F. Acupuncture Modulates the Spontaneous Activity and Functional Connectivity of Calcarine in Patients With Chronic Stable Angina Pectoris. Front Mol Neurosci 2022; 15:842674. [PMID: 35557556 PMCID: PMC9087858 DOI: 10.3389/fnmol.2022.842674] [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: 12/24/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAcupuncture is an effective adjunctive therapy for chronic stable angina pectoris (CSAP), while the underlying mechanism is unclear. This study aimed to investigate the central pathophysiology of CSAP and explore the mechanism of different acupoint prescriptions for CSAP from the perspective of brain-heart interaction.MethodsThirty-seven CSAP patients and sixty-five healthy subjects (HS) were enrolled, and thirty CSAP patients were divided into two acupoint prescriptions groups (Group A: acupoints on the meridian directly related to the Heart; Group B: acupoints on the meridian indirectly related to the Heart). The Magnetic Resonance Imaging data and clinical data were collected at baseline and after treatment. The comparisons of brain spontaneous activity patterns were performed between CSAP patients and HS, as well as between baseline and after treatment in CSAP patients. Then, the changes in resting-state functional connectivity before and after treatment were compared between the two acupoint prescriptions.ResultsChronic stable angina pectoris patients manifested higher spontaneous activity on the bilateral calcarine, left middle occipital gyrus, right superior temporal gyrus, and right postcentral gyrus. After acupuncture treatment, the spontaneous activity of the left calcarine, left cuneus, and right orbitofrontal gyrus was decreased. The left calcarine was identified as region-of-interest for functional connectivity analysis. Compared with group B, CSAP patients in group A had significantly increased functional connectivity between left calcarine and the left inferior temporal gyrus/cerebellum crus 1, left hippocampus, left thalamus, and left middle cingulate cortex after treatment. Thresholds for all comparisons were p < 0.05, Gaussian Random Field corrected.ConclusionRegulating the aberrant spontaneous activity of the calcarine might be an underlying mechanism of acupuncture for CSAP. The multi-threaded modulation of functional connectivity between calcarine and multiple pain-related brain regions might be a potential mechanism for better efficacy of acupuncture at points on the meridian directly related to the Heart.
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Affiliation(s)
- Lei Lan
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yin
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zilei Tian
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Lan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhengjie Li
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Miaomiao Jing
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Qiao Wen
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shenghong Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
- *Correspondence: Fanrong Liang,
| | - Fang Zeng
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
- Fang Zeng,
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50
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Li H, Wang J, Liu S, Liu Z, Xu Y. Neuroanatomical Correlates of Mild-to-Moderate Depression: Memory Ability Mediates the Association Between Gray Matter Volume and Antidepressant Treatment Outcome. Front Neurosci 2022; 16:872228. [PMID: 35431790 PMCID: PMC9007321 DOI: 10.3389/fnins.2022.872228] [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: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Mild-to-moderate depression (MMD) is frequently encountered in clinical practice. Investigating the brain mechanism and its relationship with symptoms in patients with MMD can help us understand the occurrence and development of depression, thus optimizing the prevention and treatment of depression. Shugan Jieyu capsule (SG), a traditional Chinese medicine, is commonly used to ameliorate emotional and cognitive symptoms induced by patients with MMD. Combining clinical assessments and magnetic resonance imaging (MRI), we obtained the emotional and cognitive status of MMD patients and also explored the structural and functional alterations in MMD patients after SG treatments. Structural MRI demonstrated that the gray matter volumes of the left thalamus, right thalamus, and right amygdala in MMD patients were significantly smaller than in healthy controls, and the right amygdala volume was negatively related to depression symptoms in MMD patients. Resting-state functional MRI data demonstrated that MMD patients exhibited decreased temporal coupling between the right amygdala and nucleus accumbens, which was further associated with the severity of depression. Furthermore, right amygdala volume at baseline served as a significant predictor to identify the treatment outcome after 8 weeks of SG treatment in the patients’ group, and importantly, the memory ability mediated the relationship from right amygdala volume to the treatment outcome. These data revealed the structural and functional deficits in the right amygdala, which were highly correlated with the symptoms of depression and its cognitive ability, likely predicting treatment outcome. Therefore, this study strengthened our understanding of the pathogenesis of MMD, which is hoped that it will contribute to tailoring a personalized method for treating the patients.
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Affiliation(s)
- Hong Li
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- *Correspondence: Hong Li,
| | - Junjie Wang
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- Yong Xu,
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