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Pinilla-Fernández I, Ríos-León M, Deelchand DK, Garrido L, Torres-Llacsa M, García-García F, Vidorreta M, Ip IB, Bridge H, Taylor J, Barriga-Martín A. Chronic neuropathic pain components in whiplash-associated disorders correlate with metabolite concentrations in the anterior cingulate and dorsolateral prefrontal cortex: a consensus-driven MRS re-examination. Front Med (Lausanne) 2024; 11:1404939. [PMID: 39156690 PMCID: PMC11328873 DOI: 10.3389/fmed.2024.1404939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Whiplash injury (WHI) is characterised by a forced neck flexion/extension, which frequently occurs after motor vehicle collisions. Previous studies characterising differences in brain metabolite concentrations and correlations with neuropathic pain (NP) components with chronic whiplash-associated disorders (WAD) have been demonstrated in affective pain-processing areas such as the anterior cingulate cortex (ACC). However, the detection of a difference in metabolite concentrations within these cortical areas with chronic WAD pain has been elusive. In this study, single-voxel magnetic resonance spectroscopy (MRS), following the latest MRSinMRS consensus group guidelines, was performed in the anterior cingulate cortex (ACC), left dorsolateral prefrontal cortex (DLPFC), and occipital cortex (OCC) to quantify differences in metabolite concentrations in individuals with chronic WAD with or without neuropathic pain (NP) components. Materials and methods Healthy individuals (n = 29) and participants with chronic WAD (n = 29) were screened with the Douleur Neuropathique 4 Questionnaire (DN4) and divided into groups without (WAD-noNP, n = 15) or with NP components (WAD-NP, n = 14). Metabolites were quantified with LCModel following a single session in a 3 T MRI scanner within the ACC, DLPFC, and OCC. Results Participants with WAD-NP presented moderate pain intensity and interference compared with the WAD-noNP group. Single-voxel MRS analysis demonstrated a higher glutamate concentration in the ACC and lower total choline (tCho) in the DLPFC in the WAD-NP versus WAD-noNP group, with no intergroup metabolite difference detected in the OCC. Best fit and stepwise multiple regression revealed that the normalised ACC glutamate/total creatine (tCr) (p = 0.01), DLPFC n-acetyl-aspartate (NAA)/tCr (p = 0.001), and DLPFC tCho/tCr levels (p = 0.02) predicted NP components in the WAD-NP group (ACC r 2 = 0.26, α = 0.81; DLPFC r 2 = 0.62, α = 0.98). The normalised Glu/tCr concentration was higher in the healthy than the WAD-noNP group within the ACC (p < 0.05), but not in the DLPFC or OCC. Neither sex nor age affected key normalised metabolite concentrations related to WAD-NP components when compared to the WAD-noNP group. Discussion This study demonstrates that elevated glutamate concentrations within the ACC are related to chronic WAD-NP components, while higher NAA and lower tCho metabolite levels suggest a role for increased neuronal-glial signalling and cell membrane dysfunction in individuals with chronic WAD-NP components.
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Affiliation(s)
- Irene Pinilla-Fernández
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
| | - Dinesh Kumar Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Leoncio Garrido
- Departamento de Química-Física, Instituto de Ciencia y Tecnología de Polímeros (ICTP-CSIC), CSIC, Madrid, Spain
| | - Mabel Torres-Llacsa
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Fernando García-García
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - I. Betina Ip
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Holly Bridge
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Andrés Barriga-Martín
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Research Group in Spine Pathology, Orthopedic Surgery and Traumatology Unit, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Faculty of Medicine, University of Castilla La Mancha, Toledo, Spain
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Chaikla R, Sremakaew M, Kothan S, Saekho S, Wantanajittikul K, Uthaikhup S. Effects of manual therapy combined with therapeutic exercise versus routine physical therapy on brain biomarkers in patients with chronic non-specific neck pain in Thailand: a study protocol for a single-blinded randomised controlled trial. BMJ Open 2023; 13:e072624. [PMID: 37094892 PMCID: PMC10151953 DOI: 10.1136/bmjopen-2023-072624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Structural brain alterations in pain-related areas have been demonstrated in patients with non-specific neck pain. While manual therapy combined with therapeutic exercise is an effective management for neck pain, its underlying mechanisms are poorly understood. The primary objective of this trial is to investigate the effects of manual therapy combined with therapeutic exercise on grey matter volume and thickness in patients with chronic non-specific neck pain. The secondary objectives are to assess changes in white matter integrity, neurochemical biomarkers, clinical features of neck pain, cervical range of motion and cervical muscle strength. METHODS AND ANALYSIS This study is a single-blinded, randomised controlled trial. Fifty-two participants with chronic non-specific neck pain will be recruited into the study. Participants will be randomly allocated to either an intervention or control group (1:1 ratio). Participants in the intervention group will receive manual therapy combined with therapeutic exercise for 10 weeks (two visits per week). The control group will receive routine physical therapy. Primary outcomes are whole-brain and regional grey matter volume and thickness. Secondary outcomes are white matter integrity (fractional anisotropy and mean diffusivity), neurochemical biomarkers (N-acetylaspartate, creatine, glutamate/glutamine, myoinositol and choline), clinical features (neck pain intensity, duration, neck disability and psychological symptoms), cervical range of motion and cervical muscle strength. All outcome measures will be taken at baseline and postintervention. ETHICS AND DISSEMINATION Ethical approval of this study has been granted by Faculty of Associated Medical Science, Chiang Mai University. The results of this trial will be disseminated through a peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT05568394.
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Affiliation(s)
- Rungtawan Chaikla
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Munlika Sremakaew
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Suchart Kothan
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Suwit Saekho
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - S Uthaikhup
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
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White L, Smith AD, Farrell SF. Associations between resting heart rate, resting blood pressure, psychological variables and pain processing in chronic whiplash-associated disorder: a cross-sectional study. PAIN MEDICINE 2022; 23:1882-1890. [PMID: 35587744 PMCID: PMC9629357 DOI: 10.1093/pm/pnac075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
Objective Autonomic nervous system dysfunction has been implicated in chronic whiplash-associated disorder (WAD). However, the relationship between autonomic variables (e.g., resting heart rate and blood pressure) and clinical factors in chronic WAD is not well understood. This study sought to examine the associations between resting heart rate, resting blood pressure, pain processing and psychological variables in chronic WAD and in pain-free controls. Design Secondary analysis of a cross-sectional study. Setting University clinical research laboratory. Subjects Thirty-six people with chronic WAD Grade II (mean [SD] age 40.1 [14.6] years, 28 females) and 25 pain-free controls (35.6 [13.0] years, 17 females). Methods Participants had resting heart rate, systolic and diastolic blood pressure measured. Pain processing measures comprised: (i) pain pressure threshold at the cervical spine, hand and leg, (ii) temporal summation at the cervical spine and hand, and (iii) conditioned pain modulation. Psychological outcomes included measures of kinesiophobia, pain catastrophizing and post-traumatic stress symptoms. Correlations between autonomic variables, pain processing and psychological variables were determined (P < .05, 5% FDR). Results No significant correlations between autonomic and pain processing variables, or autonomic and psychological variables were found in the chronic WAD group. In the control group, diastolic blood pressure was positively correlated with cervical spine pressure pain threshold (r = 0.53, P = .007). Conclusions An association between blood pressure and pain sensitivity was observed in the control group but not the chronic WAD group. Such an association appears to be disrupted in chronic WAD, which may infer involvement of autonomic pathways in the pathophysiology of this condition.
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Affiliation(s)
- Liam White
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ashley D Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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