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Li Q, Ma TL, Qiu YQ, Cui WQ, Chen T, Zhang WW, Wang J, Mao-Ying QL, Mi WL, Wang YQ, Chu YX. Connexin 36 Mediates Orofacial Pain Hypersensitivity Through GluK2 and TRPA1. Neurosci Bull 2020; 36:1484-1499. [PMID: 33067780 PMCID: PMC7719140 DOI: 10.1007/s12264-020-00594-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/06/2020] [Indexed: 12/15/2022] Open
Abstract
Trigeminal neuralgia is a debilitating condition, and the pain easily spreads to other parts of the face. Here, we established a mouse model of partial transection of the infraorbital nerve (pT-ION) and found that the Connexin 36 (Cx36) inhibitor mefloquine caused greater alleviation of pT-ION-induced cold allodynia compared to the reduction of mechanical allodynia. Mefloquine reversed the pT-ION-induced upregulation of Cx36, glutamate receptor ionotropic kainate 2 (GluK2), transient receptor potential ankyrin 1 (TRPA1), and phosphorylated extracellular signal regulated kinase (p-ERK) in the trigeminal ganglion. Cold allodynia but not mechanical allodynia induced by pT-ION or by virus-mediated overexpression of Cx36 in the trigeminal ganglion was reversed by the GluK2 antagonist NS102, and knocking down Cx36 expression in Nav1.8-expressing nociceptors by injecting virus into the orofacial skin area of Nav1.8-Cre mice attenuated cold allodynia but not mechanical allodynia. In conclusion, we show that Cx36 contributes greatly to the development of orofacial pain hypersensitivity through GluK2, TRPA1, and p-ERK signaling.
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Affiliation(s)
- Qian Li
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Tian-Le Ma
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - You-Qi Qiu
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Wen-Qiang Cui
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
- Department of Pain Management, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, 250000, China
| | - Teng Chen
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Wen-Wen Zhang
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Jing Wang
- Department of Nephropathy, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen, 518001, China
| | - Qi-Liang Mao-Ying
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Wen-Li Mi
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Yan-Qing Wang
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China
| | - Yu-Xia Chu
- Department of Integrative Medicine and Neurobiology, Institutes of Integrative Medicine, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Center, State Key Laboratory of Medical Neurobiology, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, China.
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Do TM, Unis GD, Kattar N, Ananth A, McCoul ED. Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:1235-1253. [PMID: 33037835 DOI: 10.1002/lary.29162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of neuromodulating agents for the management of atypical facial pain and primary facial neuralgias. METHODS We searched MEDLINE, Embase, CINAHL, and ClinicalTrials.gov databases for original research articles that examine the effectiveness and adverse reactions of pharmacologic therapy for the treatment of trigeminal neuralgia and atypical facial pain. Studies that included surgical interventions for atypical facial pain or facial pain secondary to other causes were excluded. Meta-analysis was conducted for reductions in symptom scores and adverse effects. RESULTS Of 3,409 articles screened, 73 full-text articles were included, consisting of 45 observational studies and 29 randomized controlled trials. Twenty-four different pharmacological agents were assessed; carbamazepine was the most frequently studied while botulinum toxin A demonstrated the highest consistency in reduction of symptom scores. Pooled estimate of three randomized controlled trials revealed that patients with trigeminal neuralgia who received botulinum toxin A had higher odds (odds ratio 7.46; 95% CI 3.53-15.78) of achieving a ≥50% reduction in visual analogue scale scores compared to controls. Pooled estimate of 15 observational studies showed that three-fourths of patients with trigeminal neuralgia who received carbamazepine experienced clinically significant pain reduction (prevalence proportion 0.75; 95% CI 0.66-0.83). CONCLUSIONS Patients receiving botulinum toxin A for trigeminal neuralgia had higher odds of achieving ≥50% reduction in pain scores. A significant proportion of patients with trigeminal neuralgia experienced positive response to carbamazepine. There was moderate evidence for amitriptyline in patients with atypical facial pain. Standardization of outcome reporting would facilitate future quantitative comparisons of therapeutic effectiveness. Laryngoscope, 131:1235-1253, 2021.
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Affiliation(s)
- Triet M Do
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Graham D Unis
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A
| | - Nrusheel Kattar
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Ashwin Ananth
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Edward D McCoul
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
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Peng KP, May A. Targeting migraine treatment with neuroimaging-Pharmacological neuroimaging in headaches. PROGRESS IN BRAIN RESEARCH 2020; 255:327-342. [PMID: 33008512 DOI: 10.1016/bs.pbr.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The current review provides a recapitulation of recent advances in pharmacological neuroimaging in headache, a promising tool to understanding of how a drug works in the brain and how it may lead to new insights of disease mechanisms of headache. RESULTS Pharmacological positron emission tomography with radioligand-labeled medication may provide evidence whether and where a medication binds in the brain but is still mostly restricted to animal work. Pharmacological functional MRI using task-specific approaches identified central modulation patterns as a consequence of attack and preventative headache medication, which may be distinct to a specific drug mechanism. Pharmacological neuroimaging and specifically in combination with functional imaging is a promising tool to better understand not only certain medications but also certain disease mechanisms. SUMMARY Pharmacological imaging techniques have advanced over the last few years and showed great potential of providing new insights into drug pharmacodynamics and disease mechanism. There are still limitations and challenges to be overcome.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Calcium Channel α2δ1 Subunit Mediates Secondary Orofacial Hyperalgesia Through PKC-TRPA1/Gap Junction Signaling. THE JOURNAL OF PAIN 2020; 21:238-257. [DOI: 10.1016/j.jpain.2019.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/06/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
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Gupta MA, Pur DR, Vujcic B, Gupta AK. Use of antiepileptic mood stabilizers in dermatology. Clin Dermatol 2018; 36:756-764. [DOI: 10.1016/j.clindermatol.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tsai Y, Yuan R, Patel D, Chandrasekaran S, Weng H, Yang J, Lin C, Biswal BB. Altered structure and functional connection in patients with classical trigeminal neuralgia. Hum Brain Mapp 2018; 39:609-621. [PMID: 29105886 PMCID: PMC6866571 DOI: 10.1002/hbm.23696] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022] Open
Abstract
Classical trigeminal neuralgia (TN) is a specific type of neuropathic orofacial pain of which the plasticity of brain structure and connectivity have remained largely unknown. A total of 62 TN patients were included and referred to MRI scans. Voxel-based morphometry was used to analyze the change of gray matter volume. Resting-state functional imaging was used to analyze the connectivity between brain regions. The results showed gray matter volume reduction in components of the prefrontal cortex, precentral gyrus, cerebellar tonsil, thalamus, hypothalamus, and nucleus accumbens among right TN patient and in the inferior frontal gyrus, precentral gyrus, cerebellum, thalamus, ventral striatum, and putamen among left TN patients. The connections between the right superior frontal gyrus and right middle frontal gyrus were lower in right TN patients. The connection between the left precentral gyrus and the left superior frontal gyrus was lower while the connection between bilateral thalamus was higher in left TN patients. The changes of volume in bilateral thalamus of right TN patients and left ventral striatum of left TN patients, and the connectivity between bilateral thalamus of left TN patients were moderately correlated with pain duration. These findings suggest that brain regions such as the thalamus may not only be involved in processing of pain stimuli but also be important for the development of TN. The left hemisphere may be dominant in processing and modulation of TN pain signal. Chronification of TN induces volume changes in brain regions which are associated with emotional or cognitive modulation of pain. Hum Brain Mapp 39:609-621, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuan‐Hsiung Tsai
- Department of Diagnostic RadiologyChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Rui Yuan
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Dharni Patel
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Subhashini Chandrasekaran
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Hsu‐Huei Weng
- Department of Diagnostic RadiologyChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Jen‐Tsung Yang
- Department of NeurosurgeryChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Ching‐Po Lin
- Institute of Neuroscience, National Yang Ming UniversityTaipeiTaiwan
| | - Bharat B. Biswal
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
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Upadhyay J, Geber C, Hargreaves R, Birklein F, Borsook D. A critical evaluation of validity and utility of translational imaging in pain and analgesia: Utilizing functional imaging to enhance the process. Neurosci Biobehav Rev 2018; 84:407-423. [PMID: 28807753 PMCID: PMC5729102 DOI: 10.1016/j.neubiorev.2017.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
Assessing clinical pain and metrics related to function or quality of life predominantly relies on patient reported subjective measures. These outcome measures are generally not applicable to the preclinical setting where early signs pointing to analgesic value of a therapy are sought, thus introducing difficulties in animal to human translation in pain research. Evaluating brain function in patients and respective animal model(s) has the potential to characterize mechanisms associated with pain or pain-related phenotypes and thereby provide a means of laboratory to clinic translation. This review summarizes the progress made towards understanding of brain function in clinical and preclinical pain states elucidated using an imaging approach as well as the current level of validity of translational pain imaging. We hypothesize that neuroimaging can describe the central representation of pain or pain phenotypes and yields a basis for the development and selection of clinically relevant animal assays. This approach may increase the probability of finding meaningful new analgesics that can help satisfy the significant unmet medical needs of patients.
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Affiliation(s)
| | - Christian Geber
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany; DRK Schmerz-Zentrum Mainz, Mainz, Germany
| | - Richard Hargreaves
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States
| | - Frank Birklein
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany
| | - David Borsook
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States.
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Hebestreit JM, May A. The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls. J Headache Pain 2017; 18:116. [PMID: 29285569 PMCID: PMC5745371 DOI: 10.1186/s10194-017-0827-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/07/2017] [Indexed: 01/03/2023] Open
Abstract
Background Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. All participants underwent functional magnetic resonance imaging (fMRI) during trigeminal pain twice: Healthy subjects took part in a placebo-controlled, randomized and double-blind study, receiving a single dose of metoprolol and placebo. Patients were examined with a baseline scan before starting the preventive medication and 3 months later whilst treated with metoprolol. Results Mean pain intensity ratings were not significantly altered under metoprolol. Functional imaging revealed no significant differences in nociceptive processing in both groups. Contrary to earlier findings from animal studies, we did not find an effect of metoprolol on the thalamus in either group. However, using a more liberal and exploratory threshold, hypothalamic activity was slightly increased under metoprolol in patients and migraineurs. Conclusions No significant effect of metoprolol on trigeminal pain processing was observed, suggesting a peripheral effect of metoprolol. Exploratory analyses revealed slightly enhanced hypothalamic activity under metoprolol in both groups. Given the emerging role of the hypothalamus in migraine attack generation, these data need further examination.
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Affiliation(s)
- Julia M Hebestreit
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:93-106. [PMID: 28408961 PMCID: PMC5390340 DOI: 10.1016/j.jdsr.2016.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 04/14/2016] [Accepted: 04/26/2016] [Indexed: 12/30/2022] Open
Abstract
The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.
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Affiliation(s)
- Shigeaki Suenaga
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Kunihiro Nagayama
- Department of Orthodontics and Dentofacial Orthopedics, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Taisuke Nagasawa
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hiroko Indo
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hideyuki J. Majima
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
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Asad ABA, Seah S, Baumgartner R, Feng D, Jensen A, Manigbas E, Henry B, Houghton A, Evelhoch JL, Derbyshire SWG, Chin CL. Distinct BOLD fMRI Responses of Capsaicin-Induced Thermal Sensation Reveal Pain-Related Brain Activation in Nonhuman Primates. PLoS One 2016; 11:e0156805. [PMID: 27309348 PMCID: PMC4911046 DOI: 10.1371/journal.pone.0156805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 05/18/2016] [Indexed: 01/05/2023] Open
Abstract
Background Approximately 20% of the adult population suffer from chronic pain that is not adequately treated by current therapies, highlighting a great need for improved treatment options. To develop effective analgesics, experimental human and animal models of pain are critical. Topically/intra-dermally applied capsaicin induces hyperalgesia and allodynia to thermal and tactile stimuli that mimics chronic pain and is a useful translation from preclinical research to clinical investigation. Many behavioral and self-report studies of pain have exploited the use of the capsaicin pain model, but objective biomarker correlates of the capsaicin augmented nociceptive response in nonhuman primates remains to be explored. Methodology Here we establish an aversive capsaicin-induced fMRI model using non-noxious heat stimuli in Cynomolgus monkeys (n = 8). BOLD fMRI data were collected during thermal challenge (ON:20 s/42°C; OFF:40 s/35°C, 4-cycle) at baseline and 30 min post-capsaicin (0.1 mg, topical, forearm) application. Tail withdrawal behavioral studies were also conducted in the same animals using 42°C or 48°C water bath pre- and post- capsaicin application (0.1 mg, subcutaneous, tail). Principal Findings Group comparisons between pre- and post-capsaicin application revealed significant BOLD signal increases in brain regions associated with the ‘pain matrix’, including somatosensory, frontal, and cingulate cortices, as well as the cerebellum (paired t-test, p<0.02, n = 8), while no significant change was found after the vehicle application. The tail withdrawal behavioral study demonstrated a significant main effect of temperature and a trend towards capsaicin induced reduction of latency at both temperatures. Conclusions These findings provide insights into the specific brain regions involved with aversive, ‘pain-like’, responses in a nonhuman primate model. Future studies may employ both behavioral and fMRI measures as translational biomarkers to gain deeper understanding of pain processing and evaluate the preclinical efficacy of novel analgesics.
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Affiliation(s)
- Abu Bakar Ali Asad
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
- * E-mail:
| | - Stephanie Seah
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
| | - Richard Baumgartner
- Biometrics Research, Biostatistics & Research Decision Sciences, Merck Research Laboratories, Merck & Co., Rahway, NJ, United States of America
| | - Dai Feng
- Biometrics Research, Biostatistics & Research Decision Sciences, Merck Research Laboratories, Merck & Co., Rahway, NJ, United States of America
| | - Andres Jensen
- Early Discovery Pharmacology, Merck Research Laboratories, MSD, Singapore, Singapore
| | | | - Brian Henry
- Early Discovery Pharmacology, Merck Research Laboratories, MSD, Singapore, Singapore
| | - Andrea Houghton
- Early Discovery Pharmacology, Merck Research Laboratories, Merck & Co., West Point, PA, United States of America
| | - Jeffrey L. Evelhoch
- Translational Biomarkers, Merck Research Laboratories, Merck & Co., West Point, PA, United States of America
| | - Stuart W. G. Derbyshire
- Dept of Psychology, National University of Singapore, Singapore, Singapore
- A*STAR-NUS Clinical Imaging Research Centre, Singapore, Singapore
| | - Chih-Liang Chin
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
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Sanders D, Krause K, O'Muircheartaigh J, Thacker MA, Huggins JP, Vennart W, Massat NJ, Choy E, Williams SCR, Howard MA. Pharmacologic modulation of hand pain in osteoarthritis: a double-blind placebo-controlled functional magnetic resonance imaging study using naproxen. Arthritis Rheumatol 2015; 67:741-51. [PMID: 25533872 PMCID: PMC4365729 DOI: 10.1002/art.38987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/04/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In an attempt to shed light on management of chronic pain conditions, there has long been a desire to complement behavioral measures of pain perception with measures of underlying brain mechanisms. Using functional magnetic resonance imaging (fMRI), we undertook this study to investigate changes in brain activity following the administration of naproxen or placebo in patients with pain related to osteoarthritis (OA) of the carpometacarpal (CMC) joint. METHODS A placebo-controlled, double-blind, 2-period crossover study was performed in 19 individuals with painful OA of the CMC joint of the right hand. Following placebo or naproxen treatment periods, a functionally relevant task was performed, and behavioral measures of the pain experience were collected in identical fMRI examinations. Voxelwise and a priori region of interest analyses were performed to detect between-period differences in brain activity. RESULTS Significant reductions in brain activity following treatment with naproxen, compared to placebo, were observed in brain regions commonly associated with pain perception, including the bilateral primary somatosensory cortex, thalamus, and amygdala. Significant relationships between changes in perceived pain intensity and changes in brain activity were also observed in brain regions previously associated with pain intensity. CONCLUSION This study demonstrates the sensitivity of fMRI to detect the mechanisms underlying treatments of known efficacy. The data illustrate the enticing potential of fMRI as an adjunct to self-report for detecting early signals of efficacy of novel therapies, both pharmacologic and nonpharmacologic, in small numbers of individuals with persistent pain.
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Affiliation(s)
- Duncan Sanders
- King's College London, London, UK; University of Sydney at Royal North Shore Hospital, Sydney, New South Wales, Australia
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Barmettler G, Brawn J, Maleki N, Scrivani S, Burstein R, Becerra L, Borsook D. A new electronic diary tool for mapping and tracking spatial and temporal head pain patterns in migraine. Cephalalgia 2014; 35:417-25. [PMID: 25143550 DOI: 10.1177/0333102414545892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM We present an electronic tool for collecting data on the patterns of migraine headache onset and progression. METHODS A digitized map consisting of 44 color-coded segments was defined based on previous reports of migraine pain and the distribution of nerves in the face, head and neck. The map was overlaid on a schematic map of the face, head and neck nerves. Thirty-six patients (N = 36, 28 female/eight male), who met ICDH-II criteria for episodic migraine and had headaches for at least three years, identified all regions where pain typically started and how pain spread and subsequently progressed. RESULTS Consistent with previous findings, throbbing was the most prevalent quality of migraine pain, always present in 70% of patients surveyed. For the 70% of the patients with throbbing pain, the temple was the onset site of throbbing pain, with no significant difference in the laterality of onset site (58.3% on the right vs. 55.6% on the left hemisphere). The tool was able to capture patterns of pain distribution for throbbing and pressure headache pain and also may be used to assess the change in the pattern of the pain distribution as the disease progresses. DISCUSSION The pain map survey may be a useful tool for recording and tracking the temporal pattern of migraine onset both for clinical and research purposes. The tool could be used to create maps of pain locations on a large population scale and thus will be a very useful tool in correlating the temporal nature of headache symptoms with potential mechanisms of disease evolution.
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Affiliation(s)
- Gabi Barmettler
- Center for Pain and the Brain and P.A.I.N. Group, Boston Children's Hospital, Harvard Medical School, USA
| | - Jennifer Brawn
- Center for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Nasim Maleki
- Center for Pain and the Brain and P.A.I.N. Group, Boston Children's Hospital, Harvard Medical School, USA
| | - Steven Scrivani
- The Craniofacial Pain and Headache Center, Tufts University School of Dental Medicine, USA Department of Public Health and Community Medicine, Tufts University School of Medicine, USA
| | - Rami Burstein
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Lino Becerra
- Center for Pain and the Brain and P.A.I.N. Group, Boston Children's Hospital, Harvard Medical School, USA Department of Psychiatry, P.A.I.N. Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, USA
| | - David Borsook
- Center for Pain and the Brain and P.A.I.N. Group, Boston Children's Hospital, Harvard Medical School, USA Department of Psychiatry, P.A.I.N. Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, USA
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Brain signature of chronic orofacial pain: a systematic review and meta-analysis on neuroimaging research of trigeminal neuropathic pain and temporomandibular joint disorders. PLoS One 2014; 9:e94300. [PMID: 24759798 PMCID: PMC3997345 DOI: 10.1371/journal.pone.0094300] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/15/2014] [Indexed: 12/02/2022] Open
Abstract
Brain neuroimaging has been widely used to investigate the bran signature of chronic orofacial pain, including trigeminal neuropathic pain (TNP) and pain related to temporomandibular joint disorders (TMD). We here systematically reviewed the neuroimaging literature regarding the functional and structural changes in the brain of TNP and TMD pain patients, using a computerized search of journal articles via PubMed. Ten TNP studies and 14 TMD studies were reviewed. Study quality and risk of bias were assessed based on the criteria of patient selection, the history of medication, the use of standardized pain/psychological assessments, and the model and statistics of imaging analyses. Qualitative meta-analysis was performed by examining the brain regions which showed significant changes in either brain functions (including the blood-oxygen-level dependent signal, cerebral blood flow and the magnetic resonance spectroscopy signal) or brain structure (including gray matter and white matter anatomy). We hypothesized that the neuroimaging findings would display a common pattern as well as distinct patterns of brain signature in the disorders. This major hypothesis was supported by the following findings: (1) TNP and TMD patients showed consistent functional/structural changes in the thalamus and the primary somatosensory cortex, indicating the thalamocortical pathway as the major site of plasticity. (2) The TNP patients showed more alterations at the thalamocortical pathway, and the two disorders showed distinct patterns of thalamic and insular connectivity. Additionally, functional and structural changes were frequently reported in the prefrontal cortex and the basal ganglia, suggesting the role of cognitive modulation and reward processing in chronic orofacial pain. The findings highlight the potential for brain neuroimaging as an investigating tool for understanding chronic orofacial pain.
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Abstract
PURPOSE OF REVIEW The current review gives an overview about recent advances in neuroimaging studies with specific emphasis on pharmacological modulation of pain and headache. Further, we want to highlight how imaging methods have changed our understanding of chronic pain and discuss how pharmacological MRI could lead to new insights into underlying mechanisms of headache and pain. RECENT FINDINGS Several studies from different imaging laboratories have highlighted the outstanding role of imaging in getting a deeper insight regarding the central mechanisms of drugs. Neuroimaging techniques start to unravel how analgesic drugs, antidepressants or NSAIDs act on pain perception and in particular on central pain processes. Furthermore, the studies included in this review show how context dependent drugs act and how differently they reveal their action in the human brain. SUMMARY Imaging techniques give us the opportunity to gain a better understanding of drug processes in the central nervous system and help to understand where drugs reveal their therapeutic effect. While some substances work on the emotional-affective component of pain, others modulate sensory-discriminative pain pathways. Especially in the field of headache research, still a lot has to be done to understand how preventatives and acute medication modulate the human brain. Future studies should also replicate and extend recent findings.
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Abstract
The guidelines on trigeminal neuralgia management published by the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) recommended that patients unresponsive to carbamazepine or oxcarbazepine be offered the surgical option. However, because some patients may not be willing to resort to surgery, we searched the literature for treatment in refractory trigeminal neuralgia. We found other oral treatments, intranasal spray, subcutaneous injections, various kinds of peripheral nerve blocks and injections of botulinum toxin. On the basis of the available evidence we suggest that no oral treatment other than carbamazepine or oxcarbazepine is useful. Among the other options, there is increasingly strong evidence that botulinum toxin injections are efficacious and may be offered before surgery or to those unwilling to undergo surgery.
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Affiliation(s)
- Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185, Rome, Italy.
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Functional Imaging for Interpretation of Pain Pathways: Current Clinical Application/Relevance and Future Initiatives. Curr Pain Headache Rep 2013; 17:311. [DOI: 10.1007/s11916-012-0311-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Cyclotraxin-B, a new TrkB antagonist, and glial blockade by propentofylline, equally prevent and reverse cold allodynia induced by BDNF or partial infraorbital nerve constriction in mice. THE JOURNAL OF PAIN 2012; 13:579-89. [PMID: 22560237 DOI: 10.1016/j.jpain.2012.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 01/20/2012] [Accepted: 03/09/2012] [Indexed: 01/03/2023]
Abstract
UNLABELLED Several lines of evidence indicate that brain-derived neurotrophic factor (BDNF) plays a key role as a central pronociceptive modulator of pain, acting through postsynaptic TrkB receptors that trigger intracellular signaling cascades leading to central sensitization. The overall aim of this study was to investigate to what extent BDNF could participate in the generation and maintenance of trigeminal neuropathic pain. The results showed that acute intracisternal administration of nanogram doses of BDNF in naïve mice elicited long-lasting, dose-related, cold allodynic responses to topical application of acetone onto vibrissal pad skin. The systemic administration of cyclotraxin-B (CTX-B), a new TrkB receptor antagonist, or propentofylline, an inhibitor of glial activation, was able to either prevent or reverse the effects of intracisternal BDNF on cold nociception. In addition, the blockade of TrkB receptor by CTX-B inhibited the mechanisms that either initiate or maintain cold allodynia in the ipsilateral vibrissal pad skin after unilateral constriction of the infraorbital nerve. These observations raise the possibility that BDNF is capable on its own of conveying many features of the signaling mechanisms that underlie central sensitization caused by nerve constriction. PERSPECTIVE Although further studies are necessary to examine in detail the mechanisms underlying the strong anti-allodynic action of CTX-B, this compound may represent an interesting lead for the development of novel therapeutic strategies aimed at preventing and/or suppressing central sensitization associated with neuropathic pain.
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