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Estivill-Torrús G, Martínez-Padilla AB, Sánchez-Salido L, Evercooren ABV, García-Díaz B. The dorsal root ganglion as a target for neurorestoration in neuropathic pain. Neural Regen Res 2024; 19:296-301. [PMID: 37488881 PMCID: PMC10503598 DOI: 10.4103/1673-5374.374655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 07/26/2023] Open
Abstract
Neuropathic pain is a severe and chronic condition widely found in the general population. The reason for this is the extensive variety of damage or diseases that can spark this unpleasant constant feeling in patients. During the processing of pain, the dorsal root ganglia constitute an important region where dorsal root ganglion neurons play a crucial role in the transmission and propagation of sensory electrical stimulation. Furthermore, the dorsal root ganglia have recently exhibited a regenerative capacity that should not be neglected in the understanding of the development and resolution of neuropathic pain and in the elucidation of innovative therapies. Here, we will review the complex interplay between cells (satellite glial cells and inflammatory cells) and factors (cytokines, neurotrophic factors and genetic factors) that takes place within the dorsal root ganglia and accounts for the generation of the aberrant excitation of primary sensory neurons occurring in neuropathic pain. More importantly, we will summarize an updated view of the current pharmacologic and nonpharmacologic therapies targeting the dorsal root ganglia for the treatment of neuropathic pain.
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Affiliation(s)
- Guillermo Estivill-Torrús
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain
- Unidad Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Lourdes Sánchez-Salido
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain
- Unidad Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Anne Baron-Van Evercooren
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute-ICM, INSERM, CNRS, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Beatriz García-Díaz
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain
- Unidad Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
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2
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Stroman PW, Umraw M, Keast B, Algitami H, Hassanpour S, Merletti J. Structural and Physiological Modeling (SAPM) for the Analysis of Functional MRI Data Applied to a Study of Human Nociceptive Processing. Brain Sci 2023; 13:1568. [PMID: 38002528 PMCID: PMC10669617 DOI: 10.3390/brainsci13111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
A novel method has been developed for analyzing connectivity between regions based on functional magnetic resonance imaging (fMRI) data. This method, termed structural and physiological modeling (SAPM), combines information about blood oxygenation-level dependent (BOLD) responses, anatomy, and physiology to model coordinated signaling across networks of regions, including input and output signaling from each region and whether signaling is predominantly inhibitory or excitatory. The present study builds on a prior proof-of-concept demonstration of the SAPM method by providing evidence for the choice of network model and anatomical sub-regions, demonstrating the reproducibility of the results and identifying statistical thresholds needed to infer significance. The method is further validated by applying it to investigate human nociceptive processing in the brainstem and spinal cord and comparing the results to the known neuroanatomy, including anatomical regions and inhibitory and excitatory signaling. The results of this analysis demonstrate that it is possible to obtain reliable information about input and output signaling from anatomical regions and to identify whether this signaling has predominantly inhibitory or excitatory effects. SAPM provides much more detailed information about neuroanatomy than was previously possible based on fMRI data.
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Affiliation(s)
- Patrick W. Stroman
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Physics, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Maya Umraw
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
| | - Brieana Keast
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
| | - Hannan Algitami
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
| | - Shima Hassanpour
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
| | - Jessica Merletti
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (M.U.); (B.K.); (H.A.); (S.H.); (J.M.)
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3
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Koning E, Powers JM, Ioachim G, Stroman PW. A Comparison of Functional Connectivity in the Human Brainstem and Spinal Cord Associated with Noxious and Innocuous Thermal Stimulation Identified by Means of Functional MRI. Brain Sci 2023; 13:brainsci13050777. [PMID: 37239249 DOI: 10.3390/brainsci13050777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The somatosensory system is multidimensional and processes important information for survival, including the experience of pain. The brainstem and spinal cord serve pivotal roles in both transmitting and modulating pain signals from the periphery; although, they are studied less frequently with neuroimaging when compared to the brain. In addition, imaging studies of pain often lack a sensory control condition, failing to differentiate the neural processes associated with pain versus innocuous sensations. The purpose of this study was to investigate neural connectivity between key regions involved in descending modulation of pain in response to a hot, noxious stimulus as compared to a warm, innocuous stimulus. This was achieved with functional magnetic resonance imaging (fMRI) of the brainstem and spinal cord in 20 healthy men and women. Functional connectivity was observed to vary between specific regions across painful and innocuous conditions. However, the same variations were not observed in the period of anticipation prior to the onset of stimulation. Specific connections varied with individual pain scores only during the noxious stimulation condition, indicating a significant role of individual differences in the experience of pain which are distinct from that of innocuous sensation. The results also illustrate significant differences in descending modulation before and during stimulation in both conditions. These findings contribute to a deeper understanding of the mechanisms underlying pain processing at the level of the brainstem and spinal cord, and how pain is modulated.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Jocelyn M Powers
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Gabriela Ioachim
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Patrick W Stroman
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
- Department of Physics, Queen's University, Kingston, ON K7L 3N6, Canada
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Li T, Feng J, Hu R, Lv M, Chang W, Ma X, Qi W, Zhang Y, Chen X, Ding L, Gu Y, Xu W. Effect and safety of C7 neurotomy at the intervertebral foramen in patients with chronic poststroke aphasia: a multicentre, randomised, controlled study protocol. BMJ Open 2023; 13:e065173. [PMID: 37130672 PMCID: PMC10163524 DOI: 10.1136/bmjopen-2022-065173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Aphasia affects many stroke survivors; therefore, effective treatments are urgently needed. Preliminary clinical findings have suggested an association between contralateral C7-C7 cross nerve transfer and recovery from chronic aphasia. Randomised controlled trials supporting the efficacy of C7 neurotomy (NC7) are lacking. This study will explore the efficacy of NC7 at the intervertebral foramen for improving chronic poststroke aphasia. METHODS AND ANALYSIS This study protocol reports a multicentre, randomised, assessor-blinded active-controlled trial. A total of 50 patients with chronic poststroke aphasia for over 1 year and with a aphasia quotient calculated by Western Aphasia Battery Aphasia Quotient (WAB-AQ) score below 93.8 will be recruited. Participants will be randomly assigned to 1 of 2 groups (25 individuals each) to receive NC7 plus intensive speech and language therapy (iSLT), or iSLT alone programme. The primary outcome is the change in Boston Naming Test score from baseline to the first follow-up after NC7 plus 3 weeks of iSLT or iSLT alone. The secondary outcomes include the changes in the WAB-AQ, Communication Activities of Daily Living-3, International Classification of Functioning, Disability and Health (ICF) speech language function, Barthel Index, Stroke Aphasic Depression Questionnaire-hospital version and sensorimotor assessments. The study will also collect functional imaging outcomes of naming and semantic violation tasks through functional MRI and electroencephalogram to evaluate the intervention-induced neuroplasticity. ETHICS AND DISSEMINATION This study was approved by the institutional review boards of Huashan Hospital, Fudan University, and all participating institutions. The study findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200057180.
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Affiliation(s)
- Tie Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Juntao Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Ruiping Hu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Minzhi Lv
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Wenshuo Chang
- Institute of Linguistics, Shanghai International Studies University, Shanghai, People's Republic of China
| | - Xingyi Ma
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenjun Qi
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Xiuen Chen
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Ling Ding
- Department of Rehabilitation, Shanghai Pudong Hospital, Shanghai, People's Republic of China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
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Shkorbatova PY, Lyakhovetskii VA, Veshchitskii AA, Bazhenova EY, Pavlova NV, Musienko PE, Merkulyeva NS. Postnatal growth of the lumbosacral spinal segments in cat: Their lengths and positions in relation to vertebrae. Anat Rec (Hoboken) 2023; 306:831-843. [PMID: 35466553 DOI: 10.1002/ar.24945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/22/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022]
Abstract
Cat is a prominent model for investigating neural networks of the lumbosacral spinal cord that control locomotor and visceral activity. We previously proposed an integral function, establishing the topographical relationship between the spinal cord segments and vertebrae in adult animals. Here, we investigated the dynamic of this topographical relationship through early and middle periods of development in kittens. We calculated the length of each vertebra relative to the total length of the region from 13th thoracic (T) to the 7th lumbar (L) vertebrae (V) as well as the length of each segment relative to the total region from T13 to the three-dimensional sacral (S) segment. As in our previous work, the length and position of VL2 were used to establish relationships between the characteristics of the segments and vertebrae. Cubic regression reliably approximates the lengths of segments relative to VL2 length. As the cat aged, the relative length of VT13 and VL1 decreased while the relative length of VL5 increased. The relative length of the T13 and L3 segments increased while the relative length of the S1-S2 segments decreased. The T13-L2 segments are descended monotonically relative to the VL1-VL2 border. The L3-S1 segments are also descended, though with more complex dynamics. The positions of the S2-S3 segments remained unchanged. To conclude, different spinal segments displayed different developmental dynamics. The revealed relationship between vertebrae and lumbosacral spinal segments may be helpful for clearly defining stimulation regions to invoke particular functions, both in experimental studies on the spinal cord and clinical treatment.
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Affiliation(s)
- Polina Y Shkorbatova
- Pavlov Institute of Physiology Russian Academy of Sciences, Saint Petersburg, Russia
- Institute of Translational Biomedicine, Saint Petersburg State University, Saint Petersburg, Russia
| | | | | | - Elena Y Bazhenova
- Pavlov Institute of Physiology Russian Academy of Sciences, Saint Petersburg, Russia
- Institute of Translational Biomedicine, Saint Petersburg State University, Saint Petersburg, Russia
| | - Natalia V Pavlova
- Pavlov Institute of Physiology Russian Academy of Sciences, Saint Petersburg, Russia
| | - Pavel E Musienko
- Pavlov Institute of Physiology Russian Academy of Sciences, Saint Petersburg, Russia
- Institute of Translational Biomedicine, Saint Petersburg State University, Saint Petersburg, Russia
| | - Natalia S Merkulyeva
- Pavlov Institute of Physiology Russian Academy of Sciences, Saint Petersburg, Russia
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6
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Franz S, Eck U, Schuld C, Heutehaus L, Wolf M, Wilder-Smith E, Schulte-Mattler W, Weber MA, Rupp R, Weidner N. Lower motoneuron dysfunction impacts spontaneous motor recovery in acute cervical spinal cord injury. J Neurotrauma 2022; 40:862-875. [PMID: 36006372 PMCID: PMC10162119 DOI: 10.1089/neu.2022.0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paresis after spinal cord injury is caused by damage to upper and lower motoneurons and may differentially impact neurological recovery. This prospective monocentric longitudinal observational study investigated the extent and severity of lower motoneuron dysfunction and its impact on upper extremity motor recovery after acute cervical spinal cord injury. Pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials recorded by needle electromyography (EMG) were taken as parameters for lower motoneuron dysfunction and its relation to the extent of myelopathy in the first available spine MRI was determined. Motor recovery was assessed by standardized neurological examination within the first 4 weeks (acute stage) and up to 1 year (chronic stage) after injury. Eighty-five muscles of 17 individuals with cervical spinal cord injury (neurological level of injury from C1 to C7) and a median age of 54 (28-59) were examined. The results showed that muscles with signs of lower motoneuron dysfunction peaked at the lesion center (Χ²[2,n=85]=6.6, p=0.04) and that the severity of lower motoneuron dysfunction correlated with T2-weighted hyperintense MRI signal changes in routine spine MRI at the lesion site (spearman ρ=0.31, p=0.01). Muscles exhibiting signs of lower motoneuron dysfunction, as indicated by pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials, were associated with more severe paresis in both the acute and chronic stages after spinal cord injury (spearman ρ acute=-0.22, p=0.04 and chronic=-0.31, p=0.004). Moreover, the severity of lower motoneuron dysfunction in the acute stage was also associated with a greater degree of paresis (spearman ρ acute=-0.24, p=0.03 and chronic=-0.35, p=0.001). While both muscles with and without signs of lower motoneuron dysfunction were capable of regaining strength over time, those without lower motoneuron dysfunctions had a higher potential to reach full strength. Muscles with signs of lower motoneuron dysfunction in the acute stage displayed increased amplitudes of motor unit action potentials with chronic-stage needle EMG, indicating reinnervation through peripheral collateral sprouting as compensatory mechanism (Χ²[1,n=72]=4.3, p=0.04). Thus, lower motoneuron dysfunction represents a relevant factor contributing to motor impairment and recovery in acute cervical spinal cord injury. Defined recovery mechanisms (peripheral reinnervation) may at least partially underlie spontaneous recovery in respective muscles. Therefore, assessment of lower motoneuron dysfunction could help refine prediction of motor recovery following spinal cord injury.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Address correspondence to: Steffen Franz, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Ute Eck
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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Powers JM, Ioachim G, Stroman PW. Music to My Senses: Functional Magnetic Resonance Imaging Evidence of Music Analgesia Across Connectivity Networks Spanning the Brain and Brainstem. FRONTIERS IN PAIN RESEARCH 2022; 3:878258. [PMID: 35663249 PMCID: PMC9160574 DOI: 10.3389/fpain.2022.878258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is often viewed and studied as an isolated perception. However, cognition, emotion, salience effects, and autonomic and sensory input are all integrated to create a comprehensive experience. Music-induced analgesia has been used for thousands of years, with moderate behavioural effects on pain perception, yet the neural mechanisms remain ambiguous. The purpose of this study was to investigate the effects of music analgesia through individual ratings of pain, and changes in connectivity across a network of regions spanning the brain and brainstem that are involved in limbic, paralimbic, autonomic, cognitive, and sensory domains. This is the first study of its kind to assess the effects of music analgesia using complex network analyses in the human brain and brainstem. Functional MRI data were collected from 20 healthy men and women with concurrent presentation of noxious stimulation and music, in addition to control runs without music. Ratings of peak pain intensity and unpleasantness were collected for each run and were analysed in relation to the functional data. We found that music alters connectivity across these neural networks between regions such as the insula, thalamus, hypothalamus, amygdala and hippocampus (among others), and is impacted by individual pain sensitivity. While these differences are important for how we understand pain and analgesia, it is essential to note that these effects are variable across participants and provide moderate pain relief at best. Therefore, a therapeutic strategy involving music should use it as an adjunct to pain management in combination with healthy lifestyle changes and/or pharmaceutical intervention.
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Affiliation(s)
- Jocelyn M. Powers
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Gabriela Ioachim
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Patrick W. Stroman
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Physics, Queen's University, Kingston, ON, Canada
- *Correspondence: Patrick W. Stroman
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8
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Staud R, Boissoneault J, Lai S, Mejia MS, Ramanlal R, Godfrey MM, Stroman PW. Spinal cord neural activity of patients with fibromyalgia and healthy controls during temporal summation of pain: an fMRI study. J Neurophysiol 2021; 126:946-956. [PMID: 34406893 DOI: 10.1152/jn.00276.2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The cause for the increased sensitivity of patients with fibromyalgia (FM) to painful stimuli is unclear but sensitization of dorsal horn spinal cord neurons has been suggested. There, critical changes of sensory information occur which depend on the plasticity of second-order neurons and descending pain modulation, including facilitation and inhibition. This study used repetitive stimuli that produce temporal-summation-of-second-pain (TSSP) and central sensitization, relevant mechanisms for patients with chronic pain. We examined spinal cord neural activation during TSSP in patients with FM and healthy controls (HC) and used its functional connectivity with several brainstem nuclei to model the observed blood-oxygen-level-dependent (BOLD) time-course with pain ratings. Sixteen HC and 14 FM participants received repetitive heat stimuli to the hand at 0.4 Hz to achieve TSSP during functional imaging with a 3 T-Philips Achieva MRI scanner. Stimuli were adjusted to each individual's pain sensitivity to achieve maximal pain ratings of 50 ± 10 on a numerical pain scale (0-100). Using a 16-channel neurovascular coil, multiple image series were obtained from the cervical spinal cord to the brainstem using single-shot turbo-spin echo sequences. During repetitive, sensitivity-adjusted heat stimuli, pain ratings of all subjects increased as predicted, consistent with TSSP. HC and FM participants had similar temporal patterns of spinal activation: initial BOLD increase followed by deactivation. Structural equation modeling showed that the observed spinal activity during TSSP was associated with more BOLD activity across/within the brainstem in FM subjects than HC, suggesting differences in pain modulation.NEW & NOTEWORTHY "Windup" and its behavioral correlate "temporal-summation-of-second pain" (TSSP) represent spinal cord mechanisms of pain augmentation associated with central sensitization and chronic pain. Fibromyalgia (FM) is a chronic pain disorder, where abnormal TSSP has been demonstrated. We used fMRI to study spinal cord and brainstem activation during TSSP. We characterized the time course of spinal cord and brainstem BOLD activity during TSSP which showed abnormal brainstem activity in patients with FM, possibly due to deficient pain modulation.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Marlin S Mejia
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Riddhi Ramanlal
- Department of Medicine, University of Florida, Gainesville, Florida
| | | | - Patrick W Stroman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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9
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Stroman PW, Powers JM, Ioachim G, Warren HJM, McNeil K. Investigation of the neural basis of expectation-based analgesia in the human brainstem and spinal cord by means of functional magnetic resonance imaging. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2021; 10:100068. [PMID: 34381928 PMCID: PMC8333346 DOI: 10.1016/j.ynpai.2021.100068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
Expectation of lower pain results in lower perceived pain in healthy humans. This expectation analgesia is mediated by descending regulation of the spinal cord. Connectivity analyses showed effects of expecting lower pain prior to stimulation. Expectation analgesia involves regions linked to arousal and autonomic regulation.
Purpose The expected intensity of pain resulting from a noxious stimulus has been observed to have a strong influence on the pain that is perceived. The neural basis of pain reduction, as a result of expecting lower pain, was investigated using functional magnetic resonance imaging (fMRI) in the brainstem and spinal cord. Methods Functional MRI studies were carried out in a region spanning the brainstem and cervical spinal cord in healthy participants. Participants were familiarized with a noxious heat stimulus and study procedures in advance, and were informed during each trial that either a heat calibrated to produce moderate pain (Base state), or a temperature 1 °C lower (Low state), would be applied to their hand. However, the Base temperature was applied in every trial. Results Pain ratings were significantly reduced as a result of expecting lower temperatures. FMRI results demonstrate blood oxygenation-level dependent (BOLD) signal variations in response to participants being informed of the stimulus to expect, in advance of stimulation, and in response to stimulation. Significant coordination of BOLD signals was also detected across specific brainstem and spinal cord regions, with connectivity strengths that varied significantly with the study condition, and with individual pain ratings. The results identify regions that are known to be involved with arousal and autonomic regulation. Conclusions Expectation-based analgesia is mediated by descending regulation of spinal cord nociceptive responses. This regulation appears to be related to arousal and autonomic regulation, consistent with the cognitive/affective dimension of pain.
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Affiliation(s)
- P W Stroman
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada.,Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J M Powers
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - G Ioachim
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - H J M Warren
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - K McNeil
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada.,Royal Military College of Canada, Kingston, Ontario K7L 3N6, Canada
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10
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High-resolution in vivo MR imaging of intraspinal cervical nerve rootlets at 3 and 7 Tesla. Eur Radiol 2021; 31:4625-4633. [PMID: 33409779 DOI: 10.1007/s00330-020-07557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES No routine imaging technology allows reliable visualization of nerve rootlets inside the spinal canal with positive contrast. The stronger MR signal at 7 T, with optimized protocols, may offer a solution. The purpose was to evaluate the potential of 3D Dual-Echo Steady-State (DESS) MR imaging of the cervical spine at 3 and 7 T in assessing the micro-anatomy of the nerve rootlets. MATERIALS/METHODS This prospective study was approved by the local ethics committee. Twenty-one patients, clinically referred to cervical-spine MRI, underwent additional MR exams at 3 T and 7 T, each of which consisted of a single 3D-DESS series with equal acquisition times. Artifacts, visualization quality, and number of identified rootlets (C2 to C8) were rated by two musculoskeletal radiologists. Results were compared by Wilcoxon tests. Interobserver reliability was assessed using weighted κ statistics and intraclass correlation coefficient (ICC). RESULTS Intraspinal rootlets could successfully be visualized at both field strengths. Rating differences for artifacts and quality of rootlet depiction were not significant for the two field strengths. The mean number of identified rootlets was larger for 7-T than for 3-T MR for every assessed nerve; however, this difference was not statistically significant using the Bonferroni correction (p values ranging from 0.002 to 0.53). Interobserver agreement was substantial to almost perfect (weighted κ values of 0.69 and 0.82). The ICC for the number of identified rootlets was 0.80. CONCLUSION Non-invasive 3D-DESS MR-imaging at 3 and 7 T has the potential to provide precise assessments of the micro-anatomy of intraspinal cervical nerve roots. KEY POINTS • Cervical rootlets can be successfully visualized with positive contrast using 3D-DESS MR-imaging. • 3D-DESS MR-imaging at 3 and 7 T provides precise assessments of the micro-anatomy of cervical nerves. • The mean number of identified cervical rootlets using 3D-DESS was larger for 7 T than for 3 T MR; however, this difference was not statistically significant.
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Stroman PW, Warren HJM, Ioachim G, Powers JM, McNeil K. A comparison of the effectiveness of functional MRI analysis methods for pain research: The new normal. PLoS One 2020; 15:e0243723. [PMID: 33315886 PMCID: PMC7735591 DOI: 10.1371/journal.pone.0243723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022] Open
Abstract
Studies of the neural basis of human pain processing present many challenges because of the subjective and variable nature of pain, and the inaccessibility of the central nervous system. Neuroimaging methods, such as functional magnetic resonance imaging (fMRI), have provided the ability to investigate these neural processes, and yet commonly used analysis methods may not be optimally adapted for studies of pain. Here we present a comparison of model-driven and data-driven analysis methods, specifically for the study of human pain processing. Methods are tested using data from healthy control participants in two previous studies, with separate data sets spanning the brain, and the brainstem and spinal cord. Data are analyzed by fitting time-series responses to predicted BOLD responses in order to identify significantly responding regions (model-driven), as well as with connectivity analyses (data-driven) based on temporal correlations between responses in spatially separated regions, and with connectivity analyses based on structural equation modeling, allowing for multiple source regions to explain the signal variations in each target region. The results are assessed in terms of the amount of signal variance that can be explained in each region, and in terms of the regions and connections that are identified as having BOLD responses of interest. The characteristics of BOLD responses in identified regions are also investigated. The results demonstrate that data-driven approaches are more effective than model-driven approaches for fMRI studies of pain.
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Affiliation(s)
- Patrick W. Stroman
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Physics, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| | - Howard J. M. Warren
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Gabriela Ioachim
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Jocelyn M. Powers
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Kaitlin McNeil
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
- Royal Military College of Canada, Kingston, Ontario, Canada
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Esposito MF, Malayil R, Hanes M, Deer T. Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation. PAIN MEDICINE 2020; 20:S23-S30. [PMID: 31152179 PMCID: PMC6544557 DOI: 10.1093/pm/pnz012] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The dorsal root ganglion (DRG) is a novel target for neuromodulation, and DRG stimulation is proving to be a viable option in the treatment of chronic intractable neuropathic pain. Although the overall principle of conventional spinal cord stimulation (SCS) and DRG stimulation—in which an electric field is applied to a neural target with the intent of affecting neural pathways to decrease pain perception—is similar, there are significant differences in the anatomy and physiology of the DRG that make it an ideal target for neuromodulation and may account for the superior outcomes observed in the treatment of certain chronic neuropathic pain states. This review highlights the anatomy of the DRG, its function in maintaining homeostasis and its role in neuropathic pain, and the unique value of DRG as a target in neuromodulation for pain. Methods A narrative literature review was performed. Results Overall, the DRG is a critical structure in sensory transduction and modulation, including pain transmission and the maintenance of persistent neuropathic pain states. Unique characteristics including selective somatic organization, specialized membrane characteristics, and accessible and consistent location make the DRG an ideal target for neuromodulation. Because DRG stimulation directly recruits the somata of primary sensory neurons and harnesses the filtering capacity of the pseudounipolar neural architecture, it is differentiated from SCS, peripheral nerve stimulation, and other neuromodulation options. Conclusions There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.
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Affiliation(s)
| | - Rudy Malayil
- St. Mary's Pain Relief Specialists, Huntington, West Virginia
| | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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Georgoulis G, Sindou M. Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia: Insights to myotome innervation. Clin Neurophysiol 2020; 131:1075-1086. [PMID: 32199396 DOI: 10.1016/j.clinph.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/07/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Most of knowledge on muscle radicular innervation was from explorations in root/spinal cord pathologies. Direct and individual access to each of the lumbar-sacral -ventral and dorsal- nerve roots during dorsal rhizotomy for spastic diplegia allows precise study of the corresponding muscle innervation. Authors report the lumbo-sacral segmental myotomal organization obtained from recordings of muscle responses to root stimulation in a 20-children prospective series. METHODS Seven key-muscles in each lower limb and anal sphincter were Electromyography (EMG)-recorded and clinically observed by physiotherapist during L2-to-S2 dorsal rhizotomy. Ventral roots (VR), for topographical mapping, and dorsal roots (DR), for segmental excitability testing, were stimulated, just above threshold for eliciting muscular response. RESULTS In 70% of the muscles studied, VR innervation was pluri-radicular, from 2-to-4 roots, with 1 or 2 roots being dominant at each level. Overlapping was important. Muscle responses to DR stimulation were 1.75 times more extended compared to VR stimulation. Inter-individual variability was important. CONCLUSIONS Accuracy of root identification and stimulation with the used method brings some more precise information to radicular functional anatomy. SIGNIFICANCE Those neurophysiological findings plead for performing Intra-Operative Neuromonitoring when dealing with surgery in the lumbar-sacral roots.
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Affiliation(s)
- George Georgoulis
- Department of Neurosurgery, General Hospital of Athens "G. Gennimatas", Mesogeion Avenue 154, 11527 Athens, Greece; Medical School, University of Athens, Mikras Asias 75, 11527 Athens, Greece.
| | - Marc Sindou
- University of Lyon, Lyon, France; Clinique Bretéché, Nantes, France
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Shkorbatova PY, Lyakhovetskii VA, Merkulyeva NS, Veshchitskii AA, Bazhenova EY, Laurens J, Pavlova NV, Musienko PE. Prediction Algorithm of the Cat Spinal Segments Lengths and Positions in Relation to the Vertebrae. Anat Rec (Hoboken) 2019; 302:1628-1637. [PMID: 30548810 DOI: 10.1002/ar.24054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/11/2018] [Accepted: 09/26/2018] [Indexed: 01/25/2023]
Abstract
Detailed knowledge of the topographic organization and precise access to the spinal cord segments is crucial for the neurosurgical manipulations as well as in vivo neurophysiological investigations of the spinal networks involved in sensorimotor and visceral functions. Because of high individual variability, accurate identification of particular portion of the lumbosacral enlargement is normally possible only during postmortem dissection. Yet, it is often necessary to determine the precise location of spinal segments prior to in vivo investigation, targeting spinal cord manipulations, neurointerface implantations, and neuronal activity recordings. To solve this problem, we have developed an algorithm to predict spinal segments locations based on their relation to vertebral reference points. The lengths and relative positions of the spinal cord segments (T13-S3) and the vertebrae (VT13-VL7) were measured in 17 adult cats. On the basis of these measurements, we elaborated the estimation procedure: the cubic regression of the ratio of the segment's length to the lengths of the VL2 vertebra was used for the determination of segment's length; and the quadratic regression of the ratio of their positions in relation to the VL2 rostral part was used to determine the position of the segments. The coefficients of these regressions were calculated at the training sample (nine cats) and were then confirmed at the testing sample (eight cats). Although the quality of the prediction is decreased in the caudal direction, we found high correlations between the regressions and real data. The proposed algorithm can be further translated to other species including human. Anat Rec, 302:1628-1637, 2019. © 2018 American Association for Anatomy.
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Affiliation(s)
- Polina Y Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Vsevolod A Lyakhovetskii
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia.,Russian Research Center of Radiology and Surgical Technologies, Ministry of Health of the RF, Saint-Petersburg, Russia
| | - Natalia S Merkulyeva
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia.,Russian Research Center of Radiology and Surgical Technologies, Ministry of Health of the RF, Saint-Petersburg, Russia.,Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
| | | | - Elena Y Bazhenova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Jean Laurens
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Natalia V Pavlova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Pavel E Musienko
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia.,Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Children's Surgery and Orthopedic Clinic, Department of Nonpulmonary Tuberculosis, Institute of Phthysiopulmonology, Saint-Petersburg, Russia
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Panoptic imaging of transparent mice reveals whole-body neuronal projections and skull-meninges connections. Nat Neurosci 2018; 22:317-327. [PMID: 30598527 PMCID: PMC6494982 DOI: 10.1038/s41593-018-0301-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023]
Abstract
Analysis of entire transparent rodent bodies after clearing could provide holistic biological information in health and disease, but reliable imaging and quantification of fluorescent protein signals deep inside the tissues has remained a challenge. Here, we developed vDISCO, a pressure-driven, nanobody-based whole-body immunolabeling technology to enhance the signal of fluorescent proteins by up to two orders of magnitude. This allowed us to image and quantify subcellular details through bones, skin and highly autofluorescent tissues of intact transparent mice. For the first time, we visualized whole-body neuronal projections in adult mice. We assessed CNS trauma effects in the whole body and found degeneration of peripheral nerve terminals in the torso. Furthermore, vDISCO revealed short vascular connections between skull marrow and brain meninges, which were filled with immune cells upon stroke. Thus, our new approach enables unbiased comprehensive studies of the interactions between the nervous system and the rest of the body.
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Fundamentals and Mechanisms of Dorsal Root Ganglion Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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