Individually unique dynamics of cortical connectivity reflect the ongoing intensity of chronic pain

Temporal relationships between pain, functioning, and human assumed central sensitization in patients with chronic low back pain; a single-case design

BACKGROUND

Interdisciplinary pain rehabilitation (IPR) aims to improve functioning in people with chronic low back pain (CLBP), and is not primary aimed at pain reduction. Many patients however also report a decrease in pain. An explanation could be that IPR results in a decrease in Central Sensitization (CS). As CS is not directly assessable in humans the term Human Assumed Central Sensitization (HACS) is used in this study. It is unknown whether a decrease in HACS precedes a decrease in pain and improved functioning or vice versa.

OBJECTIVES

This study aimed to gain understanding into the temporal relationships between changes in pain, functioning, and HACS in patients with CLBP during IPR.

DESIGN

Longitudinal observational small-N-study.

METHOD

Twelve patients filled in frequently repeated self-reports 1 week before, during the 12-week IPR program, and 2 weeks after IPR. Pain was assessed by Visual Analogue Scale for pain (daily), functioning by Pain Disability Index (weekly) and Work Ability Score (daily), and HACS by Central Sensitization Inventory part A (bi-weekly). Analyses were performed by visual inspection and time series cross-correlation analyses.

RESULTS

Visual inspection showed large fluctuations within and between individual participants in patterns over time. Cross-correlation analyses showed that in most participants, relationships between pain, functioning, and HACS were strongest when analyzed at the same time (55% of comparisons). Strength and direction of (strongest) correlations showed high interindividual variability (neg: 0.33-0.97; pos: 0.22-0.99).

CONCLUSION

Overall, relationships between pain, functioning, and HACS did not show consistent temporality in patients with CLBP.

Uncovering brain functional connectivity disruption patterns of lung cancer-related pain

Pain is a pervasive symptom in lung cancer patients during the onset of the disease. This study aims to investigate the connectivity disruption patterns of the whole-brain functional network in lung cancer patients with cancer pain (CP+). We constructed individual whole-brain, region of interest (ROI)-level functional connectivity (FC) networks for 50 CP+ patients, 34 lung cancer patients without pain-related complaints (CP-), and 31 matched healthy controls (HC). Then, a ROI-based FC analysis was used to determine the disruptions of FC among the three groups. The relationships between aberrant FCs and clinical parameters were also characterized. The ROI-based FC analysis demonstrated that hypo-connectivity was present both in CP+ and CP- patients compared to HC, which were particularly clustered in the somatomotor and ventral attention, frontoparietal control, and default mode modules. Notably, compared to CP- patients, CP+ patients had hyper-connectivity in several brain regions mainly distributed in the somatomotor and visual modules, suggesting these abnormal FC patterns may be significant for cancer pain. Moreover, CP+ patients also showed increased intramodular and intermodular connectivity strength of the functional network, which could be replicated in cancer stage IV and lung adenocarcinoma. Finally, abnormal FCs within the prefrontal cortex and somatomotor cortex were positively correlated with pain intensity and pain duration, respectively. These findings suggested that lung cancer patients with cancer pain had disrupted connectivity in the intrinsic brain functional network, which may be the underlying neuroimaging mechanisms.

Decoding pain through facial expressions: a study of patients with migraine

BACKGROUND

The present study used the Facial Action Coding System (FACS) to analyse changes in facial activities in individuals with migraine during resting conditions to determine the potential of facial expressions to convey information about pain during headache episodes.

METHODS

Facial activity was recorded in calm and resting conditions by using a camera for both healthy controls (HC) and patients with episodic migraine (EM) and chronic migraine (CM). The FACS was employed to analyse the collected facial images, and intensity scores for each of the 20 action units (AUs) representing expressions were generated. The groups and headache pain conditions were then examined for each AU.

RESULTS

The study involved 304 participants, that is, 46 HCs, 174 patients with EM, and 84 patients with CM. Elevated headache pain levels were associated with increased lid tightener activity and reduced mouth stretch. In the CM group, moderate to severe headache attacks exhibited decreased activation in the mouth stretch, alongside increased activation in the lid tightener, nose wrinkle, and cheek raiser, compared to mild headache attacks (all corrected p < 0.05). Notably, lid tightener activation was positively correlated with the Numeric Rating Scale (NRS) level of headache (p = 0.012). Moreover, the lip corner depressor was identified to be indicative of emotional depression severity (p < 0.001).

CONCLUSION

Facial expressions, particularly lid tightener actions, served as inherent indicators of headache intensity in individuals with migraine, even during resting conditions. This indicates that the proposed approach holds promise for providing a subjective evaluation of headaches, offering the benefits of real-time assessment and convenience for patients with migraine.

Network analysis of monoamines involved in anxiety-like behavior in a rat model of osteoarthritis

BACKGROUND

Chronic pain is a major health problem that affects a significant number of patients, resulting in personal suffering and substantial health care costs. One of the most commonly reported causal conditions is osteoarthritis (OA). In addition to sensory symptoms, chronic pain shares an inherent overlap with mood or anxiety disorders. The involvement of the frontal cortex, striatum and nucleus accumbens, in the affective processing of pain is still poorly understood.

METHODS

Male Wistar rats were divided into two groups: MIA (monoiodoacetate injected into the knee-model of OA) and sham (NaCl). Behavioral tests assessing pain, anxiety, and depressive behavior were performed at week 1, 3, 4, 6, 8, and 10. Neurochemical assays were conducted at weeks 3, 6, and 10 post-MIA injection, followed by the neurotransmitters and their metabolites correlation matrix and network analysis.

RESULTS

OA animals developed rapid pain phenotype, whereas anxiety-like behavior accompanied the development of a pain phenotype from 6 week post-MIA injection. We did not detect any depressive-like behavior. Instead, immobility time measured in the forced swimming test transiently decreased at 3 weeks post-MIA in the OA group. We detected changes in noradrenaline and serotonin levels in analyzed structures at distinct time points. Network analysis revealed noradrenaline and serotonin neurotransmission changes in the nucleus accumbens, confirming it to be the key structure affected by chronic pain.

CONCLUSION

Animals with chronic pain exhibit symptoms of anxiety-like behavior and we identified underlying neurochemical changes using network analysis.

Pain and the emotional brain: pain-related cortical processes are better reflected by affective evaluation than by cognitive evaluation

The experience of pain has been dissociated into two interwoven aspects: a sensory-discriminative aspect and an affective-motivational aspect. We aimed to explore which of the pain descriptors is more deeply rooted in the human brain. Participants were asked to evaluate applied cold pain. The majority of the trials showed distinct ratings: some were rated higher for unpleasantness and others for intensity. We compared the relationship between functional data recorded from 7 T MRI with unpleasantness and intensity ratings and revealed a stronger relationship between cortical data and unpleasantness ratings. The present study underlines the importance of the emotional-affective aspects of pain-related cortical processes in the brain. The findings corroborate previous studies showing a higher sensitivity to pain unpleasantness compared to ratings of pain intensity. For the processing of pain in healthy subjects, this effect may reflect the more direct and intuitive evaluation of emotional aspects of the pain system, which is to prevent harm and to preserve the physical integrity of the body.

Investigation on how dynamic effective connectivity patterns encode the fluctuating pain intensity in chronic migraine

Chronic migraine is characterised by persistent headaches for >15 days per month; the intensity of the pain is fluctuating over time. Here, we explored the dynamic interplay of connectivity patterns between regions known to be related to pain processing and their relation to the ongoing dynamic pain experience. We recorded EEG from 80 sessions (20 chronic migraine patients in 4 separate sessions of 25 min). The patients were asked to continuously rate the intensity of their endogenous headache. On different time-windows, a dynamic causal model (DCM) of cross spectral responses was inverted to estimate connectivity strengths. For each patient and session, the evolving dynamics of effective connectivity were related to pain intensities and to pain intensity changes by using a Bayesian linear model. Hierarchical Bayesian modelling was further used to examine which connectivity-pain relations are consistent across sessions and across patients.

The results reflect the multi-facetted clinical picture of the disease. Across all sessions, each patient with chronic migraine exhibited a distinct pattern of pain intensity-related cortical connectivity. The diversity of the individual findings are accompanied by inconsistent relations between the connectivity parameters and pain intensity or pain intensity changes at group level. This suggests a rejection of the idea of a common neuronal core problem for chronic migraine.