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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [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: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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Chen Y, Cui L, Li H, Gao A. Abnormal brain structure in atopic dermatitis: Evidence from Mendelian randomization study. Skin Res Technol 2023; 29:e13515. [PMID: 38009032 PMCID: PMC10654478 DOI: 10.1111/srt.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Structural abnormalities in the brain of patients with atopic dermatitis (AD) have been reported; however, the cause has not been determined yet. Herein, we used Mendelian randomization (MR) to reveal the causal effect of AD on brain structure. METHODS This study utilized summary statistics from genome-wide association studies (GWASs) to investigate a collection of cerebral structural measures, encompassing cortical thickness (CT), cortical surface area (CA), and subcortical volumes in T1 images. A comprehensive GWAS meta-analysis identified a total of 20 independent single nucleotide polymorphisms linked to AD, surpassing the genome-wide significance threshold (p < 5 × 10⁻⁸). MR estimates were aggregated through the application of the inverse variance weighted method. Additional complementary analyses (i.e., MR-Egger and weighted median approaches) were conducted to further assess the robustness of the obtained results. Sensitivity analysis and multivariate MR (MVMR) while adjusting for brain structural changes risk factors (i.e., depression and anxiety) were performed to assess the reliability and stability of observed causality. RESULTS Genetically determined AD exhibited a causal link with reduced caudate volumes (IVW-MR: β = -0.186, p = 0.001, p-corrected = 0.009). Furthermore, we identified potential causal associations between AD and reduced CT in the cingulate region (posterior cingulate, IVW-MR: β = -0.065, p = 0.018, p-corrected = 0.551; isthmus cingulate, IVW-MR: β = -0.086, p = 0.003, p-corrected = 0.188), as well as abnormal cortical surface area (CA) in the supramarginal (IVW-MR: β = -0.047, p = 0.044, p-corrected = 0.714) and isthmus cingulate (IVW-MR: β = 0.053, p = 0.018, p-corrected = 0.714). Additional supplementary analyses yielded consistent outcomes. There was no evidence of horizontal pleiotropy. MVMR analysis showed that the causal effects of AD on abnormal brain structure remained significant while adjusting for depression and anxiety. CONCLUSION This MR study provided suggestive evidence that decreased caudate nucleus, posterior cingulate cortex, isthmus cingulate cortex and supramarginal gyrus are suggestively associated with higher AD risk. Future investigation into the brain regions is recommended, which helps to clarify the underlying mechanisms and point to new therapies against AD.
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Affiliation(s)
- Yue Chen
- Department of DermatologyGuangzhou Institute of DermatologyGuangzhouGuangdongChina
| | - Liqian Cui
- Department of NeurologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hao Li
- Department of NeurologyDonders Center for Medical NeurosciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Aili Gao
- Department of DermatologyGuangzhou Institute of DermatologyGuangzhouGuangdongChina
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Liu JJ, Li X, Guo J, Yu S, Yang S. Role of GRPR in Acupuncture Intervention in the "Itch-scratch Vicious Cycle" Spinal Circuit of Chronic Pruritus. Chin Med 2023; 18:2. [PMID: 36597164 PMCID: PMC9809006 DOI: 10.1186/s13020-022-00706-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Many previous studies have shown the potential antipruritic effect of acupuncture. This paper reviews the antipruritic mechanisms of acupuncture according to these aspects: sample characteristics, detail of intervention, and effects evaluation. The majority of research on acupuncture's antipruritic effect has focused on primary afferents of the peripheral mechanism. Relatively few studies, however, have addressed the central mechanisms. Combination the latest research achievements of chronic itch, gastrin-releasing peptide receptor (GRPR) in the dorsal horn of the spinal cord may represent the first molecule identified that is dedicated to mediating the itch response and may provide an important therapeutic target for the treatment of chronic pruritic conditions. Therefore, GRPR may be a new target for acupuncture to relieve itch in the future and provide new ideas for acupuncture intervention in the mechanisms of the spinal level of the "itch-scratch vicious cycle" of chronic itch.
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Affiliation(s)
- Jia-jia Liu
- grid.411304.30000 0001 0376 205XAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China
| | - Xuemei Li
- grid.411304.30000 0001 0376 205XAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China
| | - Jing Guo
- grid.411304.30000 0001 0376 205XAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China
| | - Shuguang Yu
- grid.411304.30000 0001 0376 205XAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China ,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, Sichuan China
| | - Sha Yang
- grid.411304.30000 0001 0376 205XAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China ,grid.411304.30000 0001 0376 205XAcupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China
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Zhang L, Zou Z, Yu S, Xiao X, Shi Y, Cao W, Liu Y, Zheng H, Zheng Q, Zhou S, Yao J, Deng Y, Yang Q, Chen S, Hao P, Li N, Li Y. Functional connectivity impairment of thalamus-cerebellum-scratching neural circuits in pruritus of chronic spontaneous urticaria. Front Neurosci 2022; 16:1026200. [PMID: 36340791 PMCID: PMC9630740 DOI: 10.3389/fnins.2022.1026200] [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: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
Abstract
Pruritus of chronic spontaneous urticaria (CSU) is one of the most common and irritating sensations that severely affects the quality of life. However, the changes in the functional connectivity (FC) between thalamic subregions and other brain regions have not been fully elucidated. This study aimed to explore the potential changes in brain neural circuits by focusing on various subregions of the thalamus in patients with CSU pruritus to contribute to the understanding of chronic pruritus from the perspective of central mechanisms. A total of 56 patients with CSU and 30 healthy controls (HCs) completed the data analysis. Urticaria Activity Score 7 (UAS7), pruritus visual analog score (VAS-P), Dermatological Life Quality Index (DLQI), and immunoglobulin E (IgE) values were collected to assess clinical symptoms. Seed-based resting-state functional connectivity (rs-FC) analysis was used to assess relevant changes in the neural circuits of the brain. Compared to HCs, seeds within the caudal temporal thalamus (cTtha) on the right side of patients with CSU showed increased rs-FC with the cerebellum anterior lobe (CAL). Seeds within the lateral prefrontal thalamus (lPFtha) on the right side showed increased rs-FC with both CAL and pons, while those within the medial prefrontal thalamus (mPFtha) on the right side showed increased rs-FC with both CAL and the dorsal lateral prefrontal cortex (dlPFC) on the right side. Seeds within the posterior parietal thalamus (PPtha) on the right side showed increased rs-FC with the cerebellum posterior lobe (CPL) on the left side. The UAS7 values and IgE levels were positively correlated with the rs-FC of the right dlPFC. Our results suggest that patients with CSU may exhibit stronger rs-FC alterations between certain thalamic subregions and other brain regions. These changes affect areas of the brain involved in sensorimotor and scratching. Trial registration number [http://www.chictr.org.cn], identifier [ChiCTR1900022994].
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Affiliation(s)
- Leixiao Zhang
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zihao Zou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Siyi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- College of Health Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Liu
- Chinese Medicine Hospital, Chengdu, Sichuan, China
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Junpeng Yao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yanli Deng
- Sichuan Second Chinese Medicine Hospital, Chengdu, Sichuan, China
| | - Qian Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sijue Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Pingsheng Hao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ning Li
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Toyama S, Tominaga M, Takamori K. Treatment Options for Troublesome Itch. Pharmaceuticals (Basel) 2022; 15:ph15081022. [PMID: 36015170 PMCID: PMC9412524 DOI: 10.3390/ph15081022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 01/20/2023] Open
Abstract
Itch (or pruritus) is an unpleasant sensation, inducing the desire to scratch. It is also a major and distressing symptom of many skin and systemic diseases. The involvement of histamine, which is a major itch mediator, has been extensively examined. Recent studies suggest that histamine-independent pathways may play roles in chronic itch. Therefore, antihistamines are not always effective in the treatment of patients with chronic itch. The development of biologics and κ-opioid receptor (KOR) agonists has contributed to advances in the treatment of itch; however, since biologics are expensive for patients to purchase, some patients may limit or discontinue their use of these agents. Furthermore, KOR agonists need to be prescribed with caution due to risks of side effects in the central nervous system. Janus kinase (JAK) inhibitors are sometimes associated with side effects, such as infection. In this review, we summarize antidepressants, antineuralgics, cyclosporine A, antibiotics, crotamiton, phosphodiesterase 4 inhibitor, botulinum toxin type A, herbal medicines, phototherapy, and acupuncture therapy as itch treatment options other than antihistamines, biologics, opioids, and JAK inhibitors; we also explain their underlying mechanisms of action.
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Affiliation(s)
- Sumika Toyama
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
- Anti-Aging Skin Research Laboratory, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
- Anti-Aging Skin Research Laboratory, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
- Department of Dermatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan
- Correspondence: ; Tel.: +81-47-353-3171; Fax: +81-47-353-3178
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Micháľová A, Takáčová M, Karasová M, Kunay L, Grelová S, Fialkovičová M. Comparative Study of Classical and Alternative Therapy in Dogs with Allergies. Animals (Basel) 2022; 12:ani12141832. [PMID: 35883379 PMCID: PMC9312212 DOI: 10.3390/ani12141832] [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: 05/08/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Acupuncture, phytotherapy, and nutrition are part of traditional Chinese medicine, which has been used for literally hundreds to a few thousand years. These traditional therapeutic methods can effectively diagnose and treat acute and chronic diseases and can be used as a primary or complementary therapy. Used properly, these alternatives are safe and without side effects. Allergy is currently a very common diagnosis affecting dogs. Conventional Western medicine can treat symptoms but often does not identify and resolve the underlying problem. This comparative study was focused on the application of alternative and conventional medicine in allergic conditions in dogs, which were divided into two groups, where the effectiveness of both types of treatment was compared. Abstract Allergy is a malfunction of the immune system that causes an inappropriate reaction to normally harmless substances known as allergens, such as food components, pollen, parasites, mites, medication, etc. It is very important to make a correct diagnosis, to identify and to eliminate the offending allergen from the body, and provide control and long-term management to achieve a comfortable life for the animal. In the case of highly intensive pruritus, drugs such as glucocorticoids, antihistamines, and Janus kinase inhibitors are generally administered. Unfortunately, common drugs are not always able to resolve the problem. This comparative clinical-outcomes study focused on the application of alternatives, where a combination of acupuncture with phytotherapy and nutrition was applied. These traditional methods do not affect the body only symptomatologically; instead, they treat the patient as a whole. In this clinical study, the therapeutic effects and partial or complete stabilization of the allergic condition of fourteen dogs divided into two groups were observed, compared, and evaluated.
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Dehghan Nayyeri M, Missler M, Ritterbach R, Sundermann B, Wulms N, Süer A, Dugas M, Pereira MP, Ständer S, Schmelz M, Pfleiderer B. Altered resting-state functional connectivity of default mode network in brachioradial pruritus. J Eur Acad Dermatol Venereol 2022; 36:2214-2223. [PMID: 35796634 DOI: 10.1111/jdv.18411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic pruritus (CP) have a low quality of life, thus it is important to gain a better understanding of the underlying processes. Previous functional magnetic resonance imaging studies at rest (rs-fMRI) have shown that mainly areas associated with the default mode network (DMN), sensorimotor (SMN), frontoparietal (FPN) and salience networks (SN) are involved in the processing of itch in patients with chronic pruritus (CP), as well as the cortico-striatal circuit, which is involved in the motoric preparation of scratching. rs-fMRI studies on functional connectivity (FC) patterns of resting-state networks (RSNs) in patients with inflammatory atopic dermatitis (AD) or with neuropathic brachioradial pruritus (BRP) compared to healthy controls (HC) are lacking. OBJECTIVES The main goals of this study were to investigate whether functional connectivity within networks and areas associated with itch detection and processing are altered in patients with AD and BRP compared to matched healthy controls by rsfMRI, respectively. METHODS Patients with AD (n = 28) and with BRP (n = 28) were compared to corresponding matched healthy controls by rsfMRI. Group specific RSNs were identified by independent component analysis (ICA) and between-group differences in the RSNs were analyzed by dual regression technique. Seed-based functional connectivity was analyzed in several itch-related brain regions belonging to the DMN, SN and FPN, respectively. RESULTS ICA and seed-based analyses revealed decreased functional connectivity in BRP compared to HC specially within the DMN including the precuneus and cingulate cortex. For AD patients in comparison to HC, as well as when BRP and AD patients when compared directly, no significant FC differences at rest were seen. CONCLUSIONS Our findings point towards decreased FC particularly in the DMN at rest in patients with BRP. These results seem to indicate that central connectivity patterns at rest differentially encode itch in BRP and AD.
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Affiliation(s)
- Mahboobeh Dehghan Nayyeri
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Miriam Missler
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Rebecca Ritterbach
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel P Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, Medical Faculty Mannheim, Heidelberg of University, Mannheim, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Otto Creutzfeld Center for Cognitive and Behavioral Neuroscience, Muenster, Germany
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Tang Y, Cheng S, Wang J, Jin Y, Yang H, Lin Q, Xu S, Hui L, Yin Q, Yang Y, Wu X. Acupuncture for the Treatment of Itch: Peripheral and Central Mechanisms. Front Neurosci 2022; 15:786892. [PMID: 35431769 PMCID: PMC9005788 DOI: 10.3389/fnins.2021.786892] [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: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Despite the widespread clinical use of acupuncture in the treatment of pruritus caused by psoriasis, urticaria, uremic, and other diseases, insights into the mechanism of action of acupuncture are still emerging. For the above reasons, a beneficial effect of acupuncture on pruritus was not recommended or reported in recent clinical practice guidelines. Acupuncture is a kind of physical stimulation, which has the characteristics of multi-channel and multi-target effects. The biomechanical stimulation signal of acupuncture needling can be transformed into bioelectric and chemical signals; interfere with kinds of cells and nerve fibers in the skin and muscle; alter signaling pathways and transcriptional activity of cells, mediators, and receptors; and result in inhibition of peripheral and central transmission of pruritus. Available mechanistic data give insights into the biological regulation potency of acupuncture for pruritus and provide a basis for more in-depth and comprehensive mechanism research.
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Li JX, Dong RJ, Zeng YP. Characteristics, mechanism, and management of pain in atopic dermatitis: A literature review. Clin Transl Allergy 2021; 11:e12079. [PMID: 34962720 PMCID: PMC8805692 DOI: 10.1002/clt2.12079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 11/11/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic, pruritic, immune‐mediated inflammatory disease. Developments in basic science and clinical research have increased our understanding of AD. Although pain as a symptom of AD is underemphasized in previous studies, multiple researchers address pain as a frequent burden of AD. However, the exact role of pain in AD is not fully understood. Aims Our review aimed to summarize the current evidence focusing on characteristics, mechanism, and management of pain in AD. Materials & Methods We conducted a thorough literature review in the PubMed database to figure out different aspects discussing pain in AD, including pain symptoms, burden, the relationship between pain and itch, mechanism, and pain management in AD. Results and Conclusion AD patients affected by skin pain vary from 42.7%‐92.2% with remarkable intensity and heavy burden. Skin pain and itch interacted both in symptoms and mechanisms. Atopic skin with the impaired barrier, neurogenic inflammation mediators, peripheral and central sensitization of pain may possibly explain pain mechanism in AD. Future research is needed to clarify the commonality and disparity of pain and itch in AD in order to seek efficacious medications and treatment.
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Affiliation(s)
- Jia-Xin Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui-Jia Dong
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yue-Ping Zeng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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10
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Mu D, Sun YG. Circuit Mechanisms of Itch in the Brain. J Invest Dermatol 2021; 142:23-30. [PMID: 34662562 DOI: 10.1016/j.jid.2021.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Abstract
Itch is an unpleasant somatic sensation with the desire to scratch, and it consists of sensory, affective, and motivational components. Acute itch serves as a critical protective mechanism because an itch-evoked scratching response will help to remove harmful substances invading the skin. Recently, exciting progress has been made in deciphering the mechanisms of itch at both the peripheral nervous system and the CNS levels. Key neuronal subtypes and circuits have been revealed for ascending transmission and the descending modulation of itch. In this review, we mainly summarize the current understanding of the central circuit mechanisms of itch in the brain.
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Affiliation(s)
- Di Mu
- Department of Anesthesiology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Gang Sun
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China; Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology, Shanghai, China.
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Sutaria N, Adawi W, Goldberg R, Roh YS, Choi J, Kwatra SG. Itch: Pathogenesis and treatment. J Am Acad Dermatol 2021; 86:17-34. [PMID: 34648873 DOI: 10.1016/j.jaad.2021.07.078] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
Itch pathogenesis is broadly characterized into histaminergic and nonhistaminergic pathways and transmitted via 2 main receptor families: G protein-coupled receptors and transient receptor potential channels. In the skin, itch is primarily transmitted by unmyelinated type C and thinly myelinated type Aδ nerve fibers. Crosstalk between the immune and neural systems modulates itch transmission at the skin, spinal cord, and brain. Among the many known pruritogens, Th2 cytokines, such as interleukin-4, interleukin-13, interleukin-31, and thymic stromal lymphopoietin, are particularly important mediators that signal through shared Janus kinase pathways, representing novel targets for novel itch therapeutics. Emerging evidence has also revealed that the opioidergic system is a potent modulator of itch transmission, with increased μ-opioid activity and decreased κ-opioid activity contributing to itch pathogenesis. Optimal management of itch requires that treatment approaches be tailored to specific etiologic itch subtypes. When the etiology is unknown and patients are given a diagnosis of chronic pruritus of unknown origin, treatment should be guided by the presence of Th2 polarization, often reflected by increased blood eosinophils. In the second article of this 2-part series, we outline our current understanding of itch pathogenesis and discuss available and emerging treatments for itch.
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Affiliation(s)
- Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Waleed Adawi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Goldberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Youkyung S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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12
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Park JG, Lee H, Yeom M, Chae Y, Park HJ, Kim K. Effect of acupuncture treatment in patients with mild to moderate atopic dermatitis: a randomized, participant- and assessor-blind sham-controlled trial. BMC Complement Med Ther 2021; 21:132. [PMID: 33926433 PMCID: PMC8082608 DOI: 10.1186/s12906-021-03306-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease that affects 1–3% of adults worldwide. Currently, it is not possible to completely cure AD; therefore, alternative treatments need to be developed to meet the patients’ needs. Here, based on our previous pilot study, we conducted the first confirmatory randomized controlled trial to evaluate the effect of acupuncture in patients with mild to moderate AD. Methods A randomized, participant- and assessor-blinded, sham-controlled trial was designed with an intervention period twice-weekly for 4 weeks and a 4-week follow-up. We equally allocated 36 participants to the verum acupuncture (VA) and sham acupuncture (SA) groups. The main outcome measure was the change in SCORing Atopic Dermatitis index (SCORAD) score before and after treatment. Results A total of 36 participants, aged 19 to 38 years, were enrolled, and 35 were included in the intention-to-treat analyses. The mean change in total SCORAD score differed significantly among the two groups at 4 weeks after randomization (P < .0001): the mean difference was − 11.83 (7.05) in the VA group and 0.45 (7.77) in the SA group. The mean SCORAD score substantially decreased 2-weeks after starting the acupuncture treatment and continued to improve for at least 4 weeks after the end of the treatment in the VA group compared to the SA group (each P < .0001). No serious adverse events were observed. Conclusions Twice-weekly acupuncture treatment was effective in reducing AD symptoms in patients with mild to moderate AD without serious adverse events. Trial registration Clinical Research Information Service Identifier: KCT0002796. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03306-1.
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Affiliation(s)
- Jung Gun Park
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyangsook Lee
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea.,Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea
| | - Mijeong Yeom
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea
| | - Younbyoung Chae
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea.,Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea
| | - Hi-Joon Park
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea. .,Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea.
| | - Kyuseok Kim
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea.
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13
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Kim KY, Kim JSTW, Tsai AWW, Hsing WT. Acupuncture for the Treatment of Itch: Literature Review and Future Perspectives. Med Acupunct 2021; 33:137-143. [PMID: 33912270 DOI: 10.1089/acu.2020.1445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic pruritus is a prevalent, multifactorial and debilitating condition that is often underestimated. This article reviews current evidence to evaluate the efficacy of acupuncture for the treatment of itch. Results: Although many researchers have conducted observational studies, clinical trials, and systematic reviews on the subject, the lack of more-robust and well-designed studies to prove the effectiveness of acupuncture in the management of itch is evident. Many published studies are of poor quality, with no clear description of randomization methods, and an absence of control groups and measurable clinical outcomes. In addition, a lack of standardization in methods for assessing pruritus and the acupuncture treatment protocols hinders more-comprehensive and higher-quality pooled data analysis. Conclusions: Current evidence cannot fully support acupuncture for the treatment of itch yet.
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Affiliation(s)
- Kevin Yun Kim
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - André Wan Wen Tsai
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Wu Tu Hsing
- Acupuncture Center of the Orthopedics and Traumatology Institute, University of São Paulo Medical School, São Paulo, Brazil
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14
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Lee IS, Kim K, Park HJ, Lee H, Jung WM, Kim DW, Chae Y. Neural Oscillation Associated with Contagious Itch in Patients with Atopic Dermatitis. Brain Sci 2021; 11:brainsci11040438. [PMID: 33805350 PMCID: PMC8067125 DOI: 10.3390/brainsci11040438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Itch is an unpleasant sensation associated with an urge to scratch and is a major health care issue associated with atopic dermatitis (AD). Contagious itch, i.e., subjective feelings of itchiness induced by watching others’ scratching behavior, is common in patients with AD. Using electroencephalography, we examined alpha (8–13 Hz) oscillations in sensorimotor areas associated with the desire to scratch in patients with AD. Methods: Thirty-six patients with AD and 34 healthy controls (HCs) participated in this study. They evaluated their itch levels after watching short videos of a model scratching or tapping parts of his body. Neural oscillations were recorded from nine electrodes, including those placed over sensorimotor areas. Time–frequency analysis was used to compare mu rhythm suppression over the sensorimotor areas in response to these videos between patients with AD and HCs. Results: The behavioral test showed that the visual stimuli induced increased feelings of itchiness in patients with AD relative to HCs under the tapping and scratching conditions. The time–frequency analysis revealed that mu rhythm suppression in response to scratching images was significantly prominent in patients with AD, but not in HCs. Conclusion: Patients with AD exhibited increased susceptibility to contagious itch. This phenomenon might be related to enhanced mu rhythm suppression in sensorimotor areas of the brain in these patients. Our findings provide new insight into the neurophysiological basis of itch sensations in patients with AD.
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Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Kyuseok Kim
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Won-Mo Jung
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Do-Won Kim
- Department of Biomedical Engineering, Chonnam National University, Yeosu 59626, Korea
- Correspondence: (D.-W.K.); (Y.C.)
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
- Correspondence: (D.-W.K.); (Y.C.)
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15
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Najafi P, Misery L, Carré JL, Ben Salem D, Dufor O. Itch Matrixes. Front Med (Lausanne) 2021; 8:636904. [PMID: 33718409 PMCID: PMC7943862 DOI: 10.3389/fmed.2021.636904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peyman Najafi
- Univ Brest, LIEN, Brest, France.,Paris-Saclay Institute of Neuroscience, Centre National de la Recherche Scientifique/Université Paris-Saclay, Gif-sur-Yvette, France
| | - Laurent Misery
- Univ Brest, LIEN, Brest, France.,University Hospital of Brest, Department of Dermatology, Brest, France
| | | | - Douraied Ben Salem
- Univ Brest, LATIM, INSERM UMR, Brest, France.,University Hospital of Brest, Department of Radiology, Brest, France
| | - Olivier Dufor
- Univ Brest, LIEN, Brest, France.,L@bISEN Yncréa Ouest, ISEN, Brest, France
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16
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Abstract
Chronic pruritus, defined as an unpleasant sensation resulting in a need to scratch that lasts more than 6 weeks, is a prevalent and bothersome symptom associated with both cutaneous and systemic conditions. Due to complex pathogenesis and profuse contributing factors, chronic pruritus therapy remains challenging. Regardless of the well-established antipruritic properties of classic pharmacotherapy (topical therapy, phototherapy and systemic therapy), these methods often provide insufficient relief for affected individuals. Owing to the growing interest in the field of pruritic research, further experimental and clinical data have emerged, continuously supporting the possibility of instigating novel therapeutic measures. This review covers the most relevant current modalities remaining under investigation that possess promising perspectives of approval in the near future, especially opioidergic drugs (mu-opioid antagonists and kappa-opioid agonists), neurokinin-1 receptor antagonists, biologic drugs, Janus kinase inhibitors, ileal bile acid transporter inhibitors, aryl hydrocarbon receptor agonists and histamine H4 receptor antagonists.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland
| | - Piotr Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland.
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17
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Zhang L, Deng Y, Yao J, Xiao X, Yu S, Shi Y, Zheng H, Zheng Q, Zhou S, Cao W, Liu Y, Hao P, Li Y. Acupuncture for patients with chronic pruritus: protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e034784. [PMID: 32819932 PMCID: PMC7440697 DOI: 10.1136/bmjopen-2019-034784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic pruritus (CP) frequently occurs in many skin and systemic diseases, and adversely affects quality of life. This systematic review aims to evaluate treatment effects of acupuncture on CP. METHODS AND ANALYSIS An electronic and manual search will be conducted for all acupuncture treatments for CP, from the inception date of predefined database up to 28 February 2020. Databases include PubMed, Embase, Springer, Web of Science, the Cochrane Library, the World Health Organization International Clinical Trial Registration Platform, the Chinese Medicine Database, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the China Science Journal Database and the Wanfang Database. Other sources, including existing systematic reviews, conference proceedings and reference lists of identified publications will also be searched. Additionally, any clinical randomised controlled trials related to acupuncture treatment for CP, regardless of the publication status and language limitations, will be included. Study selection, data extraction and research quality assessments will be conducted independently by two researchers. The primary outcome measures include the Visual Analogue Scale, Urdu 5D-Itch Scale or other validated scales implemented after at least 2 weeks of treatment. Secondary outcomes include the effective rate, Quality of Life Scale (eg, the EQ-5D third level, the Dermatology Life Quality Index, etc.), Pittsburgh Sleep Quality Index, recurrence rate during the follow-up period and adverse events. If possible, meta-analyses will be performed using RevMan V.5.3 statistical software; otherwise, a descriptive analysis or subgroup analysis will be conducted. The results will be presented as the risk ratio of the binary data and the mean difference (MD) or standardised MD of the continuous data. ETHICS AND DISSEMINATION This systematic review protocol does not require formal ethical approval because the data are not personalised. It will be published in peer-reviewed journals and presented at international academic conferences. PROSPERO REGISTRATION NUMBER CRD42019136727.
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Affiliation(s)
- Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanli Deng
- Sichuan Second Chinese Medicine Hospital, Chengdu, China
| | - Junpeng Yao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- The People's Hospital of Jianyang City, Jianyang, China
| | - Siyi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - SiYuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pingsheng Hao
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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18
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Qiu K, Yin T, Hong X, Sun R, He Z, Liu X, Ma P, Yang J, Lan L, Li Z, Tang C, Cheng S, Liang F, Zeng F. Does the Acupoint Specificity Exist? Evidence from Functional Neuroimaging Studies. Curr Med Imaging 2020; 16:629-638. [PMID: 32723234 DOI: 10.2174/1573405615666190220113111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Using functional neuroimaging techniques to explore the central mechanism of acupoint specificity, the key of acupuncture theory and clinical practice, has attracted increasing attention worldwide. This review aimed to investigate the current status of functional neuroimaging studies on acupoint specificity and explore the potential influencing factors for the expression of acupoint specificity in neuroimaging studies. METHODS PubMed database was searched from January 1st, 1995 to December 31st, 2016 with the language restriction in English. Data including basic information, methodology and study results were extracted and analyzed from the eligible records. RESULTS Seventy-nine studies were finally enrolled. 65.8% of studies were performed in China, 73.4% of studies were conducted with healthy subjects, 77.2% of studies chose manual acupuncture as the intervention, 86.1% of studies focused on the instant efficacy and 89.9% of studies used functional magnetic resonance imaging as scanning technique. The average sample size was 16 per group. The comparison of verum acupoints and sham acupoints were the main body of acupoint specificity researches. 93.7% of studies obtained the positive results and favored the existence of acupoint specificity. CONCLUSION This review affirmed the existence of acupoint specificity and deemed that the acupoint specificity was relative. Multiple factors such as participants, sample size, acupoint combinations, treatment courses, and types of acupoint could influence the expression of acupoint specificity.
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Affiliation(s)
- Ke Qiu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Xiaojuan Hong
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Ruirui Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Zhaoxuan He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Xiaoyan Liu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Peihong Ma
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Jie Yang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Lei Lan
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Zhengjie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Chenjian Tang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Shirui Cheng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
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Golpanian RS, Kim HS, Yosipovitch G. Effects of Stress on Itch. Clin Ther 2020; 42:745-756. [PMID: 32147148 DOI: 10.1016/j.clinthera.2020.01.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Psychological stress and ensuing modulation of the immune and nervous systems can have a significant impact on itch. Stress can exacerbate itch and vice versa, resulting in a vicious cycle that can greatly impair a patient's quality of life. This review summarizes the association between stress and itch, elucidates the mechanism by which these two phenomena influence one another, and explores treatment modalities that aim to reduce stress-induced itch. METHODS A complete search of the PubMed and Google Scholar databases was completed and literature pertinent to this review was compiled. FINDINGS Both acute and chronic stress can significantly affect itch in healthy individuals and in those diagnosed with itchy skin diseases as well as systemic diseases, thus resulting in a vicious cycle in which stress exacerbates itch and vice versa. The mechanisms by which stress induces or aggravates itch include both central and peripheral activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. Activation of these systems, in turn, affects the mast cells, keratinocytes, and nerves that secrete neuropeptides, such as substance P, nerve growth factor, acetylcholine, histamine, and itchy cytokines. A dysfunctional parasympathetic response is thought to be involved in the chronic stress/itch response. Brain structures associated with emotion, such as the limbic system and periaqueductal gray, which work on the descending facilitation of itch, play a significant role in stress-induced itch. IMPLICATIONS As specific brain structures are associated with stress, drug treatments targeting these areas (ie, γ-aminobutyric acid-ergic drugs, serotonin and norepinephrine reuptake inhibitors) may help to modulate itch. Stress can also be combatted using nonpharmacologic treatments such as cognitive-behavioral therapies and stress-relieving holistic approaches (eg, yoga, acupuncture).
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Affiliation(s)
- Rachel Shireen Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hei Sung Kim
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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20
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Najafi P, Carré JL, Ben Salem D, Brenaut E, Misery L, Dufor O. Central mechanisms of itch: A systematic literature review and meta-analysis. J Neuroradiol 2019; 47:450-457. [PMID: 31809769 DOI: 10.1016/j.neurad.2019.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
In recent years, studying the central mechanism of itch has gained momentum. However, a proper meta-analysis has not been conducted in this domain. In this study, we tried to respond to this need. A systematic search and a meta-analysis were carried out to estimate the central mechanism of itch. The itch matrix comprises the thalamus and the parietal, secondary somatosensory, insular and cingulate cortices. We have shown that the basal ganglia (BG) play an important role in itch reduction. Finally, we explored itch processing in AD patients and observed that the itch matrix in these patients was different. In conclusion, this is the first meta-analysis on the central mechanisms of itch perception and processing. Our study demonstrated that different modalities of itch induction can produce a common pattern of activity in the brain and provided further insights into understanding the underlying nature of itch central perception.
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Affiliation(s)
| | - Jean-Luc Carré
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Douraied Ben Salem
- LaTIM, Inserm UMR 1101, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Emilie Brenaut
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Laurent Misery
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France.
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21
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Sensitization Mechanisms of Chronic Itch. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.1097/jd9.0000000000000045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Yosipovitch G, Rosen JD, Hashimoto T. Itch: From mechanism to (novel) therapeutic approaches. J Allergy Clin Immunol 2019; 142:1375-1390. [PMID: 30409247 DOI: 10.1016/j.jaci.2018.09.005] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
Itch is a common sensory experience that is prevalent in patients with inflammatory skin diseases, as well as in those with systemic and neuropathic conditions. In patients with these conditions, itch is often severe and significantly affects quality of life. Itch is encoded by 2 major neuronal pathways: histaminergic (in acute itch) and nonhistaminergic (in chronic itch). In the majority of cases, crosstalk existing between keratinocytes, the immune system, and nonhistaminergic sensory nerves is responsible for the pathophysiology of chronic itch. This review provides an overview of the current understanding of the molecular, neural, and immune mechanisms of itch: beginning in the skin, proceeding to the spinal cord, and eventually ascending to the brain, where itch is processed. A growing understanding of the mechanisms of chronic itch is expanding, as is our pipeline of more targeted topical and systemic therapies. Our therapeutic armamentarium for treating chronic itch has expanded in the last 5 years, with developments of topical and systemic treatments targeting the neural and immune systems.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla.
| | - Jordan Daniel Rosen
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
| | - Takashi Hashimoto
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
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23
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Mochizuki H, Hernandez LE, Yosipovitch G, Sadato N, Kakigi R. The Functional Network Processing Acute Electrical Itch Stimuli in Humans. Front Physiol 2019; 10:555. [PMID: 31156452 PMCID: PMC6529842 DOI: 10.3389/fphys.2019.00555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/23/2019] [Indexed: 01/31/2023] Open
Abstract
The posterior insula (pIns) is a major brain region that receives itch-related signals from the periphery and transfers these signals to broad areas in the brain. Previous brain imaging studies have successfully identified brain regions that respond to itch stimuli. However, it is still unknown which brain regions receive and process itch-related signals from the pIns. Addressing this question is important in identifying key functional networks that process itch. Thus, the present study investigated brain regions with significantly increased functional connectivity with the pIns during itch stimuli with 25 healthy subjects by using functional MRI. Electrical itch stimuli was applied to the left wrist. Similar to previous brain imaging studies, many cortical and subcortical areas were activated by itch stimuli. However, not all of these regions showed significant increments of functional connectivity with the pIns during itch stimuli. While the subjects perceived the itch sensation, functional connectivity was significantly increased between the right pIns and the supplementary motor area (SMA), pre-SMA, anterior midcingulate cortex (aMCC), anterior insula (aIns), secondary somatosensory cortex (SII), and basal ganglia (BG), suggesting that this is a key network in processing itch. In particular, intensity of functional connectivity between the pIns and BG was negatively correlated with itch rating. The functional pIns-BG pathway may play an important role in regulation of subjective itch sensation. This study first identified a key brain network to process itch.
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Affiliation(s)
- Hideki Mochizuki
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan
| | - Loren E Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Norihiro Sadato
- Department of System Neuroscience, National Institute for Physiological Sciences, Okazaki, Japan
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan
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Park JG, Park HJ, Chae Y, Kim YK, Lee H, Kim K. Acupuncture Treatment for Symptom Management in Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:1907578. [PMID: 31186656 PMCID: PMC6521562 DOI: 10.1155/2019/1907578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/09/2019] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with persistent itching, which impairs quality of life (QoL). Although various conventional treatments for AD exist, patients with AD often seek complementary and alternative therapies when conventional therapy has failed to relieve their AD symptoms or has had adverse effects. Acupuncture treatment may relieve AD symptoms, but controlled trials are needed to confirm this. Following our pilot study, which found that acupuncture treatment improves AD symptoms in mild-to-moderate AD patients, we will assess the effect of acupuncture treatment for symptom relief of AD using a trial with a complemented protocol. This is a two-arm, randomized, participant- and assessor-blinded, sham-controlled trial. A total of 36 mild-to-moderate AD patients will be randomly assigned in a 1:1 ratio to receive eight sessions twice weekly of either verum acupuncture (VA) or nonpenetrating sham acupuncture (SA) over four weeks. The primary outcome measured will be the change in the total Scoring Atopic Dermatitis (SCORAD) score. Secondary outcomes will be (1) changes in AD symptoms, QoL, dyspepsia symptoms, and electroencephalography (EEG) between baseline and week 4 and (2) changes in AD symptoms and QoL at baseline and at weeks 2, 4, and 8. This study will assess acupuncture treatment for the alleviation of AD symptoms in patients with mild-to-moderate AD. This clinical trial gas been registered in Korean Clinical Trial Registry (registration number: KCT0002796; date of registration: April 13, 2018).
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Affiliation(s)
- Jung Gun Park
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hi-Joon Park
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Younbyoung Chae
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yu-Kang Kim
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyangsook Lee
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kyuseok Kim
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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25
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Min S, Kim KW, Jung WM, Lee MJ, Kim YK, Chae Y, Lee H, Park HJ. Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Front Neurosci 2019; 13:215. [PMID: 30914919 PMCID: PMC6423085 DOI: 10.3389/fnins.2019.00215] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/25/2019] [Indexed: 12/19/2022] Open
Abstract
Previous studies have suggested that acupuncture is effective for ameliorating itch intensity. However, factors associated with the antipruritic effects of acupuncture have yet to be clarified. In a randomized, sham-controlled, crossover trial, we investigated the antipruritic effects of acupuncture against histamine-induced itch in healthy volunteers. Autonomic changes using heart rate variability (HRV) and brain connectivity using functional magnetic resonance imaging (fMRI) were also assessed to identify physiological factors associated with the acupuncture response. Acupuncture significantly reduced itch intensity and skin blood perfusion as assessed by laser Doppler perfusion imaging compared to sham control, indicating the antipruritic effects of acupuncture. In responder and non-responder analysis, the power of normalized high frequency (HF norm) was significantly higher, while the power of normalized low frequency (LF norm) and LF/HF ratio were significantly lower in responders compared to non-responders, suggesting the acupuncture response involved parasympathetic activation. In fMRI analysis, the putamen and the posterior part of the midcingulate cortex (pMCC) were positively connected to itch and negatively correlated with itch intensity in responders. These results suggest that parasympathetic activity and functional connectivity of the putamen and pMCC could be associated with antipruritic response to acupuncture.
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Affiliation(s)
- Seorim Min
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,East-West Medical Research Institute, Kyung Hee University, Seoul, South Korea
| | - Won-Mo Jung
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Min-Jung Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Yu-Kang Kim
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hyangsook Lee
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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27
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Current Tracking on Effectiveness and Mechanisms of Acupuncture Therapy: A Literature Review of High-Quality Studies. Chin J Integr Med 2019; 26:310-320. [DOI: 10.1007/s11655-019-3150-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 02/07/2023]
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28
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Kang S, Kim YK, Yeom M, Lee H, Jang H, Park HJ, Kim K. Acupuncture improves symptoms in patients with mild-to-moderate atopic dermatitis: A randomized, sham-controlled preliminary trial. Complement Ther Med 2018; 41:90-98. [DOI: 10.1016/j.ctim.2018.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/22/2022] Open
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29
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Xiong W, He FF, You RY, Xiong J, Wang YM, Zhang C, Meng XF, Su H. Acupuncture Application in Chronic Kidney Disease and its Potential Mechanisms. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2018; 46:1169-1185. [PMID: 30286626 DOI: 10.1142/s0192415x18500611] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The number of CKD patients on hemodialysis is growing rapidly as well. Acupuncture technique is one of the traditional Chinese medicine methods and has been used in a variety of diseases. Nowadays, the clinical application of acupuncture technique for CKD patients has become the focus for its effectiveness and security. In this paper, we will review the therapeutic effects and mechanisms of different acupuncture techniques for CKD patients. In patients with CKD, acupuncture improves renal function, reduces proteinuria, controls hypertension, corrects anemia, relieves pain, and controls many hemodialysis-related complications such as uremic pruritus, insomnia and fatigue. The mechanisms are related to the regulation of sympathetic nerve and the activation of bioactive chemicals. In conclusion, acupuncture is proved to be beneficial for CKD patients. More research, however, is needed to verify the potential mechanisms.
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Affiliation(s)
- Wei Xiong
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Fang-Fang He
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Ren-Yu You
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Jing Xiong
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Yu-Mei Wang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
| | - Xian-Fang Meng
- Department of Neurobiology, School of Basic Medical Sciences, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China
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30
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Abstract
Itch is an unpleasant sensation that initiates scratching behavior. The itch-scratch reaction is a complex phenomenon that implicates supraspinal structures required for regulation of sensory, emotional, cognitive, and motivational aspects. However, the central mechanisms underlying the processing of itch and the interplay of the supraspinal regions and spinal cord in regulating itch-scratch processes are poorly understood. Here, we have shown that the neural projections from anterior cingulate cortex (ACC) to dorsal medial striatum (DMS) constitute a critical circuit element for regulating itch-related behaviors in the brains of male C57BL/6J mice. Moreover, we demonstrate that ACC-DMS projections selectively modulate histaminergic, but not nonhistaminergic, itch-related behavior. Furthermore, photoactivation of ACC-DMS projections has also no significant effects on pain behavior induced by thermal, mechanical, and chemical stimuli except for a relief on inflammatory pain evoked by formalin and complete Freund's adjuvant. We further demonstrate that the dorsal spinal cord exerts an inhibitory effect on itch signal from ACC-DMS projections through B5-I neurons, which represent a population of spinal inhibitory interneurons that mediate the inhibition of itch. Therefore, this study presents the first evidence that the ACC-DMS projections modulate histaminergic itch-related behavior and reveals an interplay between the supraspinal and spinal levels in histaminergic itch regulation.SIGNIFICANCE STATEMENT This study reveals that the projections from anterior cingulate cortex (ACC) to dorsal medial striatum (DMS) constitute a supraspinal circuit for modulation of histaminergic, but not nonhistaminergic, itch. Manipulation of ACC-DMS projections has no effect on acute pain sensation. Furthermore, the dorsal spinal cord exerts an inhibitory effect on itch signal from ACC-DMS projections through B5-I neurons. Understanding the supraspinal itch circuits is of great significance in the development of new therapies for chronic itch-related intractable diseases.
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31
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The vicious cycle of itch and anxiety. Neurosci Biobehav Rev 2018; 87:17-26. [PMID: 29374516 DOI: 10.1016/j.neubiorev.2018.01.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/28/2017] [Accepted: 01/21/2018] [Indexed: 12/21/2022]
Abstract
Chronic itch is associated with increased stress, anxiety, and other mood disorders. In turn, stress and anxiety exacerbate itch, leading to a vicious cycle that affects patient behavior (scratching) and worsens disease prognosis and quality of life. This cycle persists across chronic itch conditions of different etiologies and even to some extent in healthy individuals, suggesting that the final common pathway for itch processing (the central nervous system) plays a major role in the relationship between itch and anxiety. Pharmacological and nonpharmacological treatments that reduce anxiety have shown promising anti-itch effects. Further research is needed to establish specific central mechanisms of the itch-anxiety cycle and provide new targets for treatment.
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32
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Wang Y, Fang JL, Cui B, Liu J, Song P, Lang C, Bao Y, Sun R, Xu C, Ding X, Yan Z, Yan Y, Kong Q, Kong J. The functional and structural alterations of the striatum in chronic spontaneous urticaria. Sci Rep 2018; 8:1725. [PMID: 29379058 PMCID: PMC5789061 DOI: 10.1038/s41598-018-19962-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/11/2018] [Indexed: 12/16/2022] Open
Abstract
The brain has long been known to be the regulation center of itch, but the neuropathology of chronic itch, such as chronic spontaneous urticaria (CSU), remains unclear. Thus, we aimed to explore the brain areas involved in the pathophysiology of CSU in hopes that our results may provide valuable insights into the treatment of chronic itch conditions. 40 CSU patients and 40 healthy controls (HCs) were recruited. Urticaria activity scores 7 (UAS7) were collected to evaluate patient’s clinical symptoms. Amplitude of low frequency fluctuations (ALFF), voxel-based morphometry (VBM), and seed-based resting-state functional connectivity (rs-FC) analysis were used to assess brain activity and related plasticity. Compared with HCs, CSU patients exhibited 1) higher ALFF values in the right ventral striatum / putamen, which were positively associated with clinical symptoms as measured by UAS7; 2) gray matter volume (GMV) increase in the right ventral striatum and putamen; and 3) decreased rs-FC between the right ventral striatum and the right occipital cortex and between the right putamen and the left precentral gyrus. Using multiple-modality brain imaging tools, we demonstrated the dysfunction of the striatum in CSU. Our results may provide valuable insights into the neuropathology and development of chronic itch.
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Affiliation(s)
- Yuming Wang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China. .,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.
| | - Ji-Liang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Bingnan Cui
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jiao Liu
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, China
| | - Ping Song
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA
| | - Yan Bao
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ruirui Sun
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA
| | - Chenchen Xu
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xu Ding
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Zhifang Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuhe Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Qian Kong
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.
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Abstract
Itch, or pruritus, is a hallmark feature of atopic dermatitis (AD). The impact of AD-related pruritus can range from mildly distressing or distracting to completely disabling. Traditionally, management of itch in AD patients has focused on restoring the altered skin barrier with topical emollients and/or reducing inflammation. A growing emphasis has been placed on directly targeting the neural transmission pathways that mediate itch signaling. Off-label use of neuromodulatory agents has helped reduce this aggravating symptom in atopic patients. This article reviews the current literature on the use of neuromodulatory agents and nonpharmacologic alternative therapies used to treat AD-related pruritus.
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Affiliation(s)
- Sarina B Elmariah
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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34
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Mueller SM, Hogg S, Mueller JM, McKie S, Itin P, Reinhardt J, Griffiths CE, Kleyn CE. Functional magnetic resonance imaging in dermatology: The skin, the brain and the invisible. Exp Dermatol 2017; 26:845-853. [DOI: 10.1111/exd.13305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Simon M. Mueller
- Department of Dermatology; University Hospital Basel; Basel Switzerland
- Dermatology Centre; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Samuel Hogg
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - Jannis M. Mueller
- Department of Neurology; Kantonsspital Muensterlingen; Muensterlingen Switzerland
| | - Shane McKie
- Neuroscience and Psychiatry Unit; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Peter Itin
- Dermatology Centre; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Julia Reinhardt
- Division of Diagnostic & Interventional Neuroradiology; University Hospital Basel; Basel Switzerland
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35
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Lee JS, Han JS, Lee K, Bang J, Lee H. The peripheral and central mechanisms underlying itch. BMB Rep 2017; 49:474-87. [PMID: 27418284 PMCID: PMC5227140 DOI: 10.5483/bmbrep.2016.49.9.108] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 12/20/2022] Open
Abstract
Itch is one of the most distressing sensations that substantially impair quality of life. It is a cardinal symptom of many skin diseases and is also caused by a variety of systemic disorders. Unfortunately, currently available itch medications are ineffective in many chronic itch conditions, and they often cause undesirable side effects. To develop novel therapeutic strategies, it is essential to identify primary afferent neurons that selectively respond to itch mediators as well as the central nervous system components that process the sensation of itch and initiate behavioral responses. This review summarizes recent progress in the study of itch, focusing on itch-selective receptors, signaling molecules, neuronal pathways from the primary sensory neurons to the brain, and potential decoding mechanisms based on which itch is distinguished from pain. [BMB Reports 2016; 49(9): 474-487]
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Affiliation(s)
- Jae Seung Lee
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988, Korea
| | | | - Kyeongho Lee
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988, Korea
| | - Juwon Bang
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988, Korea
| | - Hyosang Lee
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988, Korea
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37
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The Status of the Quality Control in Acupuncture-Neuroimaging Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:3685785. [PMID: 27242911 PMCID: PMC4875991 DOI: 10.1155/2016/3685785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/03/2016] [Accepted: 03/27/2016] [Indexed: 12/31/2022]
Abstract
Using neuroimaging techniques to explore the central mechanism of acupuncture gains increasing attention, but the quality control of acupuncture-neuroimaging study remains to be improved. We searched the PubMed Database during 1995 to 2014. The original English articles with neuroimaging scan performed on human beings were included. The data involved quality control including the author, sample size, characteristics of the participant, neuroimaging technology, and acupuncture intervention were extracted and analyzed. The rigorous inclusion and exclusion criteria are important guaranty for the participants' homogeneity. The standard operation process of acupuncture and the stricter requirement for acupuncturist play significant role in quality control. More attention should be paid to the quality control in future studies to improve the reproducibility and reliability of the acupuncture-neuroimaging studies.
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38
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Napadow V, Li A, Loggia M, Kim J, Mawla I, Desbordes G, Schalock PC, Lerner EA, Tran TN, Ring J, Rosen BR, Kaptchuk TJ, Pfab F. The imagined itch: brain circuitry supporting nocebo-induced itch in atopic dermatitis patients. Allergy 2015; 70:1485-92. [PMID: 26280659 DOI: 10.1111/all.12727] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo-induced itch, but is currently unknown. METHODS We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within-subject design, and contrast brain response to nocebo saline understood to be allergen vs open-label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients. RESULTS Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) - brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo-induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo-induced itch also demonstrated greater placebo reduction of allergen-evoked itch, suggesting increased generalized modulation of itch perception. CONCLUSIONS Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo-induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients.
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Affiliation(s)
- V. Napadow
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
- Department of Radiology; Logan University; Chesterfield MO USA
| | - A. Li
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - M.L. Loggia
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - J. Kim
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - I. Mawla
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - G. Desbordes
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - P. C. Schalock
- Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - E. A. Lerner
- Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - T. N. Tran
- Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - J. Ring
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
| | - B. R. Rosen
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
| | - T. J. Kaptchuk
- Program in Placebo Studies; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | - F. Pfab
- Martinos Center for Biomedical Imaging; Massachusetts General Hospital; Harvard Medical School; Charlestown MA USA
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
- Department of Prevention and Sports Medicine; Technische Universität München; Munich Germany
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39
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Tan HY, Lenon GB, Zhang AL, Xue CC. Efficacy of acupuncture in the management of atopic dermatitis: a systematic review. Clin Exp Dermatol 2015; 40:711-5; quiz 715-6. [DOI: 10.1111/ced.12732] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- H. Y. Tan
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - G. B. Lenon
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - A. L. Zhang
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
| | - C. C. Xue
- Traditional and Complementary Medicine Research Program; Health Innovations Research Institute; School of Health Sciences; RMIT University; Bundoora Campus Bundoora Campus Victoria Australia
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40
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Kim HJ, Park JB, Lee JH, Kim IH. How stress triggers itch: a preliminary study of the mechanism of stress-induced pruritus using fMRI. Int J Dermatol 2015; 55:434-42. [DOI: 10.1111/ijd.12864] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/25/2014] [Accepted: 09/09/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Hee Joo Kim
- Department of Dermatology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan South Korea
- Department of Dermatology; Severance Hospital; Yonsei University College of Medicine; Seoul South Korea
| | - Jae Beom Park
- Department of Dermatology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan South Korea
| | - Jong Hwan Lee
- Department of Brain and Cognitive Engineering; Korea University; Seoul South Korea
| | - Il-Hwan Kim
- Department of Dermatology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan South Korea
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41
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Mochizuki H, Kakigi R. Itch and brain. J Dermatol 2015; 42:761-7. [DOI: 10.1111/1346-8138.12956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Hideki Mochizuki
- Department of Dermatology; Temple University School of Medicine; Temple Itch Center; Philadelphia Pennsylvania USA
| | - Ryusuke Kakigi
- Department of Integrative Physiology; National Institute for Physiological Sciences; Okazaki Japan
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42
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Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out? Clin Rev Allergy Immunol 2015; 51:263-292. [DOI: 10.1007/s12016-015-8488-5] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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43
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Efficacy of Acupuncture in Itch: A Systematic Review and Meta-Analysis of Clinical Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:208690. [PMID: 26064156 PMCID: PMC4430643 DOI: 10.1155/2015/208690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 12/11/2022]
Abstract
Background. Itch (pruritus) is a sensitive state that provokes the desire to scratch. It is not only a common symptom of skin diseases but it also occurs in some systemic diseases. Clinical studies on the efficacy of the acupuncture therapy in alleviating itch are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking. Objective. This systematic review aims to assess the effectiveness of acupuncture therapy for itch. Materials and Methods. A comprehensive literature search of eight databases was performed up to June 2014, and randomized controlled trials which compared acupuncture therapy and placebo acupuncture or no treatment group were identified. Accordingly, a meta-analysis was conducted. Results. This review included three articles of randomized controlled trials (RCTs) from a total of 2530 articles. The results of Meta-analysis showed that acupuncture therapy was effective to alleviate itch compared with placebo acupuncture and no treatment group. Conclusion. Based on the findings of this systematic review, we cautiously suggest that acupuncture therapy could improve the clinical efficacy of itch. However, this conclusion needs more studies on various ethnic samples to confirm our final conclusion.
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He T, Zhu W, Du SQ, Yang JW, Li F, Yang BF, Shi GX, Liu CZ. Neural mechanisms of acupuncture as revealed by fMRI studies. Auton Neurosci 2015; 190:1-9. [PMID: 25900479 DOI: 10.1016/j.autneu.2015.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
Abstract
As an ancient therapeutic method, acupuncture has been used to treat many diseases as an adjunctive therapy. However, its clinical efficacy remains controversial and the neural mechanisms have not been well understood. Accumulating studies have revealed that fMRI has made it possible to study brain responses to acupuncture. This review aims to provide scientific evidence to support the notion and discuss how these findings contribute to the neural mechanisms of acupuncture.
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Affiliation(s)
- Tian He
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Wen Zhu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Si-Qi Du
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Jing-Wen Yang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Fang Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Bo-Feng Yang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Guang-Xia Shi
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Cun-Zhi Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China.
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45
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Abstract
Pain and itch are generally regarded antagonistic as painful stimuli such as scratching suppresses itch. Moreover, inhibition of pain processing by opioids generates itch further supporting their opposing role. Separate specific pathways for itch and pain processing have been uncovered, and several molecular markers have been established in mice that identify neurons involved in the processing of histaminergic and non-histaminergic itch on primary afferent and spinal level. These results are in agreement with the specificity theory for itch and might suggest that pain and itch should be investigated separately on the level of neurons, mediators, and mechanisms. However, in addition to broadly overlapping mediators of itch and pain, there is also evidence for overlapping functions in primary afferents: nociceptive primary afferents can provoke itch when activated very locally in the epidermis, and sensitization of both nociceptors and pruriceptors has been found following local nerve growth factor application in volunteers. Thus, also mechanisms that underlie the development of chronic itch and pain including spontaneous activity and sensitization of primary afferents as well as spinal cord sensitization may well overlap to a great extent. Rather than separating itch and pain, research concepts should therefore address the common mechanisms. Such an approach appears most appropriate for clinical conditions of neuropathic itch and pain and also chronic inflammatory conditions. While itch researchers can benefit from the large body of information of the pain field, pain researchers will find behavioral readouts of spontaneous itch much simpler than those for spontaneous pain in animals and the skin as source of the pruritic activity much more accessible even in patients.
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Affiliation(s)
- Martin Schmelz
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, Mannheim, 68167, Germany,
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46
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Yosipovitch G, Mochizuki H. Neuroimaging of itch as a tool of assessment of chronic itch and its management. Handb Exp Pharmacol 2015; 226:57-70. [PMID: 25861774 DOI: 10.1007/978-3-662-44605-8_4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic itch is a multidimensional physical state strongly associated with emotional and cognitive aspects of suffering that causes the urge to scratch. Pathophysiology, psychological stress, and social milieu can influence itch. Here, we review brain neuroimaging research in humans that detects functional and anatomic changes in health and disease states. New data are emerging that are shaping our understanding of itch mechanisms and scratching-the behavioral response as well as the effect of treatments and brain dynamics during itch. Future developments will continue to expand our knowledge of itch mechanisms, allowing translation to clinical assessment and novel therapies focused on the brain, the final relay of itch transmission.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology and Temple Itch Center, Temple University Medical Center, 3322 North Broad Street, Suite 212, Philadelphia, PA, 19140, USA,
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47
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Abstract
As we all can easily differentiate the sensations of itch and pain, the most straightforward neurophysiologic concept would consist of two specific pathways that independently encode itch and pain. Indeed, a neuronal pathway for histamine-induced itch in the peripheral and central nervous system has been described in animals and humans, and recently several non-histaminergic pathways for itch have been discovered in rodents that support a dichotomous concept differentiated into a pain and an itch pathway, with both pathways being composed of different "flavors." Numerous markers and mediators have been found that are linked to itch processing pathways. Thus, the delineation of neuronal pathways for itch from pain pathways seemingly proves that all sensory aspects of itch are based on an itch-specific neuronal pathway. However, such a concept is incomplete as itch can also be induced by the activation of the pain pathway in particular when the stimulus is applied in a highly localized spatial pattern. These opposite views reflect the old dispute between specificity and pattern theories of itch. Rather than only being of theoretic interest, this conceptual problem has key implication for the strategy to treat chronic itch as key therapeutic targets would be either itch-specific pathways or unspecific nociceptive pathways.
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Affiliation(s)
- Martin Schmelz
- Faculty of Medicine Mannheim, Department of Anesthesiology and Intensive Care Medicine, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany,
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48
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Desbordes G, Li A, Loggia ML, Kim J, Schalock PC, Lerner E, Tran TN, Ring J, Rosen BR, Kaptchuk TJ, Pfab F, Napadow V. Evoked itch perception is associated with changes in functional brain connectivity. NEUROIMAGE-CLINICAL 2014; 7:213-21. [PMID: 25610783 PMCID: PMC4300003 DOI: 10.1016/j.nicl.2014.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Abstract
Chronic itch, a highly debilitating condition, has received relatively little attention in the neuroimaging literature. Recent studies suggest that brain regions supporting itch in chronic itch patients encompass sensorimotor and salience networks, and corticostriatal circuits involved in motor preparation for scratching. However, how these different brain areas interact with one another in the context of itch is still unknown. We acquired BOLD fMRI scans in 14 atopic dermatitis patients to investigate resting-state functional connectivity before and after allergen-induced itch exacerbated the clinical itch perception in these patients. A seed-based analysis revealed decreased functional connectivity from baseline resting state to the evoked-itch state between several itch-related brain regions, particularly the insular and cingulate cortices and basal ganglia, where decreased connectivity was significantly correlated with increased levels of perceived itch. In contrast, evoked itch increased connectivity between key nodes of the frontoparietal control network (superior parietal lobule and dorsolateral prefrontal cortex), where higher increase in connectivity was correlated with a lesser increase in perceived itch, suggesting that greater interaction between nodes of this executive attention network serves to limit itch sensation via enhanced top-down regulation. Overall, our results provide the first evidence of itch-dependent changes in functional connectivity across multiple brain regions. Atopic dermatitis patients were subjected to allergen-induced itch. Evoked itch reduced functional connectivity between itch-related brain regions. Evoked itch increased functional connectivity within frontoparietal control network. The above changes in functional connectivity correlated with perceived itch level. Itch sensation may be top-down regulated by frontoparietal control network.
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Key Words
- AD, atopic dermatitis
- ASL, arterial spin labeling
- Atopic dermatitis
- BA, Brodmann area
- BOLD, blood-oxygen-level dependent
- DMN, default mode network
- ECG, electrocardiography
- Eczema
- GLM, general linear model
- ITCH, evoked itch resting-state scan
- Insula
- L, left
- MNI, Montreal Neurological Institute
- MR, magnetic resonance
- PCC, posterior cingulate cortex
- PET, positron emission tomography
- PMC, premotor cortex
- Pruritus
- Putamen
- R, right
- REST, baseline resting-state scan
- S1/M1, primary sensorimotor cortex
- SCORAD, SCORing atopic dermatitis scale
- SPL, Superior parietal lobule
- VAS, visual analog scale
- aMCC, anterior mid-cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fcMRI, functional connectivity magnetic resonance imaging
- pMCC, posterior mid-cingulate cortex
- vlPFC, ventrolateral prefrontal cortex.
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Affiliation(s)
- Gaëlle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter C Schalock
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan Lerner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thanh N Tran
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ted J Kaptchuk
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Florian Pfab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Radiology, Logan College of Chiropractic, Chesterfield, MO, USA ; Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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49
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Butorphanol suppression of histamine itch is mediated by nucleus accumbens and septal nuclei: a pharmacological fMRI study. J Invest Dermatol 2014; 135:560-568. [PMID: 25211175 PMCID: PMC4289457 DOI: 10.1038/jid.2014.398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/06/2014] [Accepted: 08/29/2014] [Indexed: 01/14/2023]
Abstract
Opioid receptors in the central nervous system are important modulators of itch transmission. In this study, we examined the effect of mixed-action opioid butorphanol on histamine itch, cowhage itch and heat pain in healthy volunteers. Using functional MRI, we investigated significant changes in cerebral perfusion to identify the critical brain centers mediating the antipruritic effect of butorphanol. Butorphanol suppressed the itch induced experimentally with histamine, reduced the intensity of cowhage itch by approximately 35%, and did not affect heat pain sensitivity. In comparison with the placebo, butorphanol produced a bilateral deactivation of claustrum, insula and putamen, areas activated during itch processing. Analysis of cerebral perfusion patterns of brain processing of itch vs. itch inhibition under the effect of the drug, revealed that the reduction of cowhage itch by butorphanol was correlated with changes in cerebral perfusion in the midbrain, thalamus, S1, insula and cerebellum. The suppression of histamine itch by butorphanol was paralleled by the activation of nucleus accumbens and septal nuclei, structures expressing high levels of kappa opioid receptors. In conclusion, important relays of the mesolimbic circuit were involved in the inhibition of itch by butorphanol and could represent potential targets for the development of antipruritic therapy.
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50
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Sclocco R, Kim J, Garcia RG, Sheehan JD, Beissner F, Bianchi AM, Cerutti S, Kuo B, Barbieri R, Napadow V. Brain Circuitry Supporting Multi-Organ Autonomic Outflow in Response to Nausea. Cereb Cortex 2014; 26:485-97. [PMID: 25115821 DOI: 10.1093/cercor/bhu172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While autonomic outflow is an important co-factor of nausea physiology, central control of this outflow is poorly understood. We evaluated sympathetic (skin conductance level) and cardiovagal (high-frequency heart rate variability) modulation, collected synchronously with functional MRI (fMRI) data during nauseogenic visual stimulation aimed to induce vection in susceptible individuals. Autonomic data guided analysis of neuroimaging data, using a stimulus-based (analysis windows set by visual stimulation protocol) and percept-based (windows set by subjects' ratings) approach. Increased sympathetic and decreased parasympathetic modulation was associated with robust and anti-correlated brain activity in response to nausea. Specifically, greater autonomic response was associated with reduced fMRI signal in brain regions such as the insula, suggesting an inhibitory relationship with premotor brainstem nuclei. Interestingly, some sympathetic/parasympathetic specificity was noted. Activity in default mode network and visual motion areas was anti-correlated with parasympathetic outflow at peak nausea. In contrast, lateral prefrontal cortical activity was anti-correlated with sympathetic outflow during recovery, soon after cessation of nauseogenic stimulation. These results suggest divergent central autonomic control for sympathetic and parasympathetic response to nausea. Autonomic outflow and the central autonomic network underlying ANS response to nausea may be an important determinant of overall nausea intensity and, ultimately, a potential therapeutic target.
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Affiliation(s)
- Roberta Sclocco
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ronald G Garcia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - James D Sheehan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Beissner
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Anna M Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Sergio Cerutti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Braden Kuo
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riccardo Barbieri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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