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Brígida N, Catela D, Mercê C, Branco M. Predictability and Complexity of Fine and Gross Motor Skills in Fibromyalgia Patients: A Pilot Study. Sports (Basel) 2024; 12:90. [PMID: 38668558 PMCID: PMC11053813 DOI: 10.3390/sports12040090] [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: 10/30/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Fine and gross motor tasks are usually used to evaluate behavioral dysfunctions and can be applied to diseases of the central nervous system, such as fibromyalgia (FM). Non-linear measures have allowed for deeper motor control analysis, focusing on the process and on the quality of movement. Therefore, to assess uncertainty, irregularity, and structural richness of a time series, different algorithms of entropy can be computed. The aim of this study was to (i) verify the single-scale and multiscale entropy values in fine and gross motor movements and (ii) to verify whether fine and gross motor tasks are sensitive to characterizing FM patients. METHODS The sample consisted of 20 females (46.2 ± 12.8 years) divided in two groups, an experimental group with 10 FM subjects and a control group with 10 subjects without FM. Inertial sensors were used to collect the finger tapping test (FTT), walking, and sit-and-stand task data. RESULTS Regarding fine motor skills, patients with FM showed a loss of structural richness (complexity), but they had information processing with greater control in the FTT, probably to simplify task execution and for correction of the movement. On the other hand, people without FM seemed to have more automatic control of the movement when performed with the preferred hand and exhibited similar difficulties to the FM group when performed with the non-preferred hand. Gross motor tasks showed similar entropy values for both groups. CONCLUSIONS The results show that FM patients have movement controls primarily at the level of the motor cortex, whereas people without FM perform movement at the medullary level, especially in fine motor tasks, indicating that the FTT is sensitive to the presence of FM, especially when performed with the preferred hand.
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Affiliation(s)
- Nancy Brígida
- ESDRM Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, Santarem Polytechnic University, 2040-413 Rio Maior, Portugal; (D.C.); (C.M.); (M.B.)
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 2001-904 Santarém, Portugal
- Educação e Treino, Centro de Investigação em Qualidade de Vida (CIEQV), Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Psicologia Aplicada, Unidade de Investigação do Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
| | - David Catela
- ESDRM Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, Santarem Polytechnic University, 2040-413 Rio Maior, Portugal; (D.C.); (C.M.); (M.B.)
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 2001-904 Santarém, Portugal
- Educação e Treino, Centro de Investigação em Qualidade de Vida (CIEQV), Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Psicologia Aplicada, Unidade de Investigação do Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
| | - Cristiana Mercê
- ESDRM Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, Santarem Polytechnic University, 2040-413 Rio Maior, Portugal; (D.C.); (C.M.); (M.B.)
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 2001-904 Santarém, Portugal
- Educação e Treino, Centro de Investigação em Qualidade de Vida (CIEQV), Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Psicologia Aplicada, Unidade de Investigação do Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada-Dafundo, 1499-002 Lisboa, Portugal
| | - Marco Branco
- ESDRM Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, Santarem Polytechnic University, 2040-413 Rio Maior, Portugal; (D.C.); (C.M.); (M.B.)
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 2001-904 Santarém, Portugal
- Educação e Treino, Centro de Investigação em Qualidade de Vida (CIEQV), Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Psicologia Aplicada, Unidade de Investigação do Instituto Politécnico de Santarém, 2001-904 Santarém, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada-Dafundo, 1499-002 Lisboa, Portugal
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Augière T, Simoneau M, Brun C, Pinard AM, Blouin J, Mouchnino L, Mercier C. Behavioral and Electrocortical Response to a Sensorimotor Conflict in Individuals with Fibromyalgia. Brain Sci 2023; 13:931. [PMID: 37371409 DOI: 10.3390/brainsci13060931] [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: 04/14/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
People with fibromyalgia have been shown to experience more somatosensory disturbances than pain-free controls during sensorimotor conflicts (i.e., incongruence between visual and somatosensory feedback). Sensorimotor conflicts are known to disturb the integration of sensory information. This study aimed to assess the cerebral response and motor performance during a sensorimotor conflict in people with fibromyalgia. Twenty participants with fibromyalgia and twenty-three pain-free controls performed a drawing task including visual feedback that was either congruent with actual movement (and thus with somatosensory information) or incongruent with actual movement (i.e., conflict). Motor performance was measured according to tracing error, and electrocortical activity was recorded using electroencephalography. Motor performance was degraded during conflict for all participants but did not differ between groups. Time-frequency analysis showed that the conflict was associated with an increase in theta power (4-8 Hz) at conflict onset over the left posterior parietal cortex in participants with fibromyalgia but not in controls. This increase in theta suggests a stronger detection of conflict in participants with fibromyalgia, which was not accompanied by differences in motor performance in comparison to controls. This points to dissociation in individuals with fibromyalgia between an altered perception of action and a seemingly unaltered control of action.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jean Blouin
- Laboratoire de Neurosciences Cognitives, Aix-Marseille University, National Center for Scientific Research (CNRS), 13331 Marseille, France
| | - Laurence Mouchnino
- Laboratoire de Neurosciences Cognitives, Aix-Marseille University, National Center for Scientific Research (CNRS), 13331 Marseille, France
- Institut Universitaire de France, 75005 Paris, France
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
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Liu N, Li Y, Hong Y, Huo J, Chang T, Wang H, Huang Y, Li W, Zhang Y. Altered brain activities in mesocorticolimbic pathway in primary dysmenorrhea patients of long-term menstrual pain. Front Neurosci 2023; 17:1098573. [PMID: 36793538 PMCID: PMC9922713 DOI: 10.3389/fnins.2023.1098573] [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] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
Background Patients with primary dysmenorrhea (PDM) often present with abnormalities other than dysmenorrhea including co-occurrence with other chronic pain conditions and central sensitization. Changes in brain activity in PDM have been demonstrated; however, the results are not consistent. Herein, this study probed into altered intraregional and interregional brain activity in patients with PDM and expounded more findings. Methods A total of 33 patients with PDM and 36 healthy controls (HCs) were recruited and underwent a resting-state functional magnetic resonance imaging scan. Regional homogeneity (ReHo) and mean amplitude of low-frequency fluctuation (mALFF) analysis were applied to compare the difference in intraregional brain activity between the two groups, and the regions with ReHo and mALFF group differences were used as seeds for functional connectivity (FC) analysis to explore the difference of interregional activity. Pearson's correlation analysis was conducted between rs-fMRI data and clinical symptoms in patients with PDM. Results Compared with HCs, patients with PDM showed altered intraregional activity in a series of brain regions, including the hippocampus, the temporal pole superior temporal gyrus, the nucleus accumbens, the pregenual anterior cingulate cortex, the cerebellum_8, the middle temporal gyrus, the inferior temporal gyrus, the rolandic operculum, the postcentral gyrus and the middle frontal gyrus (MFG), and altered interregional FC mainly between regions of the mesocorticolimbic pathway and regions associated with sensation and movement. The anxiety symptoms are correlated with the intraregional activity of the right temporal pole superior temporal gyrus and FC between MFG and superior frontal gyrus. Conclusion Our study showed a more comprehensive method to explore changes in brain activity in PDM. We found that the mesocorticolimbic pathway might play a key role in the chronic transformation of pain in PDM. We, therefore, speculate that the modulation of the mesocorticolimbic pathway may be a potential novel therapeutic mechanism for PDM.
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Affiliation(s)
- Ni Liu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yingqiu Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yueying Hong
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jianwei Huo
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Tai Chang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Haoyuan Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yiran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wenxun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China,Wenxun Li ✉
| | - Yanan Zhang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China,*Correspondence: Yanan Zhang ✉
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La Rocca M, Clemente L, Gentile E, Ricci K, Delussi M, de Tommaso M. Effect of Single Session of Anodal M1 Transcranial Direct Current Stimulation-TDCS-On Cortical Hemodynamic Activity: A Pilot Study in Fibromyalgia. Brain Sci 2022; 12:1569. [PMID: 36421893 PMCID: PMC9688269 DOI: 10.3390/brainsci12111569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 07/23/2024] Open
Abstract
Transcranial direct current stimulation (TDCS) on the primary motor cortex (M1) has been reported to be effective in fibromyalgia (FM). Our previous works have shown hypometabolism of motor networks in FM using Functional Near Infrared Spectroscopy (fNIRS), which could contribute to pain symptoms. To investigate if a single Transcranial Direct Current Stimulation (TDCS) session can restore the reduced metabolism expected in FM patients, we compared metabolic activity in FM patients and controls during a finger-tapping task in basal condition, sham condition, and under anodal TDCS on M1. During the finger tapping task, a continuous wave 20 channel fNIRS system was placed across the bilateral central-frontal areas in 22 healthy controls and 54 FM patients. Subjects were randomly assigned to real TDCS or sham stimulation. The finger-tapping slowness did not change after real and sham stimulation. After real TDCS stimulation, FM patients showed an increased activation of cortical motor regions (t-statistic = -2.5246, p-value = 0.0125 for the stimulated hemisphere and t-statistic = -4.6638, p-value = 0.0001 for the non-stimulated hemisphere). The basal differences between FM and controls reverted after real TDCS, while this effect was not observed for sham stimulation. A single TDCS session of the cortical motor network seemed able to restore basic cortical hypometabolism in FM patients. Further studies could clarify the long-term effect of M1 stimulation on cortical metabolism, and its relevance in pain processing and clinical features.
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Affiliation(s)
- Marianna La Rocca
- Physics Department, Bari Aldo Moro University, 70121 Bari, Italy
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA 90007, USA
| | - Livio Clemente
- DiBraiN Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Eleonora Gentile
- DiBraiN Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Katia Ricci
- DiBraiN Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Marianna Delussi
- DiBraiN Department, Bari Aldo Moro University, 70121 Bari, Italy
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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Mehta P, Basu A, Ahmed S. Effectiveness and adverse effects of the use of mirtazapine as compared to duloxetine for fibromyalgia: real-life data from a retrospective cohort. Rheumatol Int 2022; 42:1549-1554. [PMID: 35475940 DOI: 10.1007/s00296-022-05135-y] [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: 02/21/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
On the background of a restricted armamentarium of drugs available for the management of fibromyalgia (FM), we aimed to compare the real-world effectiveness of two serotonin-norepinephrine reuptake inhibitors (SNRIs), mirtazapine (MTZ) and duloxetine (DLX) in FM. A medical records review was done to identify patients diagnosed with FM and prescribed a stable dose of either MTZ or DLX for more than 6 months. Their present status was determined by a telephonic interview which included a subjective assessment of improvement (Likert scale), FIQR (Revised Fibromyalgia Impact Questionnaire), adverse drug effects and compliance. One-fifty-eight patients were screened to include 81 patients [mean age 46.7 (± 13.0) years, 64 (79%) females]. Sixty (79%) had primary fibromyalgia and 66 (81.5%) were on DLX (20-40 mg) while 15(18.5%) were on MTZ (7.5 mg). In addition to the drugs, lifestyle modification was followed by 57 (70.3%). A moderate-to-good improvement was seen in 66 (81.5%), while 15 (18.5%) reported poor to no improvement overall. In the DLX group, a majority (59, 89.4%) showed moderate-to-good improvement compared to 7(46.7%) on MTZ [p = 0.001, 9.6(2.6-34)]. However, FIQR was similar for those on DLX (3.6 ± 0.9) and MTZ (3.8 ± 0.7). Adverse effects were reported for 51 (77%) of patients on DLX and all (100%) on MTZ with a poorer compliance with MTZ 5 (33.3%) compared to DLX 47 (71.2%) [p = 0.008, OR 0.1(0.03-0.4)]. On multivariate analysis, DLX use [OR 16.7 (95% CI 2.7-100); p = 0.008] and lifestyle modification [p = 0.002; OR 11.2(1.5-83.3)] were associated with better subjective outcomes. Low-dose MTZ appears to be inferior to DLX in the management of FM in this real-world cohort.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George Medical University, Lucknow, India
| | - Amartya Basu
- Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
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Augière T, Desjardins A, Paquette Raynard E, Brun C, Pinard AM, Simoneau M, Mercier C. Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2021; 2:740897. [PMID: 35295451 PMCID: PMC8915638 DOI: 10.3389/fpain.2021.740897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by sensorimotor deficits and distortions of body representation, that could both be caused by alterations in sensory processing. Several studies suggest a hypersensitivity to various sensory stimulations in fibromyalgia but results on detection of both noxious and non-noxious tactile stimulation, which are particularly relevant for body representation and motor control, remain conflicting. Therefore, the aim of this study is to systematically review and quantify the detection thresholds to noxious and non-noxious tactile stimuli in individuals with fibromyalgia compared to pain-free controls. A systematic review and a meta-analysis were performed in the MEDLINE, EMBASE, CINAHL, Cochrane, PsycInfo and Web of Science databases using keywords related to fibromyalgia, tactile pain detection threshold, tactile detection threshold and quantitative sensory testing. Nineteen studies were included in the review, with 12 in the meta-analysis. Despite the heterogeneity of the results, the data from both the review and from the meta-analysis suggest a trend toward hyperalgesia and no difference of sensitivity to non-noxious tactile stimuli in participants with fibromyalgia compared to healthy controls. This contradicts the hypothesis of a general increase in responsiveness of the central nervous system to noxious and non-noxious stimulations in fibromyalgia. This study shows no alteration of the sensitivity to non-noxious tactile stimulation in fibromyalgia, suggesting that an altered unimodal processing is not sufficient to explain symptoms such as sensorimotor impairments and body representation distortions. Future research should investigate whether alterations in multisensory integration could contribute to these symptoms.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Audrey Desjardins
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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Hu XS, Nascimento TD, DaSilva AF. Shedding light on pain for the clinic: a comprehensive review of using functional near-infrared spectroscopy to monitor its process in the brain. Pain 2021; 162:2805-2820. [PMID: 33990114 PMCID: PMC8490487 DOI: 10.1097/j.pain.0000000000002293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Pain is a complex experience that involves sensation, emotion, and cognition. The subjectivity of the traditional pain measurement tools has expedited the interest in developing neuroimaging techniques to monitor pain objectively. Among noninvasive neuroimaging techniques, functional near-infrared spectroscopy (fNIRS) has balanced spatial and temporal resolution; yet, it is portable, quiet, and cost-effective. These features enable fNIRS to image the cortical mechanisms of pain in a clinical environment. In this article, we evaluated pain neuroimaging studies that used the fNIRS technique in the past decade. Starting from the experimental design, we reviewed the regions of interest, probe localization, data processing, and primary findings of these existing fNIRS studies. We also discussed the fNIRS imaging's potential as a brain surveillance technique for pain, in combination with artificial intelligence and extended reality techniques. We concluded that fNIRS is a brain imaging technique with great potential for objective pain assessment in the clinical environment.
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Affiliation(s)
- Xiao-Su Hu
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Thiago D. Nascimento
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Alexandre F. DaSilva
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
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Hall M, Kidgell D, Perraton L, Morrissey J, Jaberzadeh S. Pain Induced Changes in Brain Oxyhemoglobin: A Systematic Review and Meta-Analysis of Functional NIRS Studies. PAIN MEDICINE 2021; 22:1399-1410. [PMID: 33659994 DOI: 10.1093/pm/pnaa453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuroimaging studies show that nociceptive stimuli elicit responses in an extensive cortical network. Functional near-infrared spectroscopy (fNIRS) allows for functional assessment of changes in oxyhemoglobin (HbO), an indirect index for cortical activity. Unlike functional magnetic resonance imaging (fMRI), fNIRS is portable, relatively inexpensive, and allows subjects greater function. No systematic review or meta-analysis has drawn together the data from existing literature of fNIRS studies on the effects of experimental pain on oxyhemoglobin changes in the superficial areas of the brain. OBJECTIVES To investigate the effects of experimental pain on brain fNIRS measures in the prefrontal-cortex and the sensory-motor-area; to determine whether there is a difference in oxyhemodynamics between the prefrontal-cortex and sensory-motor-area during pain processing; to determine if there are differences in HbO between patients with centralized persistent pain and healthy controls. METHODS Studies that used fNIRS to record changes in oxyhemodynamics in prefrontal-cortex or sensory-motor-cortex in noxious and innoxious conditions were included. In total, 13 studies were included in the meta-analysis. RESULTS Pain has a significantly greater effect on pre-frontal-cortex and sensory-motor areas than nonpainful stimulation on oxyhemodynamics. The effect of pain on sensory-motor areas was greater than the effect of pain on the prefrontal-cortex. There was an effect of centralized pain in the CPP group on oxyhemodynamics from a noxious stimulus compared to control's response to pain. CONCLUSIONS Pain affects the prefrontal and sensory-motor cortices of the brain and can be measured using fNIRS. Implications of this study may lead to a simple and readily accessible objective measure of pain.
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Affiliation(s)
- MacGregor Hall
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | - Luke Perraton
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
| | | | - Shapour Jaberzadeh
- Department of Physiotherapy, Monash University,Frankston, VIC, Australia
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Çolak B, Eken A, Kuşman A, Sayar Akaslan D, Kızılpınar SÇ, Çakmak IB, Bal NB, Münir K, Öner Ö, Baskak B. The relationship of cortical activity induced by pain stimulation with clinical and cognitive features of somatic symptom disorder: A controlled functional near infrared spectroscopy study. J Psychosom Res 2021; 140:110300. [PMID: 33248397 DOI: 10.1016/j.jpsychores.2020.110300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The neurobiological correlates of Somatic Symptom Disorder (SSD) introduced in the DSM-5 has been the focus of a limited investigation. We aimed to examine the cortical response to painful stimuli and its relationship to symptom severity as well as cognitive and psychological characteristics in proposed models of somatoform disorders. METHODS We measured hemodynamic responses by 52-channel functional near-infrared spectroscopy. We compared the cortical response to painful stimuli in index patients with SSD (N = 21) versus age, and gender matched healthy control subjects (N = 21). We used brush stimulation as the control condition. We analyzed the relationship of cortical activity with SSD symptom severity as well as somatosensory amplification (SSA), alexithymia, dysfunctional illness behaviour, worry, and neuroticism. RESULTS Patients with SSD had higher somatic symptom severity, SSA, alexithymia, neuroticism, illness-related worry, and behaviour. Somatic symptom severity was predicted by a model including SSA and subjective feeling of pain in the index patients. Activity in the left-angular and right-middle temporal gyri was higher in the SSD subjects than the controls during pain stimulation. Positive correlations were detected between mean pain threshold levels and left middle occipital gyrus activity, as well as between SSA-scores and right-angular gyrus activity during pain condition in the index patients with SSD. CONCLUSION We present the first evidence that representation of pain in terms of cortical activity is different in subjects with SSD than healthy controls. SSA has functional neuroanatomic correlates and predicts symptom severity in SSD and therefore is involved as a valid intermediate phenotype in SSD pathophysiology.
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Affiliation(s)
- Burçin Çolak
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Aykut Eken
- Pompeu Fabra University, Center for Brain and Cognition, Barcelona, Spain
| | - Adnan Kuşman
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Damla Sayar Akaslan
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | | | - Işık Batuhan Çakmak
- University of Health Sciences, Ankara City Hospital, Department of Psychiatry, Ankara, Turkey
| | - Neşe Burcu Bal
- University of Health Sciences, Ankara Oncology Hospital, Department of Psychiatry, Ankara, Turkey
| | - Kerim Münir
- Harvard Medical School, Developmental Medicine Center, Boston Children's Hospital, Boston, USA
| | - Özgür Öner
- Bahçeşehir University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Bora Baskak
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey; Ankara University Brain Research Center (AUBAUM), Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey.
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11
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Karunakaran KD, Peng K, Berry D, Green S, Labadie R, Kussman B, Borsook D. NIRS measures in pain and analgesia: Fundamentals, features, and function. Neurosci Biobehav Rev 2020; 120:335-353. [PMID: 33159918 DOI: 10.1016/j.neubiorev.2020.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/28/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Current pain assessment techniques based only on clinical evaluation and self-reports are not objective and may lead to inadequate treatment. Having a functional biomarker will add to the clinical fidelity, diagnosis, and perhaps improve treatment efficacy in patients. While many approaches have been deployed in pain biomarker discovery, functional near-infrared spectroscopy (fNIRS) is a technology that allows for non-invasive measurement of cortical hemodynamics. The utility of fNIRS is especially attractive given its ability to detect specific changes in the somatosensory and high-order cortices as well as its ability to measure (1) brain function similar to functional magnetic resonance imaging, (2) graded responses to noxious and innocuous stimuli, (3) analgesia, and (4) nociception under anesthesia. In this review, we evaluate the utility of fNIRS in nociception/pain with particular focus on its sensitivity and specificity, methodological advantages and limitations, and the current and potential applications in various pain conditions. Everything considered, fNIRS technology could enhance our ability to evaluate evoked and persistent pain across different age groups and clinical populations.
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Affiliation(s)
- Keerthana Deepti Karunakaran
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
| | - Ke Peng
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States; Département en Neuroscience, Centre de Recherche du CHUM, l'Université de Montréal Montreal, QC, Canada
| | - Delany Berry
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Stephen Green
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Robert Labadie
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Barry Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
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12
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Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E365. [PMID: 31936420 PMCID: PMC7014460 DOI: 10.3390/s20020365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
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Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
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13
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Gokcay D, Eken A, Baltaci S. Binary Classification Using Neural and Clinical Features: An Application in Fibromyalgia With Likelihood-Based Decision Level Fusion. IEEE J Biomed Health Inform 2019; 23:1490-1498. [DOI: 10.1109/jbhi.2018.2844300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Gentile E, Ricci K, Delussi M, Brighina F, de Tommaso M. Motor Cortex Function in Fibromyalgia: A Study by Functional Near-Infrared Spectroscopy. PAIN RESEARCH AND TREATMENT 2019; 2019:2623161. [PMID: 30792923 PMCID: PMC6354141 DOI: 10.1155/2019/2623161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
Previous studies indicated changes of motor cortex excitability in fibromyalgia (FM) patients and the positive results of transcranial stimulation techniques. The present study aimed to explore the metabolism of motor cortex in FM patients, in resting state and during slow and fast finger tapping, using functional Near-Infrared Spectroscopy (fNIRS), an optical method which detects in real time the metabolism changes in the cortical tissue. We studied 24 FM patients and 24 healthy subjects. We found a significant slowness of motor speed in FM patients compared to controls. During resting state and slow movement conditions, the metabolism of the motor areas was similar between groups. The oxyhemoglobin concentrations were significantly lower in patients than in control group during the fast movement task. This abnormality was independent from FM severity and duration. The activation of motor cortex areas is dysfunctional in FM patients, thus supporting the rationale for the therapeutic role of motor cortex modulation in this disabling disorder.
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Affiliation(s)
- Eleonora Gentile
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Via del Vespro 143, 90127 Palermo, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
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15
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Williams DA. Phenotypic Features of Central Sensitization. JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH 2018; 23:e12135. [PMID: 30479469 PMCID: PMC6251410 DOI: 10.1111/jabr.12135] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The current manuscript reviews approaches for phenotyping central sensitization (CS). METHODS The manuscript covers the concept of diagnostic phenotyping, use of endophenotypes, biomarkers, and symptom clusters. Specifically, the components of CS that include general sensory sensitivity (assessed by quantitative sensory testing) and a symptom cluster denoting sleep difficulties, pain, affect, cognitive difficulties, and low energy (S.P.A.C.E.). RESULTS Each of the assessment domains are described with reference to CS and their presence in chronic overlapping pain conditions (COPCs) - conditions likely influenced by CS. CONCLUSIONS COPCs likely represent clinical diagnostic phenotypes of CS. Components of CS can also be assessed using QST or self-report instruments designed to assess single elements of CS or more general composite indices.
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Affiliation(s)
- David A Williams
- Department of Anesthesiology, University of Michigan Health System, 24 Frank Lloyd Wright Drive, P.O. Box 385, Lobby M, Ann Arbor, MI 48106
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