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Hanycz SA, Noorani A, Hung PSP, Walker MR, Zhang AB, Latypov TH, Hodaie M. Hippocampus diffusivity abnormalities in classical trigeminal neuralgia. Pain Rep 2024; 9:e1159. [PMID: 38655236 PMCID: PMC11037743 DOI: 10.1097/pr9.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Patients with chronic pain frequently report cognitive symptoms that affect memory and attention, which are functions attributed to the hippocampus. Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by paroxysmal attacks of unilateral orofacial pain. Given the stereotypical nature of TN pain and lack of negative symptoms including sensory loss, TN provides a unique model to investigate the hippocampal implications of chronic pain. Recent evidence demonstrated that TN is associated with macrostructural hippocampal abnormalities indicated by reduced subfield volumes; however, there is a paucity in our understanding of hippocampal microstructural abnormalities associated with TN. Objectives To explore diffusivity metrics within the hippocampus, along with its functional and structural subfields, in patients with TN. Methods To examine hippocampal microstructure, we utilized diffusion tensor imaging in 31 patients with TN and 21 controls. T1-weighted magnetic resonance images were segmented into hippocampal subfields and registered into diffusion-weighted imaging space. Fractional anisotropy (FA) and mean diffusivity were extracted for hippocampal subfields and longitudinal axis segmentations. Results Patients with TN demonstrated reduced FA in bilateral whole hippocampi and hippocampal body and contralateral subregions CA2/3 and CA4, indicating microstructural hippocampal abnormalities. Notably, patients with TN showed significant correlation between age and hippocampal FA, while controls did not exhibit this correlation. These effects were driven chiefly by female patients with TN. Conclusion This study demonstrates that TN is associated with microstructural hippocampal abnormalities, which may precede and potentially be temporally linked to volumetric hippocampal alterations demonstrated previously. These findings provide further evidence for the role of the hippocampus in chronic pain and suggest the potential for targeted interventions to mitigate cognitive symptoms in patients with chronic pain.
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Affiliation(s)
- Shaun Andrew Hanycz
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alborz Noorani
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Shih-Ping Hung
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew R. Walker
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ashley B. Zhang
- MD Program, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Timur H. Latypov
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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2
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Adler JS, Ozturk ED, Merritt VC, Delano-Wood L, Schiehser DM, Bondi MW, Ly MT, Ton-Loy A, Sorg SF. Prospective memory performance in veterans with and without histories of mild traumatic brain injury: effect of the apolipoprotein E (APOE) ε4 genotype. J Clin Exp Neuropsychol 2024; 46:352-363. [PMID: 38717052 DOI: 10.1080/13803395.2024.2351205] [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: 09/28/2023] [Accepted: 04/29/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE Identifying factors that moderate cognitive outcomes following mild traumatic brain injury (mTBI) is crucial. Prospective memory (PM) is a cognitive domain of interest in mTBI recovery as it may be especially sensitive to TBI-related changes. Since studies show that genetic status - particularly possession of the apolipoprotein E (APOE) ε4 allele - can modify PM performance, we investigated associations between mTBI status and APOE-ε4 genotype on PM performance in a well-characterized sample of Veterans with neurotrauma histories. METHODS 59 Veterans (mTBI = 33, Military Controls [MCs] = 26; age range: 24-50; average years post-injury = 10.41) underwent a structured clinical interview, neuropsychological assessment, and genotyping. The Memory for Intentions Test (MIST) measured PM across multiple subscales. ANCOVAs, adjusting for age and posttraumatic stress symptoms, tested the effects of mTBI status (mTBI vs. MC) and ε4 status (ε4+ vs. ε4-) on MIST scores. RESULTS Veterans with mTBI history performed more poorly compared to MCs on the MIST 15-min delay (p=.002, ηp2 =.160), Time Cue (p = .003, ηp2 =.157), and PM Total (p = .016, ηp2 =.102). Those with at least one copy of the ε4 allele performed more poorly compared to ε4- Veterans on the MIST 15-min delay (p = .011, ηp2 =.113) and PM Total (p = .048, ηp2 = .071). No significant interactions were observed between mTBI and APOE-ε4 status on MIST outcomes (ps>.25). Within the mTBI group, APOE-ε4+ Veterans performed worse than APOE-ε4- Veterans on the MIST 15-min delay subscale (p = .031, ηp2 = .150). CONCLUSIONS mTBI history and APOE-ε4 genotype status were independently associated with worse PM performance compared to those without head injury histories or possession of the APOE-e4 genotype. Performance on the MIST 15-min delay was worse in Veterans with both risk factors (mTBI history and APOE-ε4 positivity). Findings suggest that genetic status may modify outcomes even in relatively young Veterans with mTBI histories. Future research examining longitudinal associations and links to neuroimaging and biomarker data are needed.
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Affiliation(s)
- Jennifer S Adler
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Erin D Ozturk
- San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
| | - Victoria C Merritt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Monica T Ly
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
| | - Adan Ton-Loy
- VA San Diego Healtchare System (VASDHS), Psychology & Research Services, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Scott F Sorg
- Home Base: A Red Sox Foundation, Boston, MA, USA
- Department of Psychiatry, Massachuesetts General Hospital Program, Boston, MA, USA
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3
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Sanchis-Alfonso V, Beser-Robles M, Ten-Esteve A, Ramírez-Fuentes C, Alberich-Bayarri Á, Espert R, García-Larrea L, Martí-Bonmatí L. Brain network functional connectivity changes in patients with anterior knee pain: a resting-state fMRI exploratory study. Eur Radiol Exp 2023; 7:60. [PMID: 37806998 PMCID: PMC10560652 DOI: 10.1186/s41747-023-00378-1] [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: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND This study investigates the functional brain connectivity in patients with anterior knee pain (AKP). While biomechanical models are frequently employed to investigate AKP, it is important to recognize that pain can manifest even in the absence of structural abnormalities. Leveraging the capabilities of functional magnetic resonance imaging (fMRI), this research aims to investigate the brain mechanisms present in AKP patients. METHODS Forty-five female subjects (24 AKP patients, 21 controls) underwent resting-state fMRI and T1-weighted structural MRI. Functional brain connectivity patterns were analyzed, focusing on pain network areas, and the influence of catastrophizing thoughts was evaluated. RESULTS Comparing patients and controls, several findings emerged. First, patients with AKP exhibited increased correlation between the right supplementary motor area and cerebellum I, as well as decreased correlation between the right insula and the left rostral prefrontal cortex and superior frontal gyrus. Second, in AKP patients with catastrophizing thoughts, there was increased correlation of the left lateral parietal cortex with two regions of the right cerebellum (II and VII) and the right pallidum, and decreased correlation between the left medial frontal gyrus and the right thalamus. Furthermore, the correlation between these regions showed promising results for discriminating AKP patients from controls, achieving a cross-validation accuracy of 80.5%. CONCLUSIONS Resting-state fMRI revealed correlation differences in AKP patients compared to controls and based on catastrophizing thoughts levels. These findings shed light on neural correlates of chronic pain in AKP, suggesting that functional brain connectivity alterations may be linked to pain experience in this population. RELEVANCE STATEMENT Etiopathogenesis of pain in anterior knee pain patients might not be limited to the knee, but also to underlying alterations in the central nervous system: cortical changes might lead a perpetuation of pain. KEY POINTS • Anterior knee pain patients exhibit distinct functional brain connectivity compared to controls, and among catastrophizing subgroups. • Resting-state fMRI reveals potential for discriminating anterior knee pain patients with 80.5% accuracy. • Functional brain connectivity differences improve understanding of pain pathogenesis and objective anterior knee pain identification.
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Affiliation(s)
| | - María Beser-Robles
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Amadeo Ten-Esteve
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Technologies for Health and Well-Being, Polytechnic University of Valencia, Valencia, Spain
| | | | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Raúl Espert
- Departamento de Psicobiología, Unidad de Neuropsicología, Hospital Clinic Universitari, Universidad de Valencia, Valencia, Spain
| | - Luis García-Larrea
- Center for Neuroscience Research of Lyon (CRNL), NeuroPain Team, U 1028, INSERM, Lyon-1 University, Bron, France
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Radiology Department, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
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4
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Dass R, Kalia M, Harris J, Packham T. Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review. Can J Pain 2023; 7:2217865. [PMID: 37441085 PMCID: PMC10334862 DOI: 10.1080/24740527.2023.2217865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
Introduction Approximately 15% to 40% of persons with chronic pain as a primary disorder experience brain fog. Prior research has investigated the etiology of "brain fog" in conditions in which pain presents as a key feature (e.g., fibromyalgia). However, it remains understudied in the context of chronic 10 musculoskeletal pain. Following current scoping review guidelines, we obtained stakeholder input from patient and health care professionals (HCPs) to define this phenomenon. Specific aims of this review were to (1) identify factors contributing to brain fog, (2) identify the functional correlates of brain fog and assessments used to measure them, and (3) establish a definition of brain fog that can be employed by researchers and HCPs to advance research and care. Methods A scoping review was conducted using recommendations of the Joanna Briggs Institute methodology of scoping reviews and the Levac et al methodology. Embase, Cinahl, PsycINFO, and Medline was searched to identify relevant sources. Findings were verified with patient and healthcare professionals. Results We identified four 15 key features of brain fog: perceived variability, subjective cognitive dysfunction, participation limitations, and changes in functional activities. We developed a model of brain fog illustrating the overlapping categories of contributors to brain fog in chronic musculoskeletal pain: (1) neuroanatomical and neurophysiological, (2) mental health/emotional, and (3) environmental/lifestyle. Conclusion The results of this scoping review conclude that the inconsistency in research regarding brain fog in 20 chronic musculoskeletal pain is obstructing a clear understanding of the phenomenon and therefore may be impeding persons with chronic pain and brain fog from receiving optimal care.
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Affiliation(s)
- Ronessa Dass
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mohini Kalia
- Faculty of Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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5
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Gao H, Xia Q, Zhang X, Chen Y, Yan J, Gao J, Zhang L, Zhang J, Wang K, Li C, Ju P, Zhu C. Intermediary roles of prospective memory and retrospective memory in the comorbidity of depression and pain. Gen Psychiatr 2023; 36:e100895. [PMID: 36844966 PMCID: PMC9950883 DOI: 10.1136/gpsych-2022-100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
Background Patients who suffer comorbidity of major depressive disorder (MDD) and chronic pain (CP) maintain a complex interplay between maladaptive prospective memory (PM) and retrospective memory (RM) with physical pain, and their complications are still unknown. Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP, patients with depression without CP, and control subjects, considering the possible influence of depressed affect and chronic pain severity. Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain, a total of 124 participants were included in this cross-sectional cohort study. Among them, 82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups: a comorbidity group(patients with MDD and CP) (n=40) and a depression group (patients with depression without CP) (n=42). Meanwhile, 42 healthy controls were screened from the hospital's physical examination centre from January 2019 to January 2022. The Hamilton Depression Rating Scale-24 (HAMD-24) and Beck Depression Inventory-II (BDI-II) were used to evaluate the severity of depression. The Pain Intensity Numerical Rating Scale (PI-NRS), Short-Form McGill Pain Questionnaire-2 Chinese version (SF-MPQ-2-CN), Montreal Cognitive Assessment-Basic Section (MoCA-BC), and Prospective and Retrospective Memory Questionnaire (PRMQ) were used to assess pain-related features and the global cognitive functioning of study participants. Results The impairments in PM and RM differed remarkably among the three groups (F=7.221, p<0.001; F=7.408, p<0.001) and were severe in the comorbidity group. Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain (r=0.431, p<0.001; r=0.253, p=0.022 and r=0.415, p<0.001; r=0.247, p=0.025), respectively. Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score (β=0.594, t=6.600, p<0.001). Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP. Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP. PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP. Trial registration number chiCTR2000029917.
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Affiliation(s)
- Hua Gao
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Qingrong Xia
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Xulai Zhang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Yuanyuan Chen
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Junwei Yan
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Jianliang Gao
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Loufeng Zhang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Jie Zhang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Keming Wang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Chao Li
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
| | - Peijun Ju
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuizhen Zhu
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China,Common Psychiatry Department, Hefei Fourth People’s Hospital, Hefei, Anhui, China
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6
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Pereira Nery ECH, Rocha NP, Cruz VT, Silva AG. Systematic review and meta-analysis on the association between chronic low back pain and cognitive function. Pain Pract 2022; 23:399-408. [PMID: 36504248 DOI: 10.1111/papr.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to identify and assess the evidence on the association between idiopathic chronic low back pain (LBP) and cognitive function in individuals with LBP. A secondary aim was to explore whether changes in cognitive function are associated with pain characteristics and psychological factors (eg, catastrophizing and fear of movement). Eleven studies were included in this systematic review, and four meta-analyses were conducted. Low to very low-quality evidence suggests impaired cognitive function in individuals with LBP compared to asymptomatic controls for problem solving (k = 5; d = 0.33; CI = 0.16-0.50; z = 3.85 p = 0.0001), speed of information processing (k = 5; d = 0.44; CI = 0.22-0.65; z = 4.02 p < 0.0001), working memory (k = 6; d = 0.50; CI = 0.34-0.66; z = 6.09 p < 0.0001), and delayed memory (k = 3; d = 0.34; CI = 0.07-0.6, z = 2.49 p = 0.02). The association between LBP intensity and psychological factors and cognitive function was inconclusive. More studies are needed to explore these associations and improve evidence in this field. The results of this study suggest that cognitive aspects should be considered during the rehabilitation process of patients with LBP and raise further questions, including whether individuals with LBP are at a greater risk of developing dementia or whether targeting cognitive function will increase the probability of success of LBP treatment. These questions should, also, be considered in future studies.
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Affiliation(s)
| | - Nelson P Rocha
- IEETA and Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Vitor T Cruz
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal, EPIUnit - Institute of Public Health, Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Anabela G Silva
- CINTESIS.UA@RISE and School of Health Sciences, University of Aveiro, Aveiro, Portugal
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7
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Rahdar M, Hajisoltani R, Davoudi S, Karimi SA, Borjkhani M, Khatibi VA, Hosseinmardi N, Behzadi G, Janahmadi M. Alterations in the intrinsic discharge activity of CA1 pyramidal neurons associated with possible changes in the NADPH diaphorase activity in a rat model of autism induced by prenatal exposure to valproic acid. Brain Res 2022; 1792:148013. [PMID: 35841982 DOI: 10.1016/j.brainres.2022.148013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/24/2022] [Accepted: 07/10/2022] [Indexed: 11/02/2022]
Abstract
Autism spectrum disorder is a neurodevelopmental disorder characterized by sensory abnormalities, social skills impairment and cognitive deficits. Although recent evidence indicated that induction of autism-like behavior in animal models causes abnormal neuronal excitability, the impact of autism on neuronal properties is still an important issue. Thus, new findings at the cellular level may shed light on the pathophysiology of autism and may help to find effective treatment strategies. Here, we investigated the behavioral, electrophysiological and histochemical impacts of prenatal exposure to valproic acid (VPA) in rats. Findings revealed that VPA exposure caused a significant increase in the hot plate response latency. The novel object recognition ability was also impaired in VPA-exposed rats. Along with these behavioral alterations, neurons from VPA-exposed animals exhibited altered excitability features in response to depolarizing current injections relative to control neurons. In the VPA-exposed group, these changes consisted of a significant increase in the amplitude, evoked firing frequency and the steady-state standard deviation of spike timing of action potentials (APs). Moreover, the half-width, the AHP amplitude and the decay time constant of APs were significantly decreased in this group. These changes in the evoked electrophysiological properties were accompanied by intrinsic hyperexcitability and lower spike-frequency adaptation and also a significant increase in the number of NADPH-diaphorase stained neurons in the hippocampal CA1 area of the VPA-exposed rats. Taken together, findings demonstrate that abnormal nociception and recognition memory is associated with alterations in the neuronal responsiveness and nitrergic system in a rat model of autism-like.
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Affiliation(s)
- Mona Rahdar
- Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Hajisoltani
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Davoudi
- Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Asaad Karimi
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Tehran, Iran
| | - Mehdi Borjkhani
- Department of Electrical Engineering, Urmia University of Technology, Urmia, Iran
| | - Vahid Ahli Khatibi
- Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Hosseinmardi
- Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gila Behzadi
- Department of Physiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahyar Janahmadi
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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8
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Cardoso-Cruz H, Laranjeira I, Monteiro C, Galhardo V. Altered prefrontal-striatal theta-band oscillatory dynamics underlie working memory deficits in neuropathic pain rats. Eur J Pain 2022; 26:1546-1568. [PMID: 35603472 DOI: 10.1002/ejp.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prelimbic medial prefrontal cortex (PL-mPFC) and nucleus accumbens core region (NAcc) play an important role in supporting several executive cognitive mechanisms, such as spatial working-memory (WM). Recently, this circuit has been also associated with both sensory and affective components of pain. However, it is still unclear whether this circuit is endogenously engaged in neuropathic pain-related cognitive dysfunctions. METHODS To answer this question, we induced the expression of halorhodopsin in local PL-mPFC neurons projecting to NAcc, and then selectively inhibited the terminals of these neurons in the NAcc while recording neural activity during the performance of a delayed non-match to sample (DNMS) spatial WM task. Within-subject behavioral performance and PL-mPFC to NAcc circuit neural activity was assessed after the onset of a persistent rodent neuropathic pain model - spared nerve injury (SNI). RESULTS Our results revealed that the induction of the neuropathy reduced WM performance, and altered the interplay between PL-mPFC and NAcc neurons namely in increasing the functional connectivity from NAcc to PL-mPFC, particularly in the theta-band spontaneous oscillations; in addition, these behavioral and functional perturbations were partially reversed by selective optogenetic inhibition of PL-mPFC neuron terminals into the NAcc during the DNMS task delay-period, without significant antinociceptive effects. CONCLUSIONS Altogether, these results strongly suggest that the PL-mPFC excitatory output into the NAcc plays an important role in the deregulation of WM under pain conditions. SIGNIFICANCE Selective optogenetic inhibition of prefrontal-striatal microcircuit reverses pain-related working memory deficits, but has no significant impact on pain responses. Neuropathic pain underlies an increase of functional connectivity between the nucleus accumbens core area and the prelimbic medial prefrontal cortex mediated by theta-band activity.
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Affiliation(s)
- Helder Cardoso-Cruz
- Instituto de Investigação e Inovação em Saúde (i3S), Pain Neurobiology Group; Universidade do Porto, 4200-135, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135, Porto, Portugal.,Faculdade de Medicina (FMUP), Departamento de Biomedicina - Unidade de Biologia Experimental; Universidade do Porto, 4200-319, Porto, Portugal
| | - Inês Laranjeira
- Instituto de Investigação e Inovação em Saúde (i3S), Pain Neurobiology Group; Universidade do Porto, 4200-135, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135, Porto, Portugal.,Faculdade de Medicina (FMUP), Departamento de Biomedicina - Unidade de Biologia Experimental; Universidade do Porto, 4200-319, Porto, Portugal.,Mestrado em Neurobiologia da Faculdade de Medicina da Universidade do Porto. 4200-319, Porto, Portugal
| | - Clara Monteiro
- Instituto de Investigação e Inovação em Saúde (i3S), Pain Neurobiology Group; Universidade do Porto, 4200-135, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135, Porto, Portugal.,Faculdade de Medicina (FMUP), Departamento de Biomedicina - Unidade de Biologia Experimental; Universidade do Porto, 4200-319, Porto, Portugal
| | - Vasco Galhardo
- Instituto de Investigação e Inovação em Saúde (i3S), Pain Neurobiology Group; Universidade do Porto, 4200-135, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135, Porto, Portugal.,Faculdade de Medicina (FMUP), Departamento de Biomedicina - Unidade de Biologia Experimental; Universidade do Porto, 4200-319, Porto, Portugal
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9
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Education level is a strong determinant of cognitive function as measured by MoCA in people with chronic low back pain. Musculoskelet Sci Pract 2022; 58:102503. [PMID: 35032943 DOI: 10.1016/j.msksp.2022.102503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over recent years there has been increasing clinical interest in the relationship between chronic pain and cognitive function. There are very few studies on individuals with low back pain (LBP) in the literature, which has remained under-researched. OBJECTIVES This study aimed to evaluate cognitive function in individuals with chronic back pain and investigate the effects of different variables on cognition. DESIGN Cross-sectional study. METHODS In this study, 115 individuals with chronic low back pain (CLBP) participated. The sociodemographic characteristics of the individuals who participated were recorded, including age, sex, weight, height, education and pain duration. Pain intensity of the individuals was evaluated using the Visual Analog Scale, functional status was evaluated with the Oswestry Disability Index, and cognitive function was evaluated using Montreal Cognitive Assessment (MoCA). RESULTS One hundred fifteen individuals with CLBP were recruited. The mean age was 48.4±11.8, and the mean MoCA score was 22.9±4.4. MoCA scores were associated with education, age, gender and pain intensity. CONCLUSIONS The findings obtained in the current study showed that individuals with CLBP had low MoCA scores and cognitive function was affected. In individuals with CLBP, cognitive function was affected depending on education level, age and intensity of pain. Assessment of the cognitive function in pain management can be useful for clinicians interested in LBP.
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10
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Jang SE, Bradshaw YS, Carr DB. Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment. Cureus 2022; 14:e22037. [PMID: 35155054 PMCID: PMC8824639 DOI: 10.7759/cureus.22037] [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] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To guide clinicians in balancing the risks and benefits of opioids when treating pain, we conducted two systematic reviews: 1) the impact of pain on cognitive function, and 2) the impact of opioids on cognitive function. Methods: Part one addressed the impact of pain on cognitive impairment; Part two considered the impact of opioids on cognitive impairment. PubMed was used to search for eligible articles. For part one, 1786 articles were identified, of which 23 met our eligibility criteria. For part two, among 584 articles, 18 were found eligible. Results: For part one, 16 studies concluded that patients with chronic pain showed impaired cognitive function; six studies found that chronic pain does not worsen cognitive function; one study concluded that the impact of pain on cognitive function differs based on the underlying cognitive status. For part two, 15 studies found that using opioids to control pain did not cause significant cognitive impairment, while three studies concluded the opposite. Studies evaluating older subjects did not observe different results from those in the whole population for both reviews. Conclusion: The published literature indicates that moderate to severe pain can impair cognitive function, and that careful use of opioid analgesics in such subjects does not necessarily worsen cognition. Although our results are insufficient to support clear guidance due to heterogeneity of cohorts and outcomes, this study may assist primary care providers by rendering explicitly the factors to be considered by providers caring for this population with pain when opioids are considered.
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11
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Karoly P. How Pain Shapes Depression and Anxiety: A Hybrid Self-regulatory/Predictive Mind Perspective. J Clin Psychol Med Settings 2021; 28:201-211. [PMID: 31897919 DOI: 10.1007/s10880-019-09693-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Because many persons living with chronic pain achieve a relatively balanced lifestyle without experiencing functional disability, medical psychologists must explain the well-documented co-occurrence of pain complaints and DSM-5-disorders (including but not limited to depression and anxiety) in a significant subset of individuals. The question of differential resilience versus susceptibility has received modest theoretical and empirical attention, but remains open. In this review, I deconstruct the temporally extended pain adaptation process in order to address this vexing question, relying upon two complementary explanatory frames. The first is a motivational/cybernetic systems formulation labeled the Goal-Centered, Self-Regulatory, Automated Social Systems Psychology (GRASSP) model, erected upon feedback sensitive, goal-guided, hierarchically organized self-regulatory processes. Depression and anxiety presumably result from compromised regulatory functions undermining pain processing, goal pursuit, and everyday performance. The second perspective postulates a "Bayesian Brain"/"Predictive Mind" capable of unifying perception, action, and emotion via predictive processing. From a Bayesian perspective, predictive processing implies that our brains evolved to compare, without conscious direction, incoming environmental information against prior, model-based predictions in order to arrive at accurate perceptual representations of the world. Maladjustment results from failures of active inference. When applied to the perception of visceral information, the embodied process, termed interoceptive inference, can also yield pathogenic outcomes. The Bayesian model holds that depression and anxiety in individuals with pain result from error-prone (biased, rigid, or highly certain) prior evaluations of aversive feeling states and their relation to the external milieu. I consider how the hybrid conceptual framework advanced by the two models points to several novel and familiar avenues of intervention.
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Affiliation(s)
- Paul Karoly
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA.
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12
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Noorani A, Hung PSP, Zhang JY, Sohng K, Laperriere N, Moayedi M, Hodaie M. Pain relief reverses hippocampal abnormalities in trigeminal neuralgia. THE JOURNAL OF PAIN 2021; 23:141-155. [PMID: 34380093 DOI: 10.1016/j.jpain.2021.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
Chronic pain patients frequently report memory and concentration difficulties. Objective testing in this population points to poor performance on memory and cognitive tests, and increased comorbid anxiety and depression. Recent evidence has suggested convergence between chronic pain and memory deficits onto the hippocampus. The hippocampus consists of heterogenous subfields involved in memory consolidation, behavior regulation, and stress modulation. Despite significant studies outlining hippocampal changes in human and chronic pain animal models, the effect of pain relief on hippocampal abnormalities remains unknown. Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder which is highly amenable to surgical interventions, providing a unique opportunity to investigate the effect of pain relief. This study investigates the effect of pain relief on hippocampal subfields in TN. Anatomical MR images of 61 TN patients were examined before and 6 months after surgery. Treatment responders (n=47) reported 95% pain relief, whereas non-responders (n=14) reported 40% change in pain on average. At baseline, patients had smaller hippocampal volumes, compared to controls. After surgery, responders' hippocampal volumes normalized, largely driven by CA2/3, CA4 and dentate gyrus, which are involved in memory consolidation and neurogenesis. We propose that hippocampal atrophy in TN is pain-driven and successful treatment normalizes such abnormalities.
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Affiliation(s)
- Alborz Noorani
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Peter Shih-Ping Hung
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Jia Y Zhang
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kaylee Sohng
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Normand Laperriere
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Massieh Moayedi
- Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada; Division of Clinical & Computational Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Ontario, Canada.
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13
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Coppieters MW, Andersen J, Selbæk H, Herland K, Ajja R, Markussen H, Hodges PW. Sense of effort is distorted in people with chronic low back pain. Musculoskelet Sci Pract 2021; 53:102376. [PMID: 33848943 DOI: 10.1016/j.msksp.2021.102376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proprioceptive deficits in people with low back pain (LBP) have traditionally been attributed to altered paraspinal muscle spindle afference and its central processing. Studies conducted in the upper limb demonstrated that sense of effort is also an important source of kinaesthetic information. OBJECTIVES To better understand proprioceptive deficits in people with chronic LBP (cLBP), this study aimed to test whether sense of effort is affected in people with cLBP. DESIGN Cross-sectional study. METHOD Fourteen participants with cLBP and fourteen healthy participants performed a 120 s force matching task with their trunk extensor muscles at a low intensity. RESULTS When visual feedback of the generated force was provided, both groups performed the task accurately. Removal of visual feedback resulted in an increase in error for both groups (p < 0.0001), but the increase in error was significantly larger for the cLBP group (p = 0.023). This larger error could be attributed to undershooting of the target force (p = 0.020). The control group did not consistently undershoot or overshoot the target force (p = 0.93). Furthermore, the amount of undershooting for the cLBP group increased as the task progressed (p = 0.016), which was not observed for the control group (p = 0.80). CONCLUSIONS The results of this study revealed that sense of effort is affected in cLBP. People with cLBP overestimated the trunk extension force they generated, and the error increased as the trial progressed. With visual feedback however, people with cLBP were able to compensate and perform the task as accurately as people without cLBP.
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Affiliation(s)
- Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Parklands Drive, QLD 4222, Southport, Australia; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands.
| | | | | | | | - Rahma Ajja
- Public Health and Nutrition Department, College of Natural and Health Sciences, Zayed University, United Arab Emirates
| | - Harald Markussen
- Norwegian Handball Federation, Oslo, Norway; Department of Health, Olympiatoppen, Oslo, Norway; Norwegian Athletics Federation, Oslo, Norway
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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14
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Corti EJ, Gasson N, Loftus AM. Cognitive profile and mild cognitive impairment in people with chronic lower back pain. Brain Cogn 2021; 151:105737. [PMID: 33945940 DOI: 10.1016/j.bandc.2021.105737] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
A growing body of evidence suggests Chronic Lower Back Pain (CLBP) is associated with cognitive dysfunction. Little is known, however, about the extent of cognitive impairment in CLBP. The present study explored the cognitive profile of people with CLBP and sought to determine the extent of Mild Cognitive Impairment (MCI) according to the DSM-V and the Movement Disorders Society criteria for MCI. Thirty-one participants with CLBP and 27 age and gender matched healthy controls completed a full neuropsychological battery, consisting of two tasks for each of the five cognitive domains (Executive Function, Attention/Working Memory, Memory, Language, and Visuospatial). Participants with CLBP performed worse, compared to controls, on measures of Attention/Working Memory, Memory, Language, and Visuospatial performance. Cognitive performance in CLBP was also compared to equivalent normative data to determine cognitive impairment. Sixteen CLBP participants were impaired on at least one cognitive measure, with 5 participants meeting criteria for MCI. MCI was not associated with pain-related experience, or psychological health. The present study supports and extends previous findings that CLBP is associated with cognitive dysfunction and some people with CLBP meet criteria for MCI. These findings support that rehabilitation in people with CLBP requires a multidisciplinary approach.
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Affiliation(s)
- Emily J Corti
- School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Western Australia, Australia.
| | - Natalie Gasson
- School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Western Australia, Australia.
| | - Andrea M Loftus
- School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Western Australia, Australia.
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15
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Murasawa H, Pawlak A, Kobayashi H, Saeki K, Yasuda SI, Kitano Y. Mirogabalin, a novel ligand for α 2δ subunit of voltage-gated calcium channels, improves cognitive impairments in repeated intramuscular acidic saline injection model rats, an experimental model of fibromyalgia. Biomed Pharmacother 2021; 139:111647. [PMID: 33940507 DOI: 10.1016/j.biopha.2021.111647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Mirogabalin is a novel potent and selective ligand for the α2δ subunit of voltage-gated calcium channels, and shows potent and sustained analgesic effects in neuropathic pain and fibromyalgia models. Fibromyalgia is often associated with multiple comorbid symptoms, such as anxiety, depression and cognitive impairment. In the present study, we investigated the effects of mirogabalin on cognitive impairments in an experimental animal model for fibromyalgia, repeated intramuscular acidic saline injection model (Sluka model) rats. Male rats received two repeated intramuscular injections of pH 4 acidic saline into their gastrocnemius muscle. After developing mechanical hypersensitivity as identified in the von Frey test, the animals received the test substance orally once daily for 13 days and were subjected to four cognitive function tests, (Y-maze, novel object recognition, Morris water maze and step-through passive avoidance). Sluka model rats showed cognitive impairments in all four tests. Oral administration of mirogabalin (3 and 10 mg/kg) improved the cognitive impairments in these rats. In conclusion, mirogabalin improved the impaired cognitive function in Sluka model rats. It may thus also alleviate cognitive impairments as well as painful symptoms in fibromyalgia patients.
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Affiliation(s)
- Hiroyasu Murasawa
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Akiko Pawlak
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Hiroyuki Kobayashi
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Kensuke Saeki
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Shun-Ichi Yasuda
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Yutaka Kitano
- Specialty Medicine Research Laboratories I, Daiichi-Sankyo Co., Ltd., 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan.
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16
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Castel A, Cascón-Pereira R, Boada S. Memory complaints and cognitive performance in fibromyalgia and chronic pain: The key role of depression. Scand J Psychol 2021; 62:328-338. [PMID: 33538343 DOI: 10.1111/sjop.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
To explore the relationship between perceived cognitive problems and cognitive performance in three different samples, taking into account the possible influence of depression, catastrophizing, pain intensity, or medication. Seventy individuals with fibromyalgia, 74 with non-malignant chronic pain and 40 pain-free controls, completed measures of verbal episodic memory, sustained attention, response inhibition, depression, catastrophizing, and pain intensity. Fibromyalgia and chronic pain patients performed worse than controls in verbal memory and sustained attention, but these differences disappeared when depressed participants were excluded from the analyses. Memory complaints were related with depression in all pain patients. However, in the case of fibromyalgia, memory complaints were also related by pain intensity and inversely related by short-term episodic memory. This case-control study shows the importance of jointly assessing cognitive performance and memory complaints and of controlling for variables such as depression, catastrophizing, pain intensity and medication in the studied samples. Accordingly, this study highlights the differences in memory complaints, between the patients with fibromyalgia and the patients with other chronic pain conditions. Finally, it has highlighted the important role played by depression in cognitive performance and memory complaints considering the Neurocognitive Model of Attention to pain.
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Affiliation(s)
- Antoni Castel
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Rosalia Cascón-Pereira
- Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain.,Business Management Unit, Universitat Rovira i Virgili, Reus, Spain
| | - Sergi Boada
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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17
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Selective optogenetic inhibition of medial prefrontal glutamatergic neurons reverses working memory deficits induced by neuropathic pain. Pain 2019; 160:805-823. [PMID: 30681984 DOI: 10.1097/j.pain.0000000000001457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stability of local medial prefrontal cortex (mPFC) network activity is believed to be critical for sustaining cognitive processes such as working memory (WM) and decision making. Dysfunction of the mPFC has been identified as a leading cause to WM deficits in several chronic pain conditions; however, the underlying mechanisms remain largely undetermined. Here, to address this issue, we implanted multichannel arrays of electrodes in the prelimbic region of the mPFC and recorded the neuronal activity during a food-reinforced delayed nonmatch to sample (DNMS) task of spatial WM. In addition, we used an optogenetic technique to selectively suppress the activity of excitatory pyramidal neurons that are considered the neuronal substrate for memory retention during the delay period of the behavioral task. Within-subject behavioral performance and pattern of neuronal activity were assessed after the onset of persistent pain using the spared nerve injury model of peripheral neuropathy. Our results show that the nerve lesion caused a disruption in WM and prelimbic spike activity and that this disruption was reversed by the selective inhibition of prelimbic glutamatergic pyramidal neurons during the delay period of the WM task. In spared nerve injury animals, photoinhibition of excitatory neurons improved the performance level and restored neural activity to a similar profile observed in the control animals. In addition, we found that selective inhibition of excitatory neurons does not produce antinociceptive effects. Together, our findings suggest that disruption of balance in local prelimbic networks may be crucial for the neurological and cognitive deficits observed during painful syndromes.
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18
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Arnold NR, Bayen UJ. Prospective Memory: Comparing Self- and Proxy-Reports with Cognitive Modeling of Task Performance. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2019. [DOI: 10.1016/j.jarmac.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Mbada (PhD PT) CE, Afolabi (MSc PT) AD, Johnson (PhD PT) OE, Odole (PhD PT) AC, Afolabi (MSc PT) TO, Akinola (PhD PT) OT, Makindes (BMR PT) MO. Comparison of STarT Back Screening Tool and Simmonds Physical Performance Based Test Battery in Prediction of Disability Risks Among Patients with Chronic Low-Back Pain. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.
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20
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A comprehensive literature review of chronic pain and memory. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:183-192. [PMID: 28797640 DOI: 10.1016/j.pnpbp.2017.08.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/29/2017] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
Abstract
Chronic pain patients often complain of their "poor memory" and numerous studies objectively confirmed such difficulties in reporting working memory (WM) and long-term memory (LTM) dysfunctions. This paper provides a comprehensive review of the literature on memory impairment in chronic pain (CP) patients. Twenty-four observational studies evaluating WM or/and LTM in a chronic pain group and a control group were included in this review. Results showed that studies consistently reported a moderate decline, in both WM and LTM performances in CP patients. Even if CP patients complained about forgetfulness, objective measurements did not permit to conclude to a long-term storage impairment. CP patients exhibited more specifically encoding or retrieving difficulties compared to controls. Results showed that chronic pain selectively impacted the most attention-demanding memory processes, such as working memory and recollection in long-term memory. Results also demonstrated that CP patients exhibited a memory bias directed towards painful events compared to control subjects. Several authors have suggested that CP could be a maladaptive consequence of memory mechanisms. The long-lasting presence of pain continuously reinforces aversive emotional associations with incidental events. The inability to extinguish this painful memory trace could explain the chronic persistence of pain even when the original injury has disappeared. A major concern is the need to extricate pain-related cognitive effects from those resulting from all the co-morbidities associated with CP which both have a deleterious effect on cognitive function.
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21
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Pitães M, Blais C, Karoly P, Okun MA, Brewer GA. Acute pain disrupts prospective memory cue detection processes. Memory 2018; 26:1450-1459. [PMID: 29962319 DOI: 10.1080/09658211.2018.1491602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Prospective memory refers to the planning, retention, retrieval, and execution of intentions for future behaviours and it is integral to the enterprise of daily living. Although prospective memory relies upon retrospective memory and executive processes often disrupted by pain, limited research has explored the influence of acute or chronic pain on the ability to complete prospective memory tasks. In the present study we investigated the influence of acute pain on prospective memory tasks that varied in their demands on executive processes (i.e., non-focal versus focal prospective memory cues). Complex-span working memory tasks were also administered to examine whether individual differences in working memory capacity moderated any negative impact of pain on prospective memory. Acute pain significantly impaired prospective memory performance in conditions that encouraged non-focal strategic processing of prospective memory cues, but not in conditions that encouraged more spontaneous focal processing. Individual differences in working memory capacity did not moderate the effect of acute pain on non-focal prospective memory. These findings provide new insights into prospective memory dysfunction created by painful experiences.
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Affiliation(s)
- Margarida Pitães
- a Department of Psychology , Arizona State University , Tempe , USA
| | - Chris Blais
- a Department of Psychology , Arizona State University , Tempe , USA
| | - Paul Karoly
- a Department of Psychology , Arizona State University , Tempe , USA
| | - Morris A Okun
- a Department of Psychology , Arizona State University , Tempe , USA
| | - Gene A Brewer
- a Department of Psychology , Arizona State University , Tempe , USA
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22
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Retrospective and Prospective Memory Among OEF/OIF/OND Veterans With a Self-Reported History of Blast-Related mTBI. J Int Neuropsychol Soc 2018; 24:324-334. [PMID: 29284552 DOI: 10.1017/s1355617717001217] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate prospective and retrospective memory abilities in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with and without a self-reported history of blast-related mild traumatic brain injury (mTBI). METHODS Sixty-one OEF/OIF/OND Veterans, including Veterans with a self-reported history of blast-related mTBI (mTBI group; n=42) and Veterans without a self-reported history of TBI (control group; n=19) completed the Memory for Intentions Test, a measure of prospective memory (PM), and two measures of retrospective memory (RM), the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. RESULTS Veterans in the mTBI group exhibited significantly lower PM performance than the control group, but the groups did not differ in their performance on RM measures. Further analysis revealed that Veterans in the mTBI group with current PTSD (mTBI/PTSD+) demonstrated significantly lower performance on the PM measure than Veterans in the control group. PM performance by Veterans in the mTBI group without current PTSD (mTBI/PTSD-) was intermediate between the mTBI/PTSD+ and control groups, and results for the mTBI/PTSD- group were not significantly different from either of the other two groups. CONCLUSIONS Results suggest that PM performance may be a sensitive marker of cognitive dysfunction among OEF/OIF/OND Veterans with a history of self-reported blast-related mTBI and comorbid PTSD. Reduced PM may account, in part, for complaints of cognitive difficulties in this Veteran cohort, even years post-injury. (JINS, 2018, 24, 324-334).
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Gatzounis R, Schrooten MGS, Crombez G, Vlaeyen JWS. Forgetting to remember? Prospective memory within the context of pain. Eur J Pain 2017; 22:614-625. [PMID: 29226495 DOI: 10.1002/ejp.1152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased. METHODS Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues. RESULTS Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context. CONCLUSIONS Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed. SIGNIFICANCE This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.
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Affiliation(s)
- R Gatzounis
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Belgium.,Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - M G S Schrooten
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Belgium.,Centre for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Sweden
| | - G Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - J W S Vlaeyen
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Belgium.,Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, The Netherlands
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Boadas-Vaello P, Homs J, Reina F, Carrera A, Verdú E. Neuroplasticity of Supraspinal Structures Associated with Pathological Pain. Anat Rec (Hoboken) 2017; 300:1481-1501. [PMID: 28263454 DOI: 10.1002/ar.23587] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/27/2016] [Accepted: 10/18/2016] [Indexed: 12/19/2022]
Abstract
Peripheral nerve and spinal cord injuries, along with other painful syndromes such as fibromyalgia, diabetic neuropathy, chemotherapeutic neuropathy, trigeminal neuralgia, complex regional pain syndrome, and/or irritable bowel syndrome, cause several neuroplasticity changes in the nervous system along its entire axis affecting the different neuronal nuclei. This paper reviews these changes, focusing on the supraspinal structures that are involved in the modulation and processing of pain, including the periaqueductal gray matter, red nucleus, locus coeruleus, rostral ventromedial medulla, thalamus, hypothalamus, basal ganglia, cerebellum, habenula, primary, and secondary somatosensory cortex, motor cortex, mammillary bodies, hippocampus, septum, amygdala, cingulated, and prefrontal cortex. Hyperexcitability caused by the modification of postsynaptic receptor expression, central sensitization, and potentiation of presynaptic delivery of neurotransmitters, as well as the reduction of inhibitory inputs, changes in dendritic spine, neural circuit remodeling, alteration of gray matter, and upregulation of proinflammatory mediators (e.g., cytokines) by reactivation of astrocytes and microglial cells are the main functional, structural, and molecular neuroplasticity changes observed in the above supraspinal structures, associated with pathological pain. Studying these changes in greater depth may lead to the implementation and improvement of new therapeutic strategies against pathological pain. Anat Rec, 300:1481-1501, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Judit Homs
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain.,Department of Physical Therapy EUSES-Universitat of Girona, Salt (Girona), Catalonia, 17190, Spain
| | - Francisco Reina
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Ana Carrera
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
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Ojeda B, Failde I, Dueñas M, Salazar A, Eccleston C. Methods and Instruments to Evaluate Cognitive Function in Chronic Pain Patients: A Systematic Review. PAIN MEDICINE 2015; 17:1465-89. [PMID: 26814300 DOI: 10.1093/pm/pnv077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to systematically review the methods and instruments used to evaluate cognitive function in chronic pain (CP) patients. METHODS A sensitive search strategy was designed using five databases. Based on the objectives and methodology, we selected cross-sectional studies on adults with chronic non-cancer pain in which cognitive function was assessed using validated instruments. The characteristics of the subjects, control groups, and other variables that might affect cognitive function, and the instruments used, were extracted from each article. RESULTS In the 42 articles identified, 53 instruments were used to assess cognitive function. Chronic pain criteria were defined in 83.3% of the articles and more than half (57.1%) included single diagnosis samples, with fibromyalgia being the most frequent studied (75%). Patients with prior cognitive impairment were excluded in 61.9% of the studies, and a control group was included in 64.3% of the studies. In most cases potential confounding variables were evaluated. More than 14% of the studies used self-report measures, and 73.8% used neuropsychological instruments, particularly for assessing attention (30%) and memory (27.5%). None of the instruments were specifically validated for pain patients and only five studies analyzed the psychometric properties of the instruments. CONCLUSIONS Various instruments and methods were used to assess cognitive function in CP patients, particularly fibromyalgia patients, but also other cohorts with well-defined CP. The instruments used had been validated, but not for pain populations, thus they require specific adaptation and validation to be used in CP patients. Certain recommendations are made in order to improve the evaluation of cognitive function in these patients.
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Affiliation(s)
- Begoña Ojeda
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
| | - María Dueñas
- Salus Infirmorum Faculty of Nursing, University of Cádiz, Spain
| | - Alejandro Salazar
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
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Anxiety- and depression-like behavior and impaired neurogenesis evoked by peripheral neuropathy persist following resolution of prolonged tactile hypersensitivity. J Neurosci 2015; 34:12304-12. [PMID: 25209272 DOI: 10.1523/jneurosci.0312-14.2014] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pain and depression are frequently associated with and often persist after resolution of an initial injury. Identifying the extent to which depression remains causally associated with ongoing physical discomfort during chronic pain, or becomes independent of it, is an important problem for basic neuroscience and psychiatry. Difficulty in distinguishing between effects of ongoing aversive sensory input and its long-term consequences is a significant roadblock, especially in animal models. To address this relationship between localized physical discomfort and its more global consequences, we investigated cellular and behavioral changes during and after reversing a mouse model of neuropathic pain. Tactile allodynia produced by placing a plastic cuff around the sciatic nerve resolved within several days when the cuff was removed. In contrast, the changes in elevated O-maze, forced-swim, Y-maze spontaneous alternation and novel-object recognition test performance that developed after nerve cuff placement remained for at least 3 weeks after the nerve cuffs were removed, or 10-15 d following complete normalization of mechanical sensitivity. Hippocampal neurogenesis, measured by doublecortin and proliferating cell nuclear antigen expression, was also suppressed after nerve cuff placement and remained suppressed 3 weeks after cuff removal. FosB expression was elevated in the central nucleus of the amygdala and spinal cord dorsal horn only in mice with ongoing allodynia. In contrast, FosB remained elevated in the basolateral amygdala of mice with resolved nociception and persisting behavioral effects. These observations suggest that different processes control tactile hypersensitivity and the behavioral changes and impaired neurogenesis that are associated with neuropathic allodynia.
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Wolrich J, Poots AJ, Kuehler BM, Rice ASC, Rahman A, Bantel C. Is number sense impaired in chronic pain patients? Br J Anaesth 2014; 113:1024-31. [PMID: 25082664 PMCID: PMC4235572 DOI: 10.1093/bja/aeu255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. Methods First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. Results Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research.
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Affiliation(s)
- J Wolrich
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - A J Poots
- NIHR CLAHRC for NWL, Department of Medicine, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - B M Kuehler
- Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A Rahman
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - C Bantel
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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Schmidt-Wilcke T, Kairys A, Ichesco E, Fernandez-Sanchez ML, Barjola P, Heitzeg M, Harris RE, Clauw DJ, Glass J, Williams DA. Changes in clinical pain in fibromyalgia patients correlate with changes in brain activation in the cingulate cortex in a response inhibition task. PAIN MEDICINE 2014; 15:1346-58. [PMID: 24995850 DOI: 10.1111/pme.12460] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary symptom of fibromyalgia is chronic, widespread pain; however, patients report additional symptoms including decreased concentration and memory. Performance-based deficits are seen mainly in tests of working memory and executive functioning. It has been hypothesized that pain interferes with cognitive performance; however, the neural correlates of this interference are still a matter of debate. In a previous, cross-sectional study, we reported that fibromyalgia patients (as compared with healthy controls) showed a decreased blood oxygen level dependent (BOLD) response related to response inhibition (in a simple Go/No-Go task) in the anterior/mid cingulate cortex, supplementary motor area, and right premotor cortex. METHODS Here in this longitudinal study, neural activation elicited by response inhibition was assessed again in the same cohort of fibromyalgia patients and healthy controls using the same Go/No-Go paradigm. RESULTS A decrease in percentage of body pain distribution was associated with an increase in BOLD signal in the anterior/mid cingulate cortex and the supplementary motor area, regions that have previously been shown to be "hyporeactive" in this cohort. CONCLUSIONS Our results suggest that the clinical distribution of pain is associated with the BOLD response elicited by a cognitive task. The cingulate cortex and the supplementary motor area are critically involved in both the pain system as well as the response inhibition network. We hypothesize that increases in the spatial distribution of pain might engage greater neural resources, thereby reducing their availability for other networks. Our data also point to the potential for, at least partial, reversibility of these changes.
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Affiliation(s)
- Tobias Schmidt-Wilcke
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA; Department of Neurology, Bergmannsheil, Ruhr Universität Bochum, Bochum, Germany
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Mutso AA, Petre B, Huang L, Baliki MN, Torbey S, Herrmann KM, Schnitzer TJ, Apkarian AV. Reorganization of hippocampal functional connectivity with transition to chronic back pain. J Neurophysiol 2013; 111:1065-76. [PMID: 24335219 DOI: 10.1152/jn.00611.2013] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The hippocampus has been shown to undergo significant changes in rodent models of neuropathic pain; however, the role of the hippocampus in human chronic pain and its contribution to pain chronification have remained unexplored. Here we examine hippocampal processing during a simple visual attention task. We used functional MRI to identify intrinsic and extrinsic hippocampal functional connectivity (synchronous neural activity), comparing subacute back pain (SBP, back pain 1-4 mo) and chronic back pain (CBP, back pain >10 yr) patients to control (CON) subjects. Both groups showed more extensive hippocampal connectivity than CON subjects. We then examined the evolution of hippocampal connectivity longitudinally in SBP patients who recovered (SBPr, back pain decreased >20% in 1 yr) and those with persistent pain (SBPp). We found that SBPp and SBPr subjects have distinct changes in hippocampal-cortical connectivity over 1 yr; specifically, SBPp subjects showed large decreases in hippocampal connectivity with medial prefrontal cortex (HG-mPFC). Furthermore, in SBP patients the strength of HG-mPFC reflected variations in back pain over the year. These relationships were replicated when examined in a different task performed by SBP patients (rating fluctuations of back pain), indicating that functional connectivity of the hippocampus changes robustly in subacute pain and the nature of these changes depends on whether or not patients recover from SBP. The observed reorganization of processing within the hippocampus and between the hippocampus and the cortex seems to contribute to the transition from subacute to chronic pain and may also underlie learning and emotional abnormalities associated with chronic pain.
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Affiliation(s)
- Amelia A Mutso
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Cardoso-Cruz H, Sousa M, Vieira JB, Lima D, Galhardo V. Prefrontal cortex and mediodorsal thalamus reduced connectivity is associated with spatial working memory impairment in rats with inflammatory pain. Pain 2013; 154:2397-2406. [DOI: 10.1016/j.pain.2013.07.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/27/2013] [Accepted: 07/15/2013] [Indexed: 01/05/2023]
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Abstract
BACKGROUND Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects. OBJECTIVE To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research. METHODS A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion. RESULTS The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain. DISCUSSION Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.
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Cardoso-Cruz H, Lima D, Galhardo V. Impaired spatial memory performance in a rat model of neuropathic pain is associated with reduced hippocampus-prefrontal cortex connectivity. J Neurosci 2013; 33:2465-80. [PMID: 23392675 PMCID: PMC6619155 DOI: 10.1523/jneurosci.5197-12.2013] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/11/2012] [Indexed: 01/28/2023] Open
Abstract
Chronic pain patients commonly complain of working memory deficits, but the mechanisms and brain areas underlying this cognitive impairment remain elusive. The neuronal populations of the mPFC and dorsal CA1 (dCA1) are well known to form an interconnected neural circuit that is crucial for correct performance in spatial memory-dependent tasks. In this study, we investigated whether the functional connectivity between these two areas is affected by the onset of an animal model of peripheral neuropathic pain. To address this issue, we implanted two multichannel arrays of electrodes in the mPFC and dCA1 of rats and recorded the neuronal activity during a food-reinforced spatial working memory task in a reward-based alternate trajectory maze. Recordings were performed for 3 weeks, before and after the establishment of the spared nerve injury model of neuropathy. Our results show that the nerve lesion caused an impairment of working memory performance that is temporally associated with changes in the mPFC populational firing activity patterns when the animals navigated between decision points-when memory retention was most needed. Moreover, the activity of both recorded neuronal populations after the nerve injury increased their phase locking with respect to hippocampal theta rhythm. Finally, our data revealed that chronic pain reduces the overall amount of information flowing in the fronto-hippocampal circuit and induces the emergence of different oscillation patterns that are well correlated with the correct/incorrect performance of the animal on a trial-by-trial basis. The present results demonstrate that functional disturbances in the fronto-hippocampal connectivity are a relevant cause for pain-related working memory deficits.
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Affiliation(s)
- Helder Cardoso-Cruz
- Departamento de Biologia Experimental, Faculdade de Medicina do Porto, 4200-319 Porto, and
- Instituto de Biologia Molecular e Celular (IBMC), Grupo de Morfofisiologia do Sistema Somatosensitivo, Universidade do Porto, 4200-319 Porto, Portugal
| | - Deolinda Lima
- Departamento de Biologia Experimental, Faculdade de Medicina do Porto, 4200-319 Porto, and
- Instituto de Biologia Molecular e Celular (IBMC), Grupo de Morfofisiologia do Sistema Somatosensitivo, Universidade do Porto, 4200-319 Porto, Portugal
| | - Vasco Galhardo
- Departamento de Biologia Experimental, Faculdade de Medicina do Porto, 4200-319 Porto, and
- Instituto de Biologia Molecular e Celular (IBMC), Grupo de Morfofisiologia do Sistema Somatosensitivo, Universidade do Porto, 4200-319 Porto, Portugal
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Grégoire S, Michaud V, Chapuy E, Eschalier A, Ardid D. Study of emotional and cognitive impairments in mononeuropathic rats: Effect of duloxetine and gabapentin. Pain 2012; 153:1657-1663. [DOI: 10.1016/j.pain.2012.04.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/04/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Takasaki H, Chien CW, Johnston V, Treleaven J, Jull G. Validity and reliability of the perceived deficit questionnaire to assess cognitive symptoms in people with chronic whiplash-associated disorders. Arch Phys Med Rehabil 2012; 93:1774-81. [PMID: 22634231 DOI: 10.1016/j.apmr.2012.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the validity and reliability of the Perceived Deficit Questionnaire (PDQ) for use in people with chronic whiplash-associated disorders. DESIGN Cross-sectional. SETTING Tertiary institution. PARTICIPANTS Patients (N=105) with chronic whiplash-associated disorders and asymptomatic controls (n=50). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The 20-item PDQ inclusive of 4 sections (attention/concentration, retrospective memory, prospective memory, and organization/planning) rated on a 5-point scale. RESULTS Internal construct validity of the PDQ was examined by Rasch analysis, confirming the appropriateness of its 5-point scale and the unidimensionality of each section after modification by eliminating 1 item each from the attention/concentration and retrospective memory sections. Preliminary evidence was also gained for external construct validity (convergent validity) of the modified PDQ by demonstrating significant (P<.05) correlations of all sections with a global measure of disability due to neck pain (the Neck Disability Index). The whiplash group demonstrated significantly (P<.05) higher scores in each section of the modified PDQ than did the control group, indicating evidence for discriminant validity. In addition, the modified PDQ demonstrated good internal consistency (Rasch-generated reliability >.8) and acceptable test-retest reliability with 1-month interval (intraclass correlation coefficients >.8). CONCLUSIONS The modified PDQ appears to be a valid and reliable questionnaire and could be used quickly in clinical practice to gain a basic understanding of perceived cognitive symptoms in people with chronic whiplash-associated disorders.
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Affiliation(s)
- Hiroshi Takasaki
- National Health and Medical Research Council Centre of Clinical Research Excellence - Spinal Pain, Injury and Health, Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia.
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Tomasevic-Todorovic S, Boskovic K, Filipovic D, Naumovic N. Assessment of memory in patients with rheumatoid arthritis. VOJNOSANIT PREGL 2011; 68:481-8. [DOI: 10.2298/vsp1106481t] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The diagnosis of emotional and cognitive dysfunction in
patients with rheumatoid arthritis is often not noticed, regardless of their
importance and frequency. The aim of this research was to assess memory
function in patients with rheumatoid arthritis with respect to its emotional
manifestation, pain intensity, the duration and degree of disease activity,
and functional and anatomical stages of the disease. Methods. The study
involved 60 patients with rheumatoid arthritis and 30 healthy subjects of
both sexes, aged up to 55, who were examined and tested in the Special
Hospital for Rheumatic Diseases in Novi Sad. Depression was diagnosed by
using the Beck?s scale for depression (Beck Depression Inventory - BDI),
anxiety by using the Spielberger Trait Anxiety Inventory - State and Trait?;
we evaluated the cognitive status (by the Wechsler scale-based memory -
WBsp), the functional status (Health Assesment Questionnaire, HAQ) and
disease activity by analyzing the index of disease activity (DAS 28).
Results. Depressive symptoms were registered in 38 (63.33%) patients, and
anxiety symptoms in 22 (36.67%) patients. The average values of the memory
coefficient were significantly lower in the group of patients with rheumatoid
arthritis compared with the control group. Conclusion. High frequency of
emotional dysfunction and damaged memory abilities in patients with
rheumatoid arthritis requires in time diagnosis and adequate treatment.
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Affiliation(s)
| | - Ksenija Boskovic
- Klinički centar Vojvodine, Klinika za medicinsku rehabilitaciju, Novi Sad
| | - Danka Filipovic
- Medicinski fakultet, Departman za neurofiziologiju, Novi Sad
| | - Nada Naumovic
- Medicinski fakultet, Departman za neurofiziologiju, Novi Sad
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Ling J, Heffernan TM, Luczakiewicz K, Stephens R. Subjective ratings of prospective memory deficits in chronic alcohol users. Psychol Rep 2010; 106:905-17. [PMID: 20712179 DOI: 10.2466/pr0.106.3.905-917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous research showing everyday memory is impaired by heavy alcohol use may have underestimated the cognitive impairment of heavy users because drinkers consuming over the recommended limits for safe drinking have often been treated as a homogeneous group, often with a low threshold for inclusion. The current study investigated whether the reported linear relationship applies to participants consuming alcohol significantly above recommended limits. The everyday memory of 80 participants (43 men; modal age, 31-35 years) was investigated using the Prospective Memory Questionnaire. Participants also detailed their average weekly intake of alcohol and other substances. Current heavy users of alcohol (who consumed on average over 25 units per week) reported more memory problems than low (1-9 units per week) or medium users (10-25 units per week). Participants undergoing counselling for alcohol use reported more deficits than low or medium drinkers, but fewer than current heavy drinkers. Possible reasons for this were discussed. Strengths and limitations of subjective approaches to memory assessment were discussed as well as suggestions for future research.
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Affiliation(s)
- Jonathan Ling
- School of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, SR1 3SD, UK.
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Abstract
Pain is a complex experience consisting of sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions. Now it has been gradually known that noxious information is processed by a widely-distributed, hierarchically- interconnected neural network, referred to as neuromatrix, in the brain. Thus, identifying the multiple neural networks subserving these functional aspects and harnessing this knowledge to manipulate the pain response in new and beneficial ways are challenging tasks. Albeit with elaborate research efforts on the cortical responses to painful stimuli or clinical pain, involvement of the hippocampal formation (HF) in pain is still a matter of controversy. Here, we integrate previous animal and human studies from the viewpoint of HF and pain, sequentially representing anatomical, behavioral, electrophysiological, molecular/biochemical and functional imaging evidence supporting the role of HF in pain processing. At last, we further expound on the relationship between pain and memory and present some unresolved issues.
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Affiliation(s)
- Ming-Gang Liu
- Institute for Biomedical Sciences of Pain, Capital Medical University, Beijing 100069, China
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Abstract
OBJECTIVE Complex regional pain syndrome (CRPS) is a severe chronic pain condition characterized by sensory, autonomic, motor, and dystrophic signs and symptoms. This study was undertaken to expand our current knowledge of the evolution of CRPS signs and symptoms with duration of disease. METHOD This was a retrospective, cross-sectional analysis using data extracted from a patient questionnaire to evaluate the clinical characteristics of CRPS at different time points of disease progression. Data from the questionnaire included pain characteristics and associated symptoms. It also included autonomic, motor, and dystrophic symptoms and also initiating events, ameliorating and aggravating factors, quality of life, work status, comorbid conditions, pattern of pain spread, family history, and demographics. Comparisons were made of different parameters as they varied with disease duration. RESULTS A total of 656 patients with CRPS of at least 1-year duration were evaluated. The average age of all participants was 37.5 years, with disease duration varying from 1 to 46 years. The majority of participants were white (96%). A total of 80.3% were females. None of the patients in this study demonstrated spontaneous remission of their symptoms. The pain in these patients was refractory showing only modest improvement with most current therapies. DISCUSSION This study shows that although CRPS is a progressive disease, after 1 year, the majority of the signs and symptoms were well developed and although many variables worsen over the course of the illness, the majority demonstrated only moderate increases with disease duration.
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Schatman ME. Working to Avoid Collateral Emotional Harm to Clients: Cases and Recommendations for the Personal Injury Attorney. PSYCHOLOGICAL INJURY & LAW 2009. [DOI: 10.1007/s12207-009-9047-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dohrenbusch R, Buchanan H, Lipka S, Ott R. Impact of Chronic Somatoform and Osteoarthritis Pain on Conscious and Preconscious Cognitive Processing. THE JOURNAL OF PAIN 2008; 9:927-39. [DOI: 10.1016/j.jpain.2008.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 05/06/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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Emotional memory and migraine: effects of amitriptyline and sex related difference. Behav Brain Res 2007; 189:220-5. [PMID: 18242724 DOI: 10.1016/j.bbr.2007.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 11/23/2022]
Abstract
Many studies suggest that emotional arousal improves memory storage. The aim of this study was to evaluate the effects of emotional content on explicit memory in untreated cephalalgic patients and in migraineurs treated with the antidepressant amitriptyline. We utilized an adaptation of two versions of the same story, with different arousing properties (neutral or emotional), which have been already employed in experiments involving the enhancing effects of emotions on memory retention. Subjects of the present study were healthy subjects and cephalalgic patients, suffering from migraine headache, which included untreated migraineurs and migraineurs treated with the antidepressant amitriptyline. The findings of our experiments suggest that chronic migraine is related to memory impairment. Taking into account that migraine is associated with major depression, in the present research the effect of the antidepressant amitriptyline was also evaluated. Our results showed that amitriptyline has an impairment effect on memory. In fact, the untreated migraineurs, compared to treated, recalled the most emotional phase of the arousal story significantly better. Then, our data suggest that amitriptyline prevents the enhancing effects of emotional content on memory processes. Moreover, in agreement with our previous data, this study suggests the existence of gender differences in the processing of emotional stimuli and underscores the importance of sex on emotional memory mechanisms.
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