1
|
Tiwari N, Qiao LY. Sex Differences in Visceral Pain and Comorbidities: Clinical Outcomes, Preclinical Models, and Cellular and Molecular Mechanisms. Cells 2024; 13:834. [PMID: 38786056 PMCID: PMC11119472 DOI: 10.3390/cells13100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Sexual dimorphism of visceral pain has been documented in clinics and experimental animal models. Aside from hormones, emerging evidence suggests the sex-differential intrinsic neural regulation of pain generation and maintenance. According to the International Association for the Study of Pain (IASP) and the American College of Gastroenterology (ACG), up to 25% of the population have visceral pain at any one time, and in the United States 10-15 percent of adults suffer from irritable bowel syndrome (IBS). Here we examine the preclinical and clinical evidence of sex differences in visceral pain focusing on IBS, other forms of bowel dysfunction and IBS-associated comorbidities. We summarize preclinical animal models that provide a means to investigate the underlying molecular mechanisms in the sexual dimorphism of visceral pain. Neurons and nonneuronal cells (glia and immune cells) in the peripheral and central nervous systems, and the communication of gut microbiota and neural systems all contribute to sex-dependent nociception and nociplasticity in visceral painful signal processing. Emotion is another factor in pain perception and appears to have sexual dimorphism.
Collapse
Affiliation(s)
- Namrata Tiwari
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Liya Y. Qiao
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| |
Collapse
|
2
|
Da Silva JT, Hernandez-Rojas LG, Mekonen HK, Hanson S, Melemedjian O, Scott AJ, Ernst RK, Seminowicz DA, Traub RJ. Sex differences in visceral sensitivity and brain activity in a rat model of comorbid pain: a longitudinal study. Pain 2024; 165:698-706. [PMID: 37756658 PMCID: PMC10859847 DOI: 10.1097/j.pain.0000000000003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
ABSTRACT Temporomandibular disorder (TMD) and irritable bowel syndrome (IBS) are 2 chronic overlapping pain conditions (COPCs) that present with significant comorbidity. Both conditions are more prevalent in women and are exacerbated by stress. While peripheral mechanisms might contribute to pain hypersensitivity for each individual condition, mechanisms underlying the comorbidity are poorly understood, complicating pain management when multiple conditions are involved. In this study, longitudinal behavioral and functional MRI-based brain changes have been identified in an animal model of TMD-like pain (masseter muscle inflammation followed by stress) that induces de novo IBS-like comorbid visceral pain hypersensitivity in rats. In particular, data indicate that increased activity in the insula and regions of the reward and limbic systems are associated with more pronounced and longer-lasting visceral pain behaviors in female rats, while the faster pain resolution in male rats may be due to increased activity in descending pain inhibitory pathways. These findings suggest the critical role of brain mechanisms in chronic pain conditions and that sex may be a risk factor of developing COPCs.
Collapse
Affiliation(s)
- Joyce T. Da Silva
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Luis G. Hernandez-Rojas
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
- Department of Computing, School of Engineering and Sciences, Tecnologico de Monterrey, Zapopan, Mexico
| | - Hayelom K. Mekonen
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Shelby Hanson
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - Ohannes Melemedjian
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Alison J. Scott
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, MD, United States
- Maastricht Multimodal Molecular Imaging (M4I) Institute, Maastricht University, Maastricht, the Netherlands
| | - Robert K. Ernst
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - David A. Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Richard J. Traub
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| |
Collapse
|
3
|
Kadakia F, Khadka A, Yazell J, Davidson S. Chemogenetic Modulation of Posterior Insula CaMKIIa Neurons Alters Pain and Thermoregulation. THE JOURNAL OF PAIN 2024; 25:766-780. [PMID: 37832899 PMCID: PMC10922377 DOI: 10.1016/j.jpain.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
The posterior insular cortex (PIC) is well positioned to perform somatosensory-limbic integration; yet, the function of neuronal subsets within the PIC in processing the sensory and affective dimensions of pain remains unclear. Here, we employ bidirectional chemogenetic modulation to characterize the function of PIC CaMKIIa-expressing excitatory neurons in a comprehensive array of sensory, affective, and thermoregulatory behaviors. Excitatory pyramidal neurons in the PIC were found to be sensitized under inflammatory pain conditions. Chemogenetic activation of excitatory CaMKIIa-expressing PIC neurons in non-injured conditions produced an increase in reflexive and affective pain- and anxiety-like behaviors. Moreover, activation of PIC CaMKIIa-expressing neurons during inflammatory pain conditions exacerbated hyperalgesia and decreased pain tolerance. However, Chemogenetic activation did not alter heat nociception via hot plate latency or body temperature. Conversely, inhibiting CaMKIIa-expressing neurons did not alter either sensory or affective pain-like behaviors in non-injured or under inflammatory pain conditions, but it did decrease body temperature and decreased hot plate latency. Our findings reveal that PIC CaMKIIa-expressing neurons are a critical hub for producing both sensory and affective pain-like behaviors and important for thermoregulatory processing. PERSPECTIVE: The present study reveals that activation of the posterior insula produces hyperalgesia and negative affect, and has a role in thermal tolerance and thermoregulation. These findings highlight the insula as a key player in contributing to the multidimensionality of pain.
Collapse
Affiliation(s)
- Feni Kadakia
- Neuroscience Graduate Program, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Department of Anesthesiology and Pain Research Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Akansha Khadka
- Department of Anesthesiology and Pain Research Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Jake Yazell
- Department of Anesthesiology and Pain Research Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Steve Davidson
- Neuroscience Graduate Program, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Department of Anesthesiology and Pain Research Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
4
|
Little KM, Kosten TA. Focus on fentanyl in females: Sex and gender differences in the physiological and behavioral effects of fentanyl. Front Neuroendocrinol 2023; 71:101096. [PMID: 37597668 DOI: 10.1016/j.yfrne.2023.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
The prevalence of opioid use disorder and overdose continues to harm the U.S. population and is further exacerbated by the use of the synthetic opioid, fentanyl, and its analogs. Gender differences in the effects of fentanyl are not well understood. The present article reviews evidence for gender and sex differences in the physiological and behavioral effects of fentanyl in humans and animals. Biological sex seems to be a foundational driver in addiction vulnerability and affects mechanisms related to opioid use including fentanyl. Fentanyl has distinct pharmacodynamics and enhanced efficacy relative to other opioids that highlights the need to investigate how females may be uniquely altered by its use. Behavioral and physiological responses to fentanyl are found to differ by sex and gender in many cases, including outputs like affective symptoms, analgesia, tolerance, and withdrawal emphasizing the need for further research about the role of biological sex on fentanyl use.
Collapse
Affiliation(s)
- Kaitlyn M Little
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Therese A Kosten
- Department of Psychology, University of Houston, Houston, TX, United States.
| |
Collapse
|
5
|
Mao Y, Zhang P, Sun R, Zhang X, He Y, Li S, Yin T, Zeng F. Altered resting-state brain activity in functional dyspepsia patients: a coordinate-based meta-analysis. Front Neurosci 2023; 17:1174287. [PMID: 37250423 PMCID: PMC10213416 DOI: 10.3389/fnins.2023.1174287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Background Neuroimaging studies have identified aberrant activity patterns in multiple brain regions in functional dyspepsia (FD) patients. However, due to the differences in study design, these previous findings are inconsistent, and the underlying neuropathological characteristics of FD remain unclear. Methods Eight databases were systematically searched for literature from inception to October 2022 with the keywords "Functional dyspepsia" and "Neuroimaging." Thereafter, the anisotropic effect size signed the differential mapping (AES-SDM) approach that was applied to meta-analyze the aberrant brain activity pattern of FD patients. Results A total of 11 articles with 260 FD patients and 202 healthy controls (HCs) were included. The AES-SDM meta-analysis demonstrated that FD patients manifested increased activity in the bilateral insula, left anterior cingulate gyrus, bilateral thalamus, right precentral gyrus, left supplementary motor area, right putamen, and left rectus gyrus and decreased functional activity in the right cerebellum compared to the HCs. Sensitivity analysis showed that all these above regions were highly reproducible, and no significant publication bias was detected. Conclusion The current study demonstrated that FD patients had significantly abnormal activity patterns in several brain regions involved in visceral sensation perception, pain modulation, and emotion regulation, which provided an integrated insight into the neuropathological characteristics of FD.
Collapse
Affiliation(s)
- Yangke Mao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pan Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyue Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuqi He
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyang Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| |
Collapse
|
6
|
Kong Y, Posada-Quintero HF, Tran H, Talati A, Acquista TJ, Chen IP, Chon KH. Differentiating between stress- and EPT-induced electrodermal activity during dental examination. Comput Biol Med 2023; 155:106695. [PMID: 36805230 PMCID: PMC10062482 DOI: 10.1016/j.compbiomed.2023.106695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/20/2022] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
Dental pain invokes the sympathetic nervous system, which can be measured by electrodermal activity (EDA). In the dental clinic, accurate quantification of pain is needed because it could enable optimized drug-dose treatments, thereby potentially reducing drug addiction. However, a confounding factor is that during pain there is also lingering residual stress, hence, both contribute to the EDA response. Therefore, we investigated whether EDA can differentiate stress from pain during dental examination. The use of electrical pulp test (EPT) is an ideal approach to tease out the dynamics of stress and mimic pain with lingering residual stress. Once the electrical sensation is felt and reaches a critical current threshold, the subject removes the probe from their tooth, hence, this stage of data represents largely EPT stimulus and the residual stress-induced EDA response is smaller. EPT was performed on necrotic and vital teeth in fifty-one subjects. We defined four different data groups of reactions based on each individual's EPT intensity level expectation based on the visual analog scale (VAS) of their baseline trial, as follows: mild stress, mild stress + EPT, strong stress, and strong stress + EPT. EDA-derived features exhibited significant difference between residual lingering stress + EPT groups and stress groups. We obtained 84.6% accuracy with 76.2% sensitivity and 86.8% specificity with multilayer perceptron in differentiating between pure-stress groups vs. stress + EPT groups. Moreover, EPT induced much greater EDA amplitude and faster response than stress. Our finding suggests that our machine learning approach can discriminate between stress and EPT stimulation in EDA signals.
Collapse
Affiliation(s)
- Youngsun Kong
- Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA.
| | | | - Hanh Tran
- Department of Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT, 06032, USA
| | - Ankur Talati
- Department of Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT, 06032, USA
| | - Thomas J Acquista
- Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - I-Ping Chen
- Department of Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT, 06032, USA
| | - Ki H Chon
- Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| |
Collapse
|
7
|
Pujo J, De Palma G, Lu J, Galipeau HJ, Surette MG, Collins SM, Bercik P. Gut microbiota modulates visceral sensitivity through calcitonin gene-related peptide (CGRP) production. Gut Microbes 2023; 15:2188874. [PMID: 36939195 PMCID: PMC10038053 DOI: 10.1080/19490976.2023.2188874] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Abdominal pain is common in patients with gastrointestinal disorders, but its pathophysiology is unclear, in part due to poor understanding of basic mechanisms underlying visceral sensitivity. Accumulating evidence suggests that gut microbiota is an important determinant of visceral sensitivity. Clinical and basic research studies also show that sex plays a role in pain perception, although the precise pathways are not elucidated. We investigated pain responses in germ-free and conventionally raised mice of both sexes, and assessed visceral sensitivity to colorectal distension, neuronal excitability of dorsal root ganglia (DRG) neurons and the production of substance P and calcitonin gene-related peptide (CGRP) in response to capsaicin or a mixture of G-protein coupled receptor (GPCR) agonists. Germ-free mice displayed greater in vivo responses to colonic distention than conventional mice, with no differences between males and females. Pretreatment with intracolonic capsaicin or GPCR agonists increased responses in conventional, but not in germ-free mice. In DRG neurons, gut microbiota and sex had no effect on neuronal activation by capsaicin or GPCR agonists. While stimulated production of substance P by DRG neurons was similar in germ-free and conventional mice, with no additional effect of sex, the CGRP production was higher in germ-free mice, mainly in females. Absence of gut microbiota increases visceral sensitivity to colorectal distention in both male and female mice. This is, at least in part, due to increased production of CGRP by DRG neurons, which is mainly evident in female mice. However, central mechanisms are also likely involved in this process.
Collapse
Affiliation(s)
- Julien Pujo
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Giada De Palma
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jun Lu
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Heather J Galipeau
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Michael G Surette
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Stephen M Collins
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
8
|
Ribeiro M, Forcelini CM, Navarini D, Soder RB, Fornari F. Disruption of the brain-esophagus axis in obese patients with heartburn. Dis Esophagus 2022; 35:6568916. [PMID: 35428882 DOI: 10.1093/dote/doac021] [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: 10/24/2021] [Revised: 02/08/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
Abstract
Obesity is a risk factor for gastroesophageal reflux disease. Studies addressing the brain-esophagus axis in obese are lacking. In obese with and without heartburn, we assessed: (i) the brain responses to esophageal acid perfusion during functional brain imaging; (ii) esophageal impedance baseline before and after acid perfusion; and (iii) abdominal fat distribution. In this exploratory study, 26 obese underwent functional magnetic resonance imaging (fMRI) of the brain combined with esophageal acid perfusion. Esophageal impedance baseline was determined before and after fMRI, followed by tomographic quantification of the abdominal fat. Among 26 obese (54% men, 39.7 years old, 33.5 kg/m2), there were 17 with heartburn and 9 without heartburn. Before fMRI, the esophageal impedance baseline was lower in obese with heartburn than without heartburn (median 1187 vs. 1890 Ω; P = 0.025). After acid perfusion, impedance baseline decreased in obese with heartburn (from 1187 to 899 Ω; P = 0.011) and was lower in this group than in obese without heartburn (899 vs. 1614 Ω; P = 0.001). fMRI task-residual analysis showed that obese with heartburn presented higher functional connectivity in several brain regions than obese without heartburn. Abdominal fat area did not differ between obese with and without heartburn either for total (72.8 ± 4.4% vs. 70.3 ± 6.0%; P = 0.280), subcutaneous (42.2 ± 9.0% vs. 37.4 ± 9.0%; P = 0.226), or visceral (30.6 ± 7.9% vs. 33.0 ± 7.8%; P = 0.484). In subjects with obesity, the brain-esophagus axis is disrupted centrally with higher functional brain connectivity and peripherally with decreased esophageal mucosa integrity in the presence of heartburn.
Collapse
Affiliation(s)
- Marcelo Ribeiro
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.,Clínica Kozma, Passo Fundo-RS, Brazil
| | | | - Daniel Navarini
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo-RS, Brazil
| | - Ricardo Bernardi Soder
- Instituto do Cérebro, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Fernando Fornari
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.,Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo-RS, Brazil.,Faculdade de Odontologia, Programa de Pós- Graduação em Odontologia, Faculdade de Odontologia, Universidade de Passo Fundo, Passo Fundo-RS, Brazil
| |
Collapse
|
9
|
Karunakaran KD, Kussman BD, Peng K, Becerra L, Labadie R, Bernier R, Berry D, Green S, Zurakowski D, Alexander ME, Borsook D. Brain-based measures of nociception during general anesthesia with remifentanil: A randomized controlled trial. PLoS Med 2022; 19:e1003965. [PMID: 35452458 PMCID: PMC9075662 DOI: 10.1371/journal.pmed.1003965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Catheter radiofrequency (RF) ablation for cardiac arrhythmias is a painful procedure. Prior work using functional near-infrared spectroscopy (fNIRS) in patients under general anesthesia has indicated that ablation results in activity in pain-related cortical regions, presumably due to inadequate blockade of afferent nociceptors originating within the cardiac system. Having an objective brain-based measure for nociception and analgesia may in the future allow for enhanced analgesic control during surgical procedures. Hence, the primary aim of this study is to demonstrate that the administration of remifentanil, an opioid widely used during surgery, can attenuate the fNIRS cortical responses to cardiac ablation. METHODS AND FINDINGS We investigated the effects of continuous remifentanil on cortical hemodynamics during cardiac ablation under anesthesia. In a randomized, double-blinded, placebo (PL)-controlled trial, we examined 32 pediatric patients (mean age of 15.8 years,16 females) undergoing catheter ablation for cardiac arrhythmias at the Cardiology Department of Boston Children's Hospital from October 2016 to March 2020; 9 received 0.9% NaCl, 12 received low-dose (LD) remifentanil (0.25 mcg/kg/min), and 11 received high-dose (HD) remifentanil (0.5 mcg/kg/min). The hemodynamic changes of primary somatosensory and prefrontal cortices were recorded during surgery using a continuous wave fNIRS system. The primary outcome measures were the changes in oxyhemoglobin concentration (NadirHbO, i.e., lowest oxyhemoglobin concentration and PeakHbO, i.e., peak change and area under the curve) of medial frontopolar cortex (mFPC), lateral prefrontal cortex (lPFC) and primary somatosensory cortex (S1) to ablation in PL versus remifentanil groups. Secondary measures included the fNIRS response to an auditory control condition. The data analysis was performed on an intention-to-treat (ITT) basis. Remifentanil group (dosage subgroups combined) was compared with PL, and a post hoc analysis was performed to identify dose effects. There were no adverse events. The groups were comparable in age, sex, and number of ablations. Results comparing remifentanil versus PL show that PL group exhibit greater NadirHbO in inferior mFPC (mean difference (MD) = 1.229, 95% confidence interval [CI] = 0.334, 2.124, p < 0.001) and superior mFPC (MD = 1.206, 95% CI = 0.303, 2.109, p = 0.001) and greater PeakHbO in inferior mFPC (MD = -1.138, 95% CI = -2.062, -0.214, p = 0.002) and superior mFPC (MD = -0.999, 95% CI = -1.961, -0.036, p = 0.008) in response to ablation. S1 activation from ablation was greatest in PL, then LD, and HD groups, but failed to reach significance, whereas lPFC activation to ablation was similar in all groups. Ablation versus auditory stimuli resulted in higher PeakHbO in inferior mFPC (MD = 0.053, 95% CI = 0.004, 0.101, p = 0.004) and superior mFPC (MD = 0.052, 95% CI = 0.013, 0.091, p < 0.001) and higher NadirHbO in posterior superior S1 (Pos. SS1; MD = -0.342, 95% CI = -0.680, -0.004, p = 0.007) during ablation of all patients. Remifentanil group had smaller NadirHbO in inferior mFPC (MD = 0.098, 95% CI = 0.009, 0.130, p = 0.003) and superior mFPC (MD = 0.096, 95% CI = 0.008, 0.116, p = 0.003) and smaller PeakHbO in superior mFPC (MD = -0.092, 95% CI = -0.680, -0.004, p = 0.007) during both the stimuli. Study limitations were small sample size, motion from surgery, indirect measure of nociception, and shallow penetration depth of fNIRS only allowing access to superficial cortical layers. CONCLUSIONS We observed cortical activity related to nociception during cardiac ablation under general anesthesia with remifentanil. It highlights the potential of fNIRS to provide an objective pain measure in unconscious patients, where cortical-based measures may be more accurate than current evaluation methods. Future research may expand on this application to produce a real-time indication of pain that will aid clinicians in providing immediate and adequate pain treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02703090.
Collapse
Affiliation(s)
- Keerthana Deepti Karunakaran
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Barry D. Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ke Peng
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Département en Neuroscience, Centre de Recherche du CHUM, l’Université de Montréal Montreal, Québec, Canada
| | - Lino Becerra
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert Labadie
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rachel Bernier
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Delany Berry
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Green
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Zurakowski
- Division of Biostatistics, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Borsook
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
10
|
Trapp MDC, Wiskur BJ, Suh JH, Brand MW, Kuhn KG, Rojas J. Sex Differences between Medical Students in the Assessment of the Fear of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063372. [PMID: 35329060 PMCID: PMC8955011 DOI: 10.3390/ijerph19063372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Background: Differing expressions of the fear of COVID-19 between men and women can potentially increase both immediate and long-term physical health risks. We predicted that women students would express greater fear of COVID-19. Methods: We used an Internet-delivered Fear of COVID-19 Scale (FCV-19S) to assess fear among men (n = 100) and women (n = 272) from a larger population of academic medical center members (n = 1761). Sex differences in emotional and physical symptoms were assessed as subcategories within fear scores. Results: Women reported greater fear of COVID-19 than men (p < 0.001). Women reported greater emotional fear (p < 0.001) on specific scale items (thinking of COVID-19, watching news stories about COVID-19, and losing sleep due to fear of contracting COVID-19). Discussion/Conclusions: These results provide a better understanding of how fear of COVID-19 can differ based on sex and how that fear may be expressed differently through emotional and physical symptoms. This information will inform academic health centers of COVID-19 prevention and management policies that may include a gender-specific focus.
Collapse
Affiliation(s)
- Maria del Carmen Trapp
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA; (M.d.C.T.); (J.H.S.); (M.W.B.); (J.R.)
| | - Brandt J. Wiskur
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA; (M.d.C.T.); (J.H.S.); (M.W.B.); (J.R.)
- Academic Affairs and Faculty Development, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
- Correspondence: ; Tel.: +1-(405)-271-2359
| | - Joy H. Suh
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA; (M.d.C.T.); (J.H.S.); (M.W.B.); (J.R.)
| | - Michael W. Brand
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA; (M.d.C.T.); (J.H.S.); (M.W.B.); (J.R.)
| | - Katrin G. Kuhn
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Julio Rojas
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA; (M.d.C.T.); (J.H.S.); (M.W.B.); (J.R.)
| |
Collapse
|
11
|
Hu C, Liu L, Liu L, Zhang J, Hu Y, Zhang W, Ding Y, Wang Y, Zhang Z, von Deneen KM, Qian L, Wang H, Duan S, Wang F, Cui G, Nie Y, Zhang Y. Cortical morphometry alterations in brain regions involved in emotional, motor-control and self-referential processing in patients with functional constipation. Brain Imaging Behav 2021; 14:1899-1907. [PMID: 31218532 DOI: 10.1007/s11682-019-00133-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Functional constipation (FC) is a common functional gastrointestinal disorder (FGID). Neuroimaging studies on patients with FC showed brain functional abnormalities in regions involved in emotional process modulation, somatic and sensory processing and motor control. Brain structural imaging studies in patients with FGID have also shown disease-related alterations in cortical morphometry, but whether and how FC affects brain structure remains unclear. Structural Magnetic Resonance Imaging and surface-based morphometry analysis were used to investigate the impact of FC on cortical morphometry in 29 patients with FC and 29 healthy controls (HC). Results showed that patients with FC compared to HC had significantly decreased cortical thickness in the left middle frontal gyrus (MFG), dorsomedial (DMPFC) and ventromedial prefrontal gyrus (VMPFC), right dorsal anterior cingulate cortex (dACC), left orbitofrontal cortex (OFC), posterior cingulate cortex (PCC)/precuneus, middle temporal gyrus (MTG), and supplementary motor area (SMA) (P < 0.01). Correlation analysis showed that sensation of incomplete evacuation was negatively correlated with cortical thickness in the SMA (P < 0.0001). In addition, patients with FC also had decreased cortical volume than HC in the MTG, precentral gyrus (PreCen) and precuneus/cuneus (P < 0.01), as well as decreased cortical surface area in the PreCen (P < 0.01). No correlation was found between cortical volume/surface area and behavioral measures. These findings suggest that patients with FC are associated with cortical morphometric abnormalities in brain regions implicated in somatic/motor-control, emotional processing and self-referential processing.
Collapse
Affiliation(s)
- Chunxin Hu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Li Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Lei Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Junwang Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yang Hu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Wenchao Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Yueyan Ding
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Yuanyuan Wang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Zhida Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Karen M von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Long Qian
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Shijun Duan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, No.4 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Fan Wang
- Xi'an Mayinglong Anorectal Hospital, Xi'an, 710032, Shaanxi, China
| | - Guangbin Cui
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, No.4 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Yongzhan Nie
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Yi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China.
| |
Collapse
|
12
|
Kano M, Oudenhove LV, Dupont P, Wager TD, Fukudo S. Imaging Brain Mechanisms of Functional Somatic Syndromes: Potential as a Biomarker? TOHOKU J EXP MED 2020; 250:137-152. [PMID: 32132323 DOI: 10.1620/tjem.250.137] [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] [Indexed: 11/18/2022]
Abstract
When patients present with persistent bodily complaints that cannot be explained by a symptom-linked organic pathology (medically unexplained symptoms), they are diagnosed with 'functional' somatic syndromes (FSS). Despite their prevalence, the management of FSS is notoriously challenging in clinical practice. This may be because FSS are heterogeneous disorders in terms of etiopathogenesis. They include patients with primarily peripheral dysfunction, primarily centrally driven somatic symptoms, and a mix of both. Brain-imaging studies, particularly data-driven pattern recognition methods using machine learning algorithms, could provide brain-based biomarkers for these clinical conditions. In this review, we provide an overview of our brain imaging data on brain-body interactions in one of the most well-known FSS, irritable bowel syndrome (IBS), and discuss the possible development of a brain-based biomarker for FSS. Anticipation of unpredictable pain, which commonly elicits fear in FSS patients, induced increased activity in brain areas associated with hypervigilance during rectal distention and non-distention conditions in IBS. This was coupled with dysfunctional inhibitory influence of the medial prefrontal cortex (mPFC) and pregenual anterior cingulate cortex (pACC) on stress regulation systems, resulting in the activated autonomic nervous system (ANS) and neuroendocrine system stimulated by corticotropin-releasing hormone (CRH). IBS subjects with higher alexithymia, a risk factor for FSS, showed stronger activity in the insula during rectal distention but reduced subjective sensitivity. Reduced top-down regulation of the ANS and CRH system by mPFC and pACC, discordance between the insula response to stimulation and subjective sensation of pain, and stronger threat responses in hypervigilance-related areas may be a candidate brain-based biomarker.
Collapse
Affiliation(s)
- Michiko Kano
- Sukawa Clinic, Kirari Health-Coop.,Behavioral Medicine, Tohoku University Graduate School of Medicine
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven
| | | | - Tor D Wager
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College
| | - Shin Fukudo
- Behavioral Medicine, Tohoku University Graduate School of Medicine.,Department of Psychosomatic Medicine, Tohoku University Hospital
| |
Collapse
|
13
|
Van Oudenhove L, Kragel PA, Dupont P, Ly HG, Pazmany E, Enzlin P, Rubio A, Delon-Martin C, Bonaz B, Aziz Q, Tack J, Fukudo S, Kano M, Wager TD. Common and distinct neural representations of aversive somatic and visceral stimulation in healthy individuals. Nat Commun 2020; 11:5939. [PMID: 33230131 PMCID: PMC7684294 DOI: 10.1038/s41467-020-19688-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022] Open
Abstract
Different pain types may be encoded in different brain circuits. Here, we examine similarities and differences in brain processing of visceral and somatic pain. We analyze data from seven fMRI studies (N = 165) and five types of pain and discomfort (esophageal, gastric, and rectal distension, cutaneous thermal stimulation, and vulvar pressure) to establish and validate generalizable pain representations. We first evaluate an established multivariate brain measure, the Neurologic Pain Signature (NPS), as a common nociceptive pain system across pain types. Then, we develop a multivariate classifier to distinguish visceral from somatic pain. The NPS responds robustly in 98% of participants across pain types, correlates with perceived intensity of visceral pain and discomfort, and shows specificity to pain when compared with cognitive and affective conditions from twelve additional studies (N = 180). Pre-defined signatures for non-pain negative affect do not respond to visceral pain. The visceral versus the somatic classifier reliably distinguishes somatic (thermal) from visceral (rectal) stimulation in both cross-validation and independent cohorts. Other pain types reflect mixtures of somatic and visceral patterns. These results validate the NPS as measuring a common core nociceptive pain system across pain types, and provide a new classifier for visceral versus somatic pain.
Collapse
Affiliation(s)
- Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Philip A Kragel
- Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Huynh Giao Ly
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, Leuven, Belgium
| | - Els Pazmany
- Interfaculty Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium
| | - Paul Enzlin
- Interfaculty Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium
| | - Amandine Rubio
- Grenoble Institute of Neuroscience, University of Grenoble Alpes, Grenoble, France
| | - Chantal Delon-Martin
- Grenoble Institute of Neuroscience, University of Grenoble Alpes, Grenoble, France
| | - Bruno Bonaz
- Grenoble Institute of Neuroscience, University of Grenoble Alpes, Grenoble, France
| | - Qasim Aziz
- Barts and The London School of Medicine and Dentistry, Wingate Institute of Neurogastroenterology, Centre for Neuroscience and Trauma, Blizzard Institute, Queen Mary University of London, London, UK
| | - Jan Tack
- Gastrointestinal Motility and Sensitivity Research Group, Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, Leuven, Belgium
| | - Shin Fukudo
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Michiko Kano
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Frontier Research Institute for Interdisciplinary Sciences (FRIS), Tohoku University, Sendai, Japan
| | - Tor D Wager
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| |
Collapse
|
14
|
Sambuco N, Costa VD, Lang PJ, Bradley MM. Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock. J Affect Disord 2020; 276:1142-1148. [PMID: 32791350 PMCID: PMC7490761 DOI: 10.1016/j.jad.2020.07.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 explicitly states that the neural system model of specific phobia is centered on the amygdala. However, this hypothesis is predominantly supported by human studies on animal phobia, whereas visual cuing of other specific phobias, such as dental fear, do not consistently show amygdala activation. Considering that fear of anticipated pain is one of the best predictors of dental phobia, the current study investigated neural and autonomic activity of pain anticipation in individuals varying in the degree of fear of dental pain. METHOD Functional brain activity (fMRI) was measured in women (n = 31) selected to vary in the degree of self-reported fear of dental pain when under the threat of shock, in which one color signaled the possibility of receiving a painful electric shock and another color signaled safety. RESULTS Enhanced functional activity during threat, compared to safety, was found in regions including anterior insula and anterior/mid cingulate cortex. Importantly, threat reactivity in the anterior insula increased as reported fear of pain increased and further predicted skin conductance changes during pain anticipation. LIMITATIONS The sample was comprised of women. CONCLUSIONS Individual differences in fear of pain vary with activation in the anterior insula, rather than with the amygdala, indicating that fear is not uniquely associated with amygdala activation. Whereas coping techniques such as emotion regulation have been found to vary with activation in a frontal-amygdala circuit when confronted with visual cues, precision psychiatry may need to target specific brain circuits to diagnose and treat different types of specific phobia.
Collapse
Affiliation(s)
- Nicola Sambuco
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL.
| | - Vincent D Costa
- Department of Behavioral Neuroscience, Oregon Health & Science University
| | - Peter J Lang
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
| | - Margaret M Bradley
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
| |
Collapse
|
15
|
Park BY, Lee JJ, Kim HJ, Woo CW, Park H. A neuroimaging marker for predicting longitudinal changes in pain intensity of subacute back pain based on large-scale brain network interactions. Sci Rep 2020; 10:17392. [PMID: 33060726 PMCID: PMC7567066 DOI: 10.1038/s41598-020-74217-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022] Open
Abstract
Identification of predictive neuroimaging markers of pain intensity changes is a crucial issue to better understand macroscopic neural mechanisms of pain. Although a single connection between the medial prefrontal cortex and nucleus accumbens has been suggested as a powerful marker, how the complex interactions on a large-scale brain network can serve as the markers is underexplored. Here, we aimed to identify a set of functional connections predictive of longitudinal changes in pain intensity using large-scale brain networks. We re-analyzed previously published resting-state functional magnetic resonance imaging data of 49 subacute back pain (SBP) patients. We built a network-level model that predicts changes in pain intensity over one year by combining independent component analysis and a penalized regression framework. Connections involving top-down pain modulation, multisensory integration, and mesocorticolimbic circuits were identified as predictive markers for pain intensity changes. Pearson’s correlations between actual and predicted pain scores were r = 0.33–0.72, and group classification results between SBP patients with persisting pain and recovering patients, in terms of area under the curve (AUC), were 0.89/0.75/0.75 for visits four/three/two, thus outperforming the previous work (AUC 0.83/0.73/0.67). This study identified functional connections important for longitudinal changes in pain intensity in SBP patients, providing provisional markers to predict future pain using large-scale brain networks.
Collapse
Affiliation(s)
- Bo-Yong Park
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jae-Joong Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hong Ji Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea. .,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea.
| |
Collapse
|
16
|
Wittbrodt MT, Moazzami K, Shah AJ, Lima BB, Hammadah M, Mehta PK, Quyyumi AA, Vaccarino V, Nye JA, Bremner JD. Neural responses during acute mental stress are associated with angina pectoris. J Psychosom Res 2020; 134:110110. [PMID: 32345456 PMCID: PMC8082434 DOI: 10.1016/j.jpsychores.2020.110110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/31/2022]
Abstract
UNLABELLED Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.
Collapse
Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Corresponding author at: 1821 Clifton Rd, Room 214, Atlanta, GA 30307, United States of America. (M.T. Wittbrodt)
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Muhammad Hammadah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine, United States of America
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Department of Radiology, Emory University School of Medicine, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
| |
Collapse
|
17
|
The medial temporal lobe in nociception: a meta-analytic and functional connectivity study. Pain 2020; 160:1245-1260. [PMID: 30747905 DOI: 10.1097/j.pain.0000000000001519] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent neuroimaging studies implicate the medial temporal lobe (MTL) in nociception and pain modulation. Here, we aim to identify which subregions of the MTL are involved in human pain and to test its connectivity in a cohort of chronic low-back pain patients (CBP). We conducted 2 coordinate-based meta-analyses to determine which regions within the MTL showed consistent spatial patterns of functional activation (1) in response to experimental pain in healthy participants and (2) in chronic pain compared with healthy participants. We followed PRISMA guidelines and performed activation likelihood estimate (ALE) meta-analyses. The first meta-analysis revealed consistent activation in the right anterior hippocampus (right antHC), parahippocampal gyrus, and amygdala. The second meta-analysis revealed consistently less activation in patients' right antHC, compared with healthy participants. We then conducted a seed-to-voxel resting state functional connectivity of the right antHC seed with the rest of the brain in 77 CBP and 79 age-matched healthy participants. We found that CBP had significantly weaker antHC functional connectivity to the medial prefrontal cortex compared with healthy participants. Taken together, these data indicate that the antHC has abnormally lower activity in chronic pain and reduced connectivity to the medial prefrontal cortex in CBP. Future studies should investigate the specific role of the antHC in the development and management of chronic pain.
Collapse
|
18
|
Icenhour A, Labrenz F, Roderigo T, Siebert C, Elsenbruch S, Benson S. Are there sex differences in visceral sensitivity in young healthy men and women? Neurogastroenterol Motil 2019; 31:e13664. [PMID: 31194287 DOI: 10.1111/nmo.13664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Visceral hypersensitivity plays a key role in the pathophysiology of chronic visceral pain like irritable bowel syndrome (IBS), which is significantly more prevalent in women. Possible sex differences in visceral sensitivity remain poorly studied. We assessed sex differences in visceral sensitivity and their association with subclinical symptoms, trait anxiety, and chronic stress in a large sample of healthy men and women. METHODS In 280 young healthy volunteers (50% female), visceral sensory and pain thresholds were determined using rectal balloon distensions. Gastrointestinal (GI) symptoms, chronic stress, and trait anxiety as IBS-related risk factors were assessed with questionnaires. Men and women were compared regarding visceral sensitivity and multiple regression analyses were conducted to evaluate the predictive value of sex and risk factors for visceral sensitivity. Subgroups with high, intermediate, and low sensitivity were compared regarding psychological and biological characteristics. KEY RESULTS Men and women did not differ in sensory or pain thresholds or in IBS-related risk factors. In multiple regression analyses, no predictor of visceral sensitivity could be identified. While sensitivity subgroups differed in sensory and pain thresholds, the proportions of men and women were comparable, and groups did not differ in IBS-related risk factors. CONCLUSIONS AND INFERENCES Despite the large sample size, we found no evidence supporting sex differences in visceral sensitivity. At least in healthy young volunteers, our findings suggest that sex, GI symptoms, anxiety, or chronic stress do not contribute to altered visceral sensitivity.
Collapse
Affiliation(s)
- Adriane Icenhour
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Franziska Labrenz
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Till Roderigo
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carsten Siebert
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
19
|
Wang Z, Guo Y, Mayer EA, Holschneider DP. Sex differences in insular functional connectivity in response to noxious visceral stimulation in rats. Brain Res 2019; 1717:15-26. [PMID: 30974090 DOI: 10.1016/j.brainres.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 03/01/2019] [Accepted: 04/07/2019] [Indexed: 01/26/2023]
Abstract
Insular cortex (INS) plays a critical role in pain processing and shows sex differences in functional activation during noxious visceral stimulation. Less is known regarding functional interactions within the INS and between this structure and other parts of the brain. Cerebral blood flow mapping was performed using [14C]-iodoantipyrine perfusion autoradiography in male and female rats during colorectal distension (CRD) or no distension (controls). Forty regions of interest (ROIs) were defined anatomically to represent the granular, dysgranular, and agranular INS along the anterior-posterior (A-P) axis. Inter-ROI correlation matrices were calculated for each group to characterize intra-insular functional connectivity (FC). Results showed a clear FC segregation within the INS into an anterior (rostral to bregma +2.4 mm), a posterior (caudal to bregma -1.2 mm), and a mid INS subregion in between. Female controls showed higher FC density compared to males. During CRD, intra-insular FC density decreased greatly in females, but only modestly in males, with a loss of long-range connections between the anterior and mid INS noted in both sexes. New functional organization was characterized in both sexes by a cluster in the mid INS and primarily short-range FC along the A-P axis. Seed correlation analysis during CRD showed sex differences in FC of the anterior and mid agranular INS with the medial prefrontal cortex, thalamus, and brainstem areas (periaqueductal gray, parabrachial nucleus), suggesting sex differences in the modulatory aspect of visceral pain processing. Our findings suggest presence of substantial sex differences in visceral pain processing at the level of the insula.
Collapse
Affiliation(s)
- Zhuo Wang
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA 90089, USA.
| | - Yumei Guo
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Emeran A Mayer
- Departments of Medicine, Physiology, Psychiatry and Biobehavioral Sciences, G Oppenheimer Center for Neurobiology of Stress and Resilience, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel P Holschneider
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA 90089, USA; Departments of Neurology, Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| |
Collapse
|
20
|
Lee JY, Park KS. [Gender Difference in Functional Gastrointestinal Disorders]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:163-169. [PMID: 30419641 DOI: 10.4166/kjg.2018.72.4.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional gastrointestinal diseases (FGIDs) are known to be influenced more by a lowering of the quality of life, such as mental health and sleep quality, compared to organic diseases. Genetic, microbiological, molecular biological, and social environmental factors are involved in the pathophysiology of FGIDs. In particular, mental factors, such as depression and anxiety, play a major role in the development of FGIDs. The prevalence of most FGIDs is higher in women. Gender needs to be analyzed in patients with FGIDs because it can have a great influence on the onset of FGIDs. Because there are differences in the treatment response according to gender, further research in the development of therapeutic drugs considering this gender difference will be needed, and ultimately it will be possible to lower the prevalence of FGIDs and improve the quality of life of patients.
Collapse
Affiliation(s)
- Ju Yup Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
21
|
Kano M, Dupont P, Aziz Q, Fukudo S. Understanding Neurogastroenterology From Neuroimaging Perspective: A Comprehensive Review of Functional and Structural Brain Imaging in Functional Gastrointestinal Disorders. J Neurogastroenterol Motil 2018; 24:512-527. [PMID: 30041284 PMCID: PMC6175554 DOI: 10.5056/jnm18072] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022] Open
Abstract
This review provides a comprehensive overview of brain imaging studies of the brain-gut interaction in functional gastrointestinal disorders (FGIDs). Functional neuroimaging studies during gut stimulation have shown enhanced brain responses in regions related to sensory processing of the homeostatic condition of the gut (homeostatic afferent) and responses to salience stimuli (salience network), as well as increased and decreased brain activity in the emotional response areas and reduced activation in areas associated with the top-down modulation of visceral afferent signals. Altered central regulation of the endocrine and autonomic nervous responses, the key mediators of the brain-gut axis, has been demonstrated. Studies using resting-state functional magnetic resonance imaging reported abnormal local and global connectivity in the areas related to pain processing and the default mode network (a physiological baseline of brain activity at rest associated with self-awareness and memory) in FGIDs. Structural imaging with brain morphometry and diffusion imaging demonstrated altered gray- and white-matter structures in areas that also showed changes in functional imaging studies, although this requires replication. Molecular imaging by magnetic resonance spectroscopy and positron emission tomography in FGIDs remains relatively sparse. Progress using analytical methods such as machine learning algorithms may shift neuroimaging studies from brain mapping to predicting clinical outcomes. Because several factors contribute to the pathophysiology of FGIDs and because its population is quite heterogeneous, a new model is needed in future studies to assess the importance of the factors and brain functions that are responsible for an optimal homeostatic state.
Collapse
Affiliation(s)
- Michiko Kano
- Frontier Research Institute for Interdisciplinary Sciences (FRIS), Tohoku University, Sendai,
Japan
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai,
Japan
- Psychosomatic Medicine, Tohoku University Hospital, Sendai,
Japan
| | | | - Qasim Aziz
- Center for Digestive Diseases, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London,
UK
| | - Shin Fukudo
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai,
Japan
- Psychosomatic Medicine, Tohoku University Hospital, Sendai,
Japan
| |
Collapse
|
22
|
Ruffle JK, Coen SJ, Giampietro V, Williams SCR, Aziz Q, Farmer AD. Preliminary report: parasympathetic tone links to functional brain networks during the anticipation and experience of visceral pain. Sci Rep 2018; 8:13410. [PMID: 30194351 PMCID: PMC6128833 DOI: 10.1038/s41598-018-31522-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
The mechanisms that underpin the anti-nociceptive effect of the parasympathetic nervous system (PNS) on visceral pain remain incompletely understood. We sought to describe the effect of resting parasympathetic tone on functional brain networks during the anticipation and experience of oesophageal pain. 21 healthy participants had their resting cardiac vagal tone (CVT), a validated measure of the PNS, quantified, and underwent functional magnetic resonance imaging during the anticipation and experience of painful oesophageal distention. The relationship between resting CVT and functional brain networks was examined using 11 hypothesis-driven nodes and network-based statistics. A network comprising all nodes was apparent in individuals with high resting CVT, compared to those with low CVT, during oesophageal pain (family wise error rate (FWER)-corrected p < 0.048). Functional connections included the thalamus-amygdala, thalamus-hypothalamus, hypothalamus-nucleus accumbens, amygdala-pallidum, pallidum-nucleus accumbens and insula-pallidum. A smaller network was seen during pain anticipation, comprising the amygdala, pallidum and anterior insula (FWER-corrected p < 0.049). These findings suggest that PNS tone is associated with functional brain networks during the anticipation and experience of visceral pain. Given the role of these subcortical regions in the descending inhibitory modulation of pain, these networks may represent a potential neurobiological explanation for the anti-nociceptive effect of the PNS.
Collapse
Affiliation(s)
- James K Ruffle
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK
| | - Steven J Coen
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Vincent Giampietro
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, SE5 8AF, UK
| | - Steven C R Williams
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, SE5 8AF, UK
| | - Qasim Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK.
| | - Adam D Farmer
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ, UK.,Institute of Applied Clinical Sciences, University of Keele, Keele, Staffordshire, ST5 5BG, UK
| |
Collapse
|
23
|
Influence of Uncertain Anticipation on Brain Responses to Aversive Rectal Distension in Patients With Irritable Bowel Syndrome. Psychosom Med 2018; 79:988-999. [PMID: 28498276 DOI: 10.1097/psy.0000000000000484] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We investigated whether certainty and uncertainty of impending aversive visceral sensation differently modulate regional brain activity, both during anticipation and visceral sensation in irritable bowel syndrome (IBS) patients compared with healthy controls. METHODS Twenty-six IBS patients (14 women) and 29 healthy controls (15 women) were enrolled in a functional magnetic resonance imaging study. Participants received rectal distention at an individually titrated severe discomfort level that was preceded by visual cues to induce certain (100% chance of distention), uncertain (50% chance), and safe (0% chance) anticipation. RESULTS Subjective ratings of anticipatory fear before and discomfort during distention were similar between IBS and control participants under cued certainty and uncertainty (p > .05). Uncertain anticipation compared with certain anticipation induced greater activation of anterior midcingulate cortex, thalamus, and visual processing areas in IBS patients compared with controls. Rectal distention after the uncertain, but not certain, cue induced higher activity in the posterior- and midcingulate cortices and the precuneus in IBS compared with controls. Controls exhibited bilateral insula activation during the nondistention period after the uncertain cue compared with the safe cue. IBS patients failed to produce this response, which was possibly due to elevated bilateral insular responses during nondistention after the safe cue. Brain data were significant at a voxel-level threshold of puncorrected value of less than .005 combined with a cluster-level threshold of pFWE-corrected value of less than .05. CONCLUSIONS Preceding uncertainty differentially modulates the brain processing of physiologically identical rectal stimulation in IBS patients. Cue-dependent alterations in brain responses may underlie hypervigilance to visceral sensations in IBS patients.
Collapse
|
24
|
Brienza A, Gianforcaro A, Suffoletto B, Callaway CW, Pacella ML. The utility of assessing for pain interference and psychological factors among emergency department patients who present with pain. Gen Hosp Psychiatry 2018. [PMID: 29518742 DOI: 10.1016/j.genhosppsych.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ashley Brienza
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Alexandro Gianforcaro
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Maria L Pacella
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| |
Collapse
|
25
|
Kano M, Muratsubaki T, Van Oudenhove L, Morishita J, Yoshizawa M, Kohno K, Yagihashi M, Tanaka Y, Mugikura S, Dupont P, Ly HG, Takase K, Kanazawa M, Fukudo S. Altered brain and gut responses to corticotropin-releasing hormone (CRH) in patients with irritable bowel syndrome. Sci Rep 2017; 7:12425. [PMID: 28963545 PMCID: PMC5622133 DOI: 10.1038/s41598-017-09635-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022] Open
Abstract
Stress is a known trigger of irritable bowel syndrome (IBS) and exacerbates its gastrointestinal symptoms. However, underlying the physiological mechanism remains unknown. Here, we investigated hypothalamic–pituitary–adrenal (HPA) axis, colonic motility, and autonomic responses to corticotropin-releasing hormone (CRH) administration as well as brain activity alterations in IBS. The study included 28 IBS patients and 34 age and sex-matched healthy control subjects. IBS patients demonstrated greater adrenocorticotropic hormone (ACTH) responses to CRH than control subjects. Male IBS patients had greater increases in colonic motility than male HCs after CRH. Female IBS patients showed altered sympathovagal balance and lower basal parasympathetic tone relative to female control subjects. Brain responses to rectal distention were measured in the same subjects using functional magnetic resonance imaging, and their associations with individual ACTH responses to CRH were tested. A negative association between ACTH response to CRH and activity in the pregenual anterior cingulate cortex (pACC) during rectal distention was identified in controls but not in IBS patients. Impaired top-down inhibitory input from the pregenual ACC to the HPA axis may lead to altered neuroendocrine and gastrointestinal responses to CRH. Centrally acting treatments may dampen the stress induced physical symptoms in IBS.
Collapse
Affiliation(s)
- Michiko Kano
- Frontier Research Institute for Interdisciplinary Sciences (FRIS), Tohoku University, Sendai, Japan. .,Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| | - Tomohiko Muratsubaki
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Joe Morishita
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Makoto Yoshizawa
- Research Division on Advanced Information Technology, Cyberscience Center, Tohoku University, Sendai, Japan
| | - Keiji Kohno
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Mao Yagihashi
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yukari Tanaka
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Shunji Mugikura
- Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, University of Leuven, Leuven, Belgium
| | - Huynh Giao Ly
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Kei Takase
- Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Motoyori Kanazawa
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Behavioral Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| |
Collapse
|
26
|
Pazmany E, Ly HG, Aerts L, Kano M, Bergeron S, Verhaeghe J, Peeters R, Tack J, Dupont P, Enzlin P, Van Oudenhove L. Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder. NEUROIMAGE-CLINICAL 2017; 16:477-490. [PMID: 28932680 PMCID: PMC5596304 DOI: 10.1016/j.nicl.2017.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/02/2017] [Accepted: 07/22/2017] [Indexed: 01/27/2023]
Abstract
Objective In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD. Methods Women with GPPPD (n = 18) and age-matched healthy controls (HC) (n = 15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales. Results Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD. Conclusions Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5. Both subjective and brain responses during anticipation and induction of vestibular pain are increased in women with GPPPD. Between-group differences were found in brain regions involved in cognitive and affective aspects of the pain experience. These results support the addition of pain-related fear and anxiety in the diagnostic criteria of GPPPD in DSM-5.
Collapse
Key Words
- Anticipation of pain
- DSM-5, Diagnostic Statistical Manual of Mental Disorders, fifth edition
- FM, fibromyalgia
- FPQ, Fear of Pain Questionnaire
- GPPPD, Genito-Pelvic Pain/Penetration Disorder
- Genito-pelvic pain/penetration disorder
- HC, healthy controls
- IBS, irritable bowel syndrome
- OFC, orbitofrontal cortex
- PASS, Pain Anxiety Symptoms Scale
- PVD, provoked vestibulodynia
- Pain-related fear and anxiety
- Provoked vestibulodynia
- Q1, Quartile 1
- Q3, Quartile 3
- SAS, statistical analysis software
- SD, standard deviation
- SII, secondary somatosensory cortex
- SMA, supplementary motor area
- SPM8, Statistical Parametric Mapping, SPM8
- SPSS, Statistical Package for Social Sciences
- STAI, State-Trait Anxiety Inventory
- TR/TE, repetition time/echo time
- VAS, Visual Analogue Scale
- Vestibular pain
- aMCC, anterior midcingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI
- fMRI, functional magnetic resonance imaging
- n, number
- pACC, perigenual anterior cingulate cortex
- vlPFC, ventrolateral prefrontal cortex
- vmPFC, ventromedial prefrontal cortex
Collapse
Affiliation(s)
- Els Pazmany
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Huynh Giao Ly
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Leen Aerts
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Michiko Kano
- The Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Johan Verhaeghe
- Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Ronald Peeters
- Medical Diagnostic Sciences, KU Leuven & Radiology University Hospitals Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven & Medical Imaging Centre, University Hospitals Leuven, Leuven, Belgium
| | - Paul Enzlin
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Centre for Clinical Sexology and Sex Therapy, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
27
|
Coulombe MA, Lawrence KS, Moulin DE, Morley-Forster P, Shokouhi M, Nielson WR, Davis KD. Lower Functional Connectivity of the Periaqueductal Gray Is Related to Negative Affect and Clinical Manifestations of Fibromyalgia. Front Neuroanat 2017. [PMID: 28642688 PMCID: PMC5462926 DOI: 10.3389/fnana.2017.00047] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fibromyalgia (FM) syndrome is characterized by chronic widespread pain, muscle tenderness and emotional distress. Previous studies found reduced endogenous pain modulation in FM. This deficiency of pain modulation may be related to the attributes of chronic pain and other clinical symptoms experienced in patients with FM. Thus, we tested whether there is a link between the clinical symptoms of FM and functional connectivity (FC) of the periaqueductal gray (PAG), a key node of pain modulation. We acquired resting state 3T functional MRI (rsfMRI) data from 23 female patients with FM and 16 age- and sex- matched healthy controls (HC) and assessed FM symptoms with the Brief Pain Inventory (BPI), Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS). We found that patients with FM exhibit statistically significant disruptions in PAG FC, particularly with brain regions implicated in negative affect, self-awareness and saliency. Specifically, we found that, compared to HCs, the FM patients had stronger PAG FC with the lingual gyrus and hippocampus but weaker PAG FC with regions associated with motor/executive functions, the salience (SN) and default mode networks (DMN). The attenuated PAG FC was also negatively correlated with FIQ scores, and positively correlated with the magnification subscale of the PCS. These alterations were correlated with emotional and behavioral symptoms of FM. Our study implicates the PAG as a site of dysfunction contributing to the clinical manifestations and pain in FM.
Collapse
Affiliation(s)
- Marie-Andrée Coulombe
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health NetworkToronto, ON, Canada
| | - Keith St Lawrence
- Lawson Health Research InstituteLondon, ON, Canada.,Department of Medical Biophysics, University of Western OntarioLondon, ON, Canada
| | - Dwight E Moulin
- Departments of Clinical Neurosciences and Oncology, University of Western OntarioLondon, ON, Canada
| | - Patricia Morley-Forster
- Department of Anesthesia and Perioperative Medicine, University of Western OntarioLondon, ON, Canada
| | - Mahsa Shokouhi
- Lawson Health Research InstituteLondon, ON, Canada.,Department of Medical Biophysics, University of Western OntarioLondon, ON, Canada
| | - Warren R Nielson
- Lawson Health Research InstituteLondon, ON, Canada.,Department of Psychology, University of Western OntarioLondon, ON, Canada
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health NetworkToronto, ON, Canada.,Department of Surgery and Institute of Medical Science, University of TorontoLondon, ON, Canada
| |
Collapse
|
28
|
Casamento-Moran A, Hunter SK, Chen YT, Kwon MH, Fox EJ, Yacoubi B, Christou EA. Sex differences in spatial accuracy relate to the neural activation of antagonistic muscles in young adults. Exp Brain Res 2017; 235:2425-2436. [DOI: 10.1007/s00221-017-4968-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/24/2017] [Indexed: 12/20/2022]
|
29
|
Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. Pain 2017; 158:1599-1608. [DOI: 10.1097/j.pain.0000000000000924] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
30
|
Rubio A, Pellissier S, Van Oudenhove L, Ly HG, Dupont P, Tack J, Dantzer C, Delon-Martin C, Bonaz B. Brain responses to uncertainty about upcoming rectal discomfort in quiescent Crohn's disease - a fMRI study. Neurogastroenterol Motil 2016; 28:1419-32. [PMID: 27132547 DOI: 10.1111/nmo.12844] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/24/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with Crohn's disease (CD) in remission are exposed to chronic psychological distress, due to the constant risk of relapse. This permanent situation of anticipation and uncertainty can lead to anxiety, which may, in turn, trigger relapse. We aimed to investigate the effects of uncertainty on behavioral and brain responses to anticipation of visceral discomfort in quiescent CD patients. METHODS Barostat-controlled rectal distensions were preceded by cued uncertain or certain anticipation in nine CD patients and nine matched healthy volunteers. Brain responses obtained before distension across the different anticipation conditions in regions of interest (ROI) involved in (anticipation of) pain were measured using functional magnetic resonance imaging and compared between CD and controls. The association between anxiety-related psychological variables and cerebral anticipatory activity was tested. KEY RESULTS During uncertainty, CD patients had significantly stronger activations than controls in the cingulate cortex, insula, amygdala, and thalamus with trends in the hippocampus, prefrontal, and secondary somatosensory cortex. In patients, brain responses to uncertainty in the majority of ROI correlated positively with gastrointestinal symptom-specific anxiety, trait-anxiety, and intolerance of uncertainty. CONCLUSIONS & INFERENCES In a context of uncertainty regarding occurrence of uncomfortable visceral sensations, CD is associated with excessive reactivity in brain regions known to be involved in sensory, cognitive and emotional aspects of pain processing and modulation, and threat appraisal. Our findings contribute to a better understanding of the role of emotional and cognitive processes in CD. This may, in turn, lead to the development of new (psycho)therapeutic approaches for management of symptoms and related anxiety.
Collapse
Affiliation(s)
- A Rubio
- INSERM, U1216, Grenoble, France.,Univ. Grenoble Alpes, GIN, Grenoble, France.,CHU Grenoble Alpes, Hôpital Couple Enfants, Grenoble, France
| | - S Pellissier
- INSERM, U1216, Grenoble, France.,Univ. Grenoble Alpes, GIN, Grenoble, France.,Univ. Savoie Mont-Blanc, LIP/PC2S, Chambery, France
| | - L Van Oudenhove
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium.,University Psychiatric Centre, Liaison Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - H G Ly
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium
| | - P Dupont
- Medical Imaging Research Centre, KU Leuven, Leuven, Belgium.,Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
| | - J Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium
| | - C Dantzer
- Univ. Savoie Mont-Blanc, LIP/PC2S, Chambery, France
| | - C Delon-Martin
- INSERM, U1216, Grenoble, France.,Univ. Grenoble Alpes, GIN, Grenoble, France
| | - B Bonaz
- INSERM, U1216, Grenoble, France.,Univ. Grenoble Alpes, GIN, Grenoble, France.,Clinique Universitaire d'Hépato-Gastroentérologie, CHU Grenoble Alpes, Grenoble, France
| |
Collapse
|
31
|
Serotonin transporter polymorphism alters citalopram effects on human pain responses to physical pain. Neuroimage 2016; 135:186-96. [DOI: 10.1016/j.neuroimage.2016.04.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022] Open
|
32
|
Sex dimorphism in a mediatory role of the posterior midcingulate cortex in the association between anxiety and pain sensitivity. Exp Brain Res 2016; 234:3119-3131. [DOI: 10.1007/s00221-016-4710-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
|
33
|
Farmer AD, Franchina M, Gregersen H, Penagini R, Shaker A, Soffer E. Provocative testing of the esophagus and its future. Ann N Y Acad Sci 2016; 1380:33-47. [DOI: 10.1111/nyas.13109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Adam D. Farmer
- Centre for Digestive Diseases, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry; Queen Mary University of London; London United Kingdom
- Department of Gastroenterology; University Hospitals of North Midlands; Stoke on Trent Staffordshire United Kingdom
| | - Marianna Franchina
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi of Milan and Gastroenterology and Endoscopy Unit; Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - Hans Gregersen
- GIOME, College of Bioengineering; Chongqing University; Chongqing China
- Department of Surgery; Prince of Wales Hospital; Shatin Hong Kong SAR
| | - Roberto Penagini
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi of Milan and Gastroenterology and Endoscopy Unit; Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - Anisa Shaker
- Department of Medicine; University of Southern California; Los Angeles California
| | - Edy Soffer
- Department of Medicine; University of Southern California; Los Angeles California
| |
Collapse
|
34
|
Smith JK, Marciani L, Humes DJ, Francis ST, Gowland P, Spiller RC. Anticipation of thermal pain in diverticular disease. Neurogastroenterol Motil 2016; 28:900-13. [PMID: 26970346 PMCID: PMC4879512 DOI: 10.1111/nmo.12790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/06/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The relative importance of peripheral nerve injury or central pain processing in painful diverticular disease (DD) is unclear. Functional magnetic resonance imaging (fMRI) has demonstrated that dysfunctional central pain processing predominates in irritable bowel syndrome (IBS). This study aims to identify anticipatory changes in symptomatic DD (SDD) compared to asymptomatic DD (ADD) and IBS patients. METHODS Gastrointestinal symptoms and somatization were evaluated via the Patient Health Question-12 Somatic Symptom and the SDD group divided into low (≤6 [LSDD]) and high (≥7 [HSDD]) somatization. Cued painful cutaneous thermal stimuli were delivered to the left hand and foot during fMRI. Fixed effect group analysis of the 'cued' anticipatory phase was performed. KEY RESULTS Within the right posterior insula, greater deactivation was found in the ADD compared to other groups. In emotion processing centers, anterior and middle insula, greater activation was identified in all patient compared to the ADD group, and in LSDD compared to IBS and HSDD groups. In comparison, amygdala deactivation was greater in ADD than the IBS and HSDD groups, and in LSDD vs HSDD groups. Descending nociceptive control centers, such as the superior medial frontal and orbitofrontal cortex, also showed greater deactivation in the ADD and LSDD compared to the HSDD and IBS groups. CONCLUSIONS & INFERENCES The HSDD group have altered anticipatory responses to thermal pain, similar to IBS group. The LSDD are similar to ADD group. This suggests underlying differences in pain pathophysiology, and the need for individualized treatment strategies to target the cause of their chronic pain.
Collapse
Affiliation(s)
- J. K. Smith
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | - L. Marciani
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK,Sir Peter Mansfield Magnetic Resonance CentreSchool of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - D. J. Humes
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK,Nottingham Digestive Diseases Biomedical Research UnitNottingham University HospitalsUniversity of NottinghamNottinghamUK
| | - S. T. Francis
- Sir Peter Mansfield Magnetic Resonance CentreSchool of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - P. Gowland
- Sir Peter Mansfield Magnetic Resonance CentreSchool of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - R. C. Spiller
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK,Nottingham Digestive Diseases Biomedical Research UnitNottingham University HospitalsUniversity of NottinghamNottinghamUK
| |
Collapse
|
35
|
Chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life: a population-based cross-sectional study. Pain 2016; 156:1765-1771. [PMID: 26010459 DOI: 10.1097/j.pain.0000000000000237] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this investigation was to examine the prevalence of and factors associated with chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life (QoL). This is a population-based cross-sectional study of chronic pain and QoL in patients treated for rectal cancer from 2001 to 2007. A modified version of the Brief Descriptive Danish Pain Questionnaire and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire were mailed to 1713 Danish patients. Informative answers were obtained from 1369 patients (80%). A total of 426 patients (31%) reported chronic pain in the pelvic area or lower extremities, 173 (41%) of whom had daily pain. Pain in other parts of the body was associated with the presence of pain in the pelvic region (odds ratio [OR] 4.81 [3.63-6.38], P < 0.001). Multivariate logistic regression analysis showed an association with chronic pain in female patients (OR 1.91 [1.51-2.43], P < 0.001) and in those who received radio(chemo)therapy (OR 1.31 [1.01-1.7], P = 0.041) or underwent abdominoperineal excision (OR 1.71 [1.19-2.44], P = 0.003), total mesorectal excision (OR 1.39 [1.01-1.90], P = 0.041), and Hartmann procedure (OR 1.72 [1.04-2.84], P = 0.33) compared with partial mesorectal excision. Ordinal regression analysis showed a strong association between all QoL subgroups and pelvic pain. Chronic pain in the pelvic region or lower extremities after rectal cancer treatment is a common but largely neglected problem that is associated with female gender, type of surgery, radio(chemo)therapy, and young age, all of which impact the patient's QoL.
Collapse
|
36
|
Calvó-Perxas L, Vilalta-Franch J, Turró-Garriga O, López-Pousa S, Garre-Olmo J. Gender differences in depression and pain: A two year follow-up study of the Survey of Health, Ageing and Retirement in Europe. J Affect Disord 2016; 193:157-64. [PMID: 26773909 DOI: 10.1016/j.jad.2015.12.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/18/2015] [Accepted: 12/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries. METHODS The study population was taken from waves 4-5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence. RESULTS Prevalences of depression, pain, and depression-pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9-2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2-1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2-2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3-2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1-1.7; treated OR=2.0; 95% CI=1.5-2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1-1.7; men OR=1.8; 95% CI=1.3-2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1-1.6). LIMITATIONS We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred. CONCLUSIONS Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.
Collapse
Affiliation(s)
- Laia Calvó-Perxas
- Girona Biomedical Research Institute (IdIBGI), IAS Research Unit, Salt, Catalonia, Spain
| | - Joan Vilalta-Franch
- Girona Biomedical Research Institute (IdIBGI), IAS Research Unit, Salt, Catalonia, Spain; Department of Medical Sciences, University of Girona, Girona, Catalonia, Spain; Memory and Dementia Assessment Unit, Institut d'Assistència Sanitària, Salt, Catalonia, Spain.
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute (IdIBGI), IAS Research Unit, Salt, Catalonia, Spain
| | - Secundino López-Pousa
- Girona Biomedical Research Institute (IdIBGI), IAS Research Unit, Salt, Catalonia, Spain; Memory and Dementia Assessment Unit, Institut d'Assistència Sanitària, Salt, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IdIBGI), IAS Research Unit, Salt, Catalonia, Spain; Department of Medical Sciences, University of Girona, Girona, Catalonia, Spain
| |
Collapse
|
37
|
Houghton LA, Heitkemper M, Crowell M, Emmanuel A, Halpert A, McRoberts JA, Toner B. Age, Gender and Women's Health and the Patient. Gastroenterology 2016; 150:S0016-5085(16)00183-9. [PMID: 27144622 DOI: 10.1053/j.gastro.2016.02.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
Abstract
Patients with functional gastrointestinal disorders (FGIDs) often experience distress, reduced quality of life, a perceived lack of validation, and an unsatisfactory experience with health care providers. A health care provider can provide the patient with a framework in which to understand and legitimize their symptoms, remove self-doubt or blame, and identify factors that contribute to symptoms that the patient can influence or control. This framework is implemented with the consideration of important factors that impact FGIDs, such as gender, age, society, and the patient's perspective. Although the majority of FGIDs, including globus, rumination syndrome, IBS, bloating, constipation, functional abdominal pain, sphincter of Oddi dyskinesia, pelvic floor dysfunction, and extra-intestinal manifestations, are more prevalent in women than men, functional chest pain, dyspepsia, vomiting, and anorectal pain do not appear to vary by gender. Studies suggest sex differences in somatic but not visceral pain perception, motility, and central processing of visceral pain; although further research is required in autonomic nervous system dysfunction, genetics and immunologic/microbiome. Gender differences in response to psychological treatments, antidepressants, fiber, probiotics, and anticholinergics have not been adequately studied. However, a greater clinical response to 5-HT3 antagonists but not 5-HT4 agonists has been reported in women compared with men.
Collapse
Affiliation(s)
- Lesley A Houghton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA; Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
| | | | - Michael Crowell
- Division of Gastroenterology and Hepatology Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | | | | |
Collapse
|
38
|
Hong JY, Naliboff B, Labus JS, Gupta A, Kilpatrick LA, Ashe-McNalley C, Stains J, Heendeniya N, Smith SR, Tillisch K, Mayer EA. Altered brain responses in subjects with irritable bowel syndrome during cued and uncued pain expectation. Neurogastroenterol Motil 2016; 28:127-38. [PMID: 26526698 PMCID: PMC4943658 DOI: 10.1111/nmo.12710] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND A majority of the subjects with irritable bowel syndrome (IBS) show increased behavioral and brain responses to expected and delivered aversive visceral stimuli during controlled rectal balloon distension, and during palpation of the sigmoid colon. We aimed to determine if altered brain responses to cued and uncued pain expectation are also seen in the context of a noxious somatic pain stimulus applied to the same dermatome as the sigmoid colon. METHODS A task-dependent functional magnetic resonance imaging technique was used to investigate the brain activity of 37 healthy controls (18 females) and 37 IBS subjects (21 females) during: (i) a cued expectation of an electric shock to the abdomen vs a cued safe condition; and (ii) an uncued cross-hair condition in which the threat is primarily based on context vs a cued safe condition. KEY RESULTS Regions within the salience, attention, default mode, and emotional arousal networks were more activated by the cued abdominal threat condition and the uncued condition than in the cued safe condition. During the uncued condition contrasted to the cued safe condition, IBS subjects (compared to healthy control subjects) showed greater brain activations in the affective (amygdala, anterior insula) and attentional (middle frontal gyrus) regions, and in the thalamus and precuneus. These disease-related differences were primarily seen in female subjects. CONCLUSIONS & INFERENCES The observed greater engagement of cognitive and emotional brain networks in IBS subjects during contextual threat may reflect the propensity of IBS subjects to overestimate the likelihood and severity of future abdominal pain.
Collapse
Affiliation(s)
- Jui-Yang Hong
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Bioengineering, University of California, Los Angeles, California 90095
| | - Bruce Naliboff
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jennifer S. Labus
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Lisa A. Kilpatrick
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Cody Ashe-McNalley
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jean Stains
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Nuwanthi Heendeniya
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Suzanne R. Smith
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Kirsten Tillisch
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Emeran A. Mayer
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Psychiatry, University of California, Los Angeles, California 90095,Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine, University of California, Los Angeles, California 90095
| |
Collapse
|
39
|
|
40
|
Ly HG, Ceccarini J, Weltens N, Bormans G, Van Laere K, Tack J, Van Oudenhove L. Increased cerebral cannabinoid-1 receptor availability is a stable feature of functional dyspepsia: a [F]MK-9470 PET study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:149-58. [PMID: 25833408 DOI: 10.1159/000375454] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/17/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functional dyspepsia (FD) is a prevalent functional gastrointestinal disorder (FGID) defined by chronic epigastric symptoms in the absence of organic abnormalities likely to explain them. Comorbidity with mood and anxiety disorders as well as with other FGIDs and functional somatic syndrome (FSS) is high. FD is characterized by abnormal regional cerebral activity in cognitive/affective pain modulatory circuits, but it is unknown which neurotransmitter systems are involved. The authors aimed to assess and compare in vivo cerebral cannabinoid-1 (CB1) receptor availability between FD patients and age-, gender- and BMI-matched healthy controls (HC). METHODS Twelve FD patients and 12 matched HC were investigated using positron emission tomography (PET) with the CB1 receptor radioligand [(18)F]MK-9470. Nine of the patients received a second PET scan after a naturalistic follow-up period of 36 ± 9.6 months (range: 25.2-50.4 months). RESULTS FD patients had significantly higher CB1 receptor availability in the cerebral regions involved in (visceral) nociception (brainstem, insula, anterior cingulate cortex) as well as in the homeostatic and hedonic regulation of food intake [hypothalamus, (ventral) striatum] (p < 0.05 corrected for multiple testing, region of interest analysis), which persisted after a follow-up period of 36 ± 9.6 months. CONCLUSIONS Although these findings need replication in larger samples, they suggest that the abnormal brain activity in several of these regions, previously demonstrated in FD, may be due to a sustained endocannabinoid system dysfunction, identifying it as a potential novel target for treatment and warranting further studies to elucidate whether it is also a feature of other FGIDs or FSSs.
Collapse
Affiliation(s)
- Huynh Giao Ly
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
41
|
Labrenz F, Icenhour A, Thürling M, Schlamann M, Forsting M, Timmann D, Elsenbruch S. Sex differences in cerebellar mechanisms involved in pain-related safety learning. Neurobiol Learn Mem 2015; 123:92-9. [PMID: 26004678 DOI: 10.1016/j.nlm.2015.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/20/2015] [Accepted: 05/15/2015] [Indexed: 12/19/2022]
Abstract
Recent studies have suggested that the cerebellum contributes to the central processing of pain, including pain-related learning and memory processes. As a complex experience with multiple emotional and cognitive facets, the response to pain and its underlying neural correlates differ between men and women. However, it remains poorly understood whether and to what extent sex differences exist in the cerebellar contribution to pain-related associative learning processes. In the present conditioning study with experimental abdominal pain as unconditioned stimuli (US), we assessed sex-dependent differences in behavioral and neural responses to conditioned warning and safety cues in healthy volunteers. The results revealed that in response to visual stimuli signaling safety from abdominal pain (CS(-)), women showed enhanced cerebellar activation in lobules I-IV, V, VI, VIIIa, IX and X as well as Crus II and the dentate nucleus, which are mostly representative of somatomotor networks. On the other hand, men showed enhanced neural activation in lobules I-IV, VI, VIIb, VIIIb, IX as well as Crus I and II in response to CS(-), which are representative of frontoparietal and ventral attention networks. No sex differences were observed in response to pain-predictive warning signals (CS(+)). Similarly, men and women did not differ in behavioral measures of conditioning, including conditioned changes in CS valence and contingency awareness. Together, we could demonstrate that the cerebellum is involved in associative learning processes of conditioned anticipatory safety from pain and mediates sex differences in the underlying neural processes. Given the high prevalence of chronic pain conditions in women, these results may contribute to improve our understanding of the acquisition and manifestation of chronic abdominal pain syndromes.
Collapse
Affiliation(s)
- Franziska Labrenz
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Adriane Icenhour
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Markus Thürling
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Marc Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Dagmar Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Germany.
| |
Collapse
|
42
|
Harshaw C. Interoceptive dysfunction: toward an integrated framework for understanding somatic and affective disturbance in depression. Psychol Bull 2015; 141:311-363. [PMID: 25365763 PMCID: PMC4346391 DOI: 10.1037/a0038101] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Depression is characterized by disturbed sleep and eating, a variety of other nonspecific somatic symptoms, and significant somatic comorbidities. Why there is such close association between cognitive and somatic dysfunction in depression is nonetheless poorly understood. An explosion of research in the area of interoception-the perception and interpretation of bodily signals-over the last decade nonetheless holds promise for illuminating what have until now been obscure links between the social, cognitive-affective, and somatic features of depression. This article reviews rapidly accumulating evidence that both somatic signaling and interoception are frequently altered in depression. This includes comparative studies showing vagus-mediated effects on depression-like behaviors in rodent models as well as studies in humans indicating both dysfunction in the neural substrates for interoception (e.g., vagus, insula, anterior cingulate cortex) and reduced sensitivity to bodily stimuli in depression. An integrative framework for organizing and interpreting this evidence is put forward which incorporates (a) multiple potential pathways to interoceptive dysfunction; (b) interaction with individual, gender, and cultural differences in interoception; and (c) a developmental psychobiological systems perspective, emphasizing likely differential susceptibility to somatic and interoceptive dysfunction across the lifespan. Combined with current theory and evidence, it is suggested that core symptoms of depression (e.g., anhedonia, social deficits) may be products of disturbed interoceptive-exteroceptive integration. More research is nonetheless needed to fully elucidate the relationship between mind, body, and social context in depression.
Collapse
|
43
|
Rubio A, Van Oudenhove L, Pellissier S, Ly HG, Dupont P, Lafaye de Micheaux H, Tack J, Dantzer C, Delon-Martin C, Bonaz B. Uncertainty in anticipation of uncomfortable rectal distension is modulated by the autonomic nervous system--a fMRI study in healthy volunteers. Neuroimage 2014; 107:10-22. [PMID: 25479021 DOI: 10.1016/j.neuroimage.2014.11.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/17/2014] [Accepted: 11/20/2014] [Indexed: 12/23/2022] Open
Abstract
The human brain responds both before and during the application of aversive stimuli. Anticipation allows the organism to prepare its nociceptive system to respond adequately to the subsequent stimulus. The context in which an uncomfortable stimulus is experienced may also influence neural processing. Uncertainty of occurrence, timing and intensity of an aversive event may lead to increased anticipatory anxiety, fear, physiological arousal and sensory perception. We aimed to identify, in healthy volunteers, the effects of uncertainty in the anticipation of uncomfortable rectal distension, and the impact of the autonomic nervous system (ANS) activity and anxiety-related psychological variables on neural mechanisms of anticipation of rectal distension using fMRI. Barostat-controlled uncomfortable rectal distensions were preceded by cued uncertain or certain anticipation in 15 healthy volunteers in a fMRI protocol at 3T. Electrocardiographic data were concurrently registered by MR scanner. The low frequency (LF)-component of the heart rate variability (HRV) time-series was extracted and inserted as a regressor in the fMRI model ('LF-HRV model'). The impact of ANS activity was analyzed by comparing the fMRI signal in the 'standard model' and in the 'LF-HRV model' across the different anticipation and distension conditions. The scores of the psychological questionnaires and the rating of perceived anticipatory anxiety were included as covariates in the fMRI data analysis. Our experiments led to the following key findings: 1) the subgenual anterior cingulate cortex (sgACC) is the only activation site that relates to uncertainty in healthy volunteers and is directly correlated to individual questionnaire score for pain-related anxiety; 2) uncertain anticipation of rectal distension involved several relevant brain regions, namely activation of sgACC and medial prefrontal cortex and deactivation of amygdala, insula, thalamus, secondary somatosensory cortex, supplementary motor area and cerebellum; 3) most of the brain activity during anticipation, but not distension, is associated with activity of the central autonomic network. This approach could be applied to study the ANS impact on brain activity in various pathological conditions, namely in patients with chronic digestive conditions characterized by visceral discomfort and ANS imbalance such as irritable bowel syndrome or inflammatory bowel diseases.
Collapse
Affiliation(s)
- Amandine Rubio
- INSERM, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France; CHU de Grenoble, Clinique Universitaire de Pédiatrie, F-38000 Grenoble, France.
| | - Lukas Van Oudenhove
- University Psychiatric Centre, Liaison Psychiatry, University Hospital Gasthuisberg, B-3000 Leuven, Belgium; Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, B-3000 Leuven, Belgium
| | - Sonia Pellissier
- INSERM, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France; Univ. Savoie, F-73000 Chambery, France
| | - Huynh Giao Ly
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, B-3000 Leuven, Belgium
| | - Patrick Dupont
- University Psychiatric Centre, Liaison Psychiatry, University Hospital Gasthuisberg, B-3000 Leuven, Belgium; Laboratory for Cognitive Neurology, KU Leuven, B-3000 Leuven, Belgium; Medical Imaging Research Centre, KU Leuven, B-3000 Leuven, Belgium
| | | | - Jan Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases, University of Leuven, B-3000 Leuven, Belgium
| | | | - Chantal Delon-Martin
- INSERM, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France
| | - Bruno Bonaz
- INSERM, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France; Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Hôpital Albert Michallon, F-38000 Grenoble, France
| |
Collapse
|
44
|
Orringer JS, Kovarik HY, Chubb H, Sachs DL. A gender-based comparison of pain tolerance during pulsed dye laser therapy. J COSMET LASER THER 2014; 16:253-7. [DOI: 10.3109/14764172.2014.949275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Sex Differences in the Neural Representation of Pain Unpleasantness. THE JOURNAL OF PAIN 2014; 15:867-77. [DOI: 10.1016/j.jpain.2014.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 05/07/2014] [Accepted: 05/20/2014] [Indexed: 01/26/2023]
|
46
|
DosSantos MF, Martikainen IK, Nascimento TD, Love TM, DeBoer MD, Schambra HM, Bikson M, Zubieta JK, DaSilva AF. Building up analgesia in humans via the endogenous μ-opioid system by combining placebo and active tDCS: a preliminary report. PLoS One 2014; 9:e102350. [PMID: 25029273 PMCID: PMC4100885 DOI: 10.1371/journal.pone.0102350] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/18/2014] [Indexed: 01/24/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. However, the molecular mechanisms underlying tDCS-mediated pain control, and most important its placebo component, are not completely established. In this pilot study, we investigated in vivo the involvement of the endogenous μ-opioid system in the global tDCS-analgesia experience. Nine healthy volunteers went through positron emission tomography (PET) scans with [11C]carfentanil, a selective μ-opioid receptor (MOR) radiotracer, to measure the central MOR activity during tDCS in vivo (non-displaceable binding potential, BPND)--one of the main analgesic mechanisms in the brain. Placebo and real anodal primary motor cortex (M1/2mA) tDCS were delivered sequentially for 20 minutes each during the PET scan. The initial placebo tDCS phase induced a decrease in MOR BPND in the periaqueductal gray matter (PAG), precuneus, and thalamus, indicating activation of endogenous μ-opioid neurotransmission, even before the active tDCS. The subsequent real tDCS also induced MOR activation in the PAG and precuneus, which were positively correlated to the changes observed with placebo tDCS. Nonetheless, real tDCS had an additional MOR activation in the left prefrontal cortex. Although significant changes in the MOR BPND occurred with both placebo and real tDCS, significant analgesic effects, measured by improvements in the heat and cold pain thresholds, were only observed after real tDCS, not the placebo tDCS. This study gives preliminary evidence that the analgesic effects reported with M1-tDCS, can be in part related to the recruitment of the same endogenous MOR mechanisms induced by placebo, and that such effects can be purposely optimized by real tDCS.
Collapse
Affiliation(s)
- Marcos F. DosSantos
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ilkka K. Martikainen
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thiago D. Nascimento
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tiffany M. Love
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Misty D. DeBoer
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heidi M. Schambra
- Departments of Neurology and Rehabilitation & Regenerative Medicine, Columbia University, New York, New York, United States of America
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - Jon-Kar Zubieta
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alexandre F. DaSilva
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
47
|
Traub RJ, Ji Y. Sex differences and hormonal modulation of deep tissue pain. Front Neuroendocrinol 2013; 34:350-66. [PMID: 23872333 PMCID: PMC3830473 DOI: 10.1016/j.yfrne.2013.07.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 12/11/2022]
Abstract
Women disproportionately suffer from many deep tissue pain conditions. Experimental studies show that women have lower pain thresholds, higher pain ratings and less tolerance to a range of painful stimuli. Most clinical and epidemiological reports suggest female gonadal hormones modulate pain for some, but not all, conditions. Similarly, animal studies support greater nociceptive sensitivity in females in many deep tissue pain models. Gonadal hormones modulate responses in primary afferents, dorsal horn neurons and supraspinal sites, but the direction of modulation is variable. This review will examine sex differences in deep tissue pain in humans and animals focusing on the role of gonadal hormones (mainly estradiol) as an underlying component of the modulation of pain sensitivity.
Collapse
Affiliation(s)
- Richard J Traub
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore St., 8 South, Baltimore, MD 21201, USA; Program in Neuroscience, University of Maryland Baltimore, Baltimore, MD 21201, USA; Center for Pain Studies, University of Maryland Baltimore, Baltimore, MD 21201, USA.
| | | |
Collapse
|