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Massé-Alarie H, Shraim M, Hodges PW. Sensorimotor Integration in Chronic Low Back Pain. Neuroscience 2024; 552:29-38. [PMID: 38878816 DOI: 10.1016/j.neuroscience.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Chronic low back pain (CLBP) impacts on spine movement. Altered sensorimotor integration can be involved. Afferents from the lumbo-pelvic area might be processed differently in CLBP and impact on descending motor control. This study aimed to determine whether afferents influence the corticomotor control of paravertebral muscles in CLBP. Fourteen individuals with CLBP (11 females) and 13 pain-free controls (8 females) were tested with transcranial magnetic stimulation (TMS) to measure the motor-evoked potential [MEP] amplitude of paravertebral muscles. Noxious and non-noxious electrical stimulation, and magnetic stimulation in the lumbo-sacral area were used as afferent stimuli and triggered 20 to 200 ms prior to TMS. EMG modulation elicited by afferent stimulation alone was measured to control net motoneuron excitability. MEP/EMG ratio was used as a measure of corticospinal excitability with control of net motoneuron excitability. MEP/EMG ratio was larger at 60, 80 and 100-ms intervals in CLBP compared to controls, and afferent stimulations alone reduced EMG amplitude greater in CLBP than controls at 100 ms. Our results suggest alteration in sensorimotor integration in CLBP highlighted by a greater facilitation of the descending corticospinal input to paravertebral muscles. Our results can help to optimise interventions by better targeting mechanisms.
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Affiliation(s)
- Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Québec, Canada.
| | - Muath Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
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Zhang X, Li L, Huang G, Zhang L, Liang Z, Shi L, Zhang Z. A Multisensory fMRI Investigation of Nociceptive-Preferential Cortical Regions and Responses. Front Neurosci 2021; 15:635733. [PMID: 33935632 PMCID: PMC8079658 DOI: 10.3389/fnins.2021.635733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
The existence of nociceptive-specific brain regions has been a controversial issue for decades. Multisensory fMRI studies, which examine fMRI activities in response to various types of sensory stimulation, could help identify nociceptive-specific brain regions, but previous studies are limited by sample size and they did not differentiate nociceptive-specific regions and nociceptive-preferential regions, which have significantly larger responses to nociceptive input. In this study, we conducted a multisensory fMRI experiment on 80 healthy participants, with the aim to determine whether there are certain brain regions that specifically or preferentially respond to nociceptive stimulation. By comparing the evoked fMRI responses across four sensory modalities, we found a series of brain regions specifically or preferentially involved in nociceptive sensory input. Particularly, we found different parts of some cortical regions, such as insula and cingulate gyrus, play different functional roles in the processing of nociceptive stimulation. Hence, this multisensory study improves our understanding of the functional integrations and segregations of the nociceptive-related regions.
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Affiliation(s)
- Xiaoxia Zhang
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Linling Li
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Gan Huang
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Li Zhang
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Zhen Liang
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Li Shi
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Zhiguo Zhang
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Peng Cheng Laboratory, Shenzhen, China
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Khodashenas M, Baghdadi G, Towhidkhah F. A modified Hodgkin-Huxley model to show the effect of motor cortex stimulation on the trigeminal neuralgia network. JOURNAL OF MATHEMATICAL NEUROSCIENCE 2019; 9:4. [PMID: 31152270 PMCID: PMC6544710 DOI: 10.1186/s13408-019-0072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a severe neuropathic pain, which has an electric shock-like characteristic. There are some common treatments for this pain such as medicine, microvascular decompression or radio frequency. In this regard, transcranial direct current stimulation (tDCS) is another therapeutic method to reduce pain, which has been recently attracting the therapists' attention. The positive effect of tDCS on TN was shown in many previous studies. However, the mechanism of the tDCS effect has remained unclear. OBJECTIVE This study aims to model the neuronal behavior of the main known regions of the brain participating in TN pathways to study the effect of transcranial direct current stimulation. METHOD The proposed model consists of several blocks: (1) trigeminal nerve, (2) trigeminal ganglion, (3) PAG (periaqueductal gray in the brainstem), (4) thalamus, (5) motor cortex (M1) and (6) somatosensory cortex (S1). Each of these components is represented by a modified Hodgkin-Huxley (HH) model. The modification of the HH model was done based on some neurological facts of pain sodium channels. The input of the model involves any stimuli to the 'trigeminal nerve,' which cause the pain, and the output is the activity of the somatosensory cortex. An external current, which is considered as an electrical current, was applied to the motor cortex block of the model. RESULT The results showed that by decreasing the conductivity of the slow sodium channels (pain channels) and applying tDCS over the M1, the activity of the somatosensory cortex would be reduced. This reduction can cause pain relief. CONCLUSION The proposed model provided some possible suggestions about the relationship between the effects of tDCS and associated components in TN, and also the relationship between the pain measurement index, somatosensory cortex activity, and the strength of tDCS.
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Affiliation(s)
| | - Golnaz Baghdadi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Huishi Zhang C, Sohrabpour A, Lu Y, He B. Spectral and spatial changes of brain rhythmic activity in response to the sustained thermal pain stimulation. Hum Brain Mapp 2016; 37:2976-91. [PMID: 27167709 DOI: 10.1002/hbm.23220] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/26/2016] [Accepted: 04/07/2016] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to investigate the neurophysiological correlates of pain caused by sustained thermal stimulation. A group of 21 healthy volunteers was studied. Sixty-four channel continuous electroencephalography (EEG) was recorded while the subject received tonic thermal stimulation. Spectral changes extracted from EEG were quantified and correlated with pain scales reported by subjects, the stimulation intensity, and the time course. Network connectivity was assessed to study the changes in connectivity patterns and strengths among brain regions that have been previously implicated in pain processing. Spectrally, a global reduction in power was observed in the lower spectral range, from delta to alpha, with the most marked changes in the alpha band. Spatially, the contralateral region of the somatosensory cortex, identified using source localization, was most responsive to stimulation status. Maximal desynchrony was observed when stimulation was present. The degree of alpha power reduction was linearly correlated to the pain rating reported by the subjects. Contralateral alpha power changes appeared to be a robust correlate of pain intensity experienced by the subjects. Granger causality analysis showed changes in network level connectivity among pain-related brain regions due to high intensity of pain stimulation versus innocuous warm stimulation. These results imply the possibility of using noninvasive EEG to predict pain intensity and to study the underlying pain processing mechanism in coping with prolonged painful experiences. Once validated in a broader population, the present EEG-based approach may provide an objective measure for better pain management in clinical applications. Hum Brain Mapp 37:2976-2991, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Clara Huishi Zhang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Abbas Sohrabpour
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Yunfeng Lu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Bin He
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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Prior exposure to extreme pain alters neural response to pain in others. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2016; 16:662-71. [DOI: 10.3758/s13415-016-0422-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vossen CJ, Vossen HGM, Joosten EA, van Os J, Lousberg R. Does habituation differ in chronic low back pain subjects compared to pain-free controls? A cross-sectional pain rating ERP study reanalyzed with the ERFIA multilevel method. Medicine (Baltimore) 2015; 94:e865. [PMID: 25984683 PMCID: PMC4602586 DOI: 10.1097/md.0000000000000865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The objective of the present study was to investigate cortical differences between chronic low back pain (CLBP) subjects and pain-free controls with respect to habituation and processing of stimulus intensity. The use of a novel event-related fixed-interval areas (ERFIA) multilevel technique enables the analysis of event-related electroencephalogram (EEG) of the whole post stimulus range at a single trial level. This technique makes it possible to disentangle the cortical processes of habituation and stimulus intensity.In a cross-sectional study, 78 individuals with CLBP and 85 pain-free controls underwent a rating paradigm of 150 nonpainful and painful somatosensory electrical stimuli. For each trial, the entire epoch was partitioned into 20-ms ERFIAs, which acted as dependent variables in a multilevel analysis. The variability of each consecutive ERFIA period was modeled with a set of predictor variables, including 3 forms of habituation and stimulus intensity.Seventy-six pain-free controls and 65 CLBP subjects were eligible for analysis. CLBP subjects showed a significantly decreased linear habituation at 340 to 460 ms in the midline electrodes and C3 (Ps < .05) and had a significantly more pronounced dishabituation for the regions of 400 to 460 ms and 800 to 820 ms for all electrodes, except for T3 and T4 (Ps < .05). No significant group differences for stimulus intensity processing were observed.In this study, group differences with respect to linear habituation and dishabituation were demonstrated. By means of the ERFIA multilevel technique, habituation effects were found in a broad post stimulus range and were not solely limited to peaks. This study suggests that habituation may be a key mechanism involved in the transition process to chronic pain. Future studies with a longitudinal design are required to solve this issue.
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Affiliation(s)
- Catherine J Vossen
- From the Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands (CJV, EAJ); Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands (HGMV); Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands (JVO, RL); King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom (JVO)
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Asghar MS, Pereira MP, Werner MU, Mårtensson J, Larsson HBW, Dahl JB. Secondary hyperalgesia phenotypes exhibit differences in brain activation during noxious stimulation. PLoS One 2015; 10:e0114840. [PMID: 25615578 PMCID: PMC4304709 DOI: 10.1371/journal.pone.0114840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/14/2014] [Indexed: 01/08/2023] Open
Abstract
Noxious stimulation of the skin with either chemical, electrical or heat stimuli leads to the development of primary hyperalgesia at the site of injury, and to secondary hyperalgesia in normal skin surrounding the injury. Secondary hyperalgesia is inducible in most individuals and is attributed to central neuronal sensitization. Some individuals develop large areas of secondary hyperalgesia (high-sensitization responders), while others develop small areas (low-sensitization responders). The magnitude of each area is reproducible within individuals, and can be regarded as a phenotypic characteristic. To study differences in the propensity to develop central sensitization we examined differences in brain activity and anatomy according to individual phenotypical expression of secondary hyperalgesia by magnetic resonance imaging. Forty healthy volunteers received a first-degree burn-injury (47°C, 7 min, 9 cm2) on the non-dominant lower-leg. Areas of secondary hyperalgesia were assessed 100 min after the injury. We measured neuronal activation by recording blood-oxygen-level-dependent-signals (BOLD-signals) during mechanical noxious stimulation before burn injury and in both primary and secondary hyperalgesia areas after burn-injury. In addition, T1-weighted images were used to measure differences in gray-matter density in cortical and subcortical regions of the brain. We found significant differences in neuronal activity between high- and low-sensitization responders at baseline (before application of the burn-injury) (p < 0.05). After the burn-injury, we found significant differences between responders during noxious stimulation of both primary (p < 0.01) and secondary hyperalgesia (p ≤ 0.04) skin areas. A decreased volume of the right (p = 0.001) and left caudate nucleus (p = 0.01) was detected in high-sensitization responders in comparison to low-sensitization responders. These findings suggest that brain-structure and neuronal activation to noxious stimulation differs according to secondary hyperalgesia phenotype. This indicates differences in central sensitization according to phenotype, which may have predictive value on the susceptibility to development of high-intensity acute and persistent pain.
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Affiliation(s)
- Mohammad Sohail Asghar
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Manuel Pedro Pereira
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Mads Utke Werner
- Multidisciplinary Pain Centre, Neuroscience Centre, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Johan Mårtensson
- Max Planck Institute for Human Development, Berlin, Germany; Department of Psychology, Lund University, Lund, Sweden
| | - Henrik B W Larsson
- Functional Imaging Unit, Hospital, Glostrup, Copenhagen University Hospitals, Glostrup, Denmark
| | - Jørgen Berg Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
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Burfield AH, Wan TT, Sole ML, Cooper JW. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population. J Pain Res 2012; 5:61-70. [PMID: 22536093 PMCID: PMC3333796 DOI: 10.2147/jpr.s29655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care. Background/significance Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly. Patients and methods Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) from the 2001–2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals. Results The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs) indicated a significant effect (P < 0.01) for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08), indicating a weak association between cognition and pain. Conclusion Understanding the concomitance of pain and cognition aids in defining additional frameworks to extend models to include secondary needs, contextual factors, and resident outcomes. Cognitive decline, as with organic brain diseases, is progressive. Pain is a symptom that can be treated and reduced to improve resident quality of life. However, cognition can be used to determine the most appropriate method to assess pain in the elderly, thereby improving accuracy of pain detection in this population.
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Affiliation(s)
- Allison H Burfield
- Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
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Blatow M, Nennig E, Sarpaczki E, Reinhardt J, Schlieter M, Herweh C, Rasche D, Tronnier VM, Sartor K, Stippich C. Altered somatosensory processing in trigeminal neuralgia. Hum Brain Mapp 2010; 30:3495-508. [PMID: 19365802 DOI: 10.1002/hbm.20773] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Trigeminal neuralgia (TN) is a pain state characterized by intermittent unilateral pain attacks in one or several facial areas innervated by the trigeminal nerve. The somatosensory cortex is heavily involved in the perception of sensory features of pain, but it is also the primary target for thalamic input of nonpainful somatosensory information. Thus, pain and somatosensory processing are accomplished in overlapping cortical structures raising the question whether pain states are associated with alteration of somatosensory function itself. To test this hypothesis, we used functional magnetic resonance imaging to assess activation of primary (SI) and secondary (SII) somatosensory cortices upon nonpainful tactile stimulation of lips and fingers in 18 patients with TN and 10 patients with TN relieved from pain after successful neurosurgical intervention in comparison with 13 healthy subjects. We found that SI and SII activations in patients did neither depend on the affected side of TN nor differ between operated and nonoperated patients. However, SI and SII activations, but not thalamic activations, were significantly reduced in patients as compared to controls. These differences were most prominent for finger stimulation, an area not associated with TN. For lip stimulation SI and SII activations were reduced in patients with TN on the contra- but not on the ipsilateral side to the stimulus. These findings suggest a general reduction of SI and SII processing in patients with TN, indicating a long-term modulation of somatosensory function and pointing to an attempt of cortical adaptation to potentially painful stimuli.
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Affiliation(s)
- Maria Blatow
- Department of Neuroradiology, University of Heidelberg Medical School, Heidelberg, Germany.
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Pujol J, Reixach J, Harrison BJ, Timoneda-Gallart C, Vilanova JC, Pérez-Alvarez F. Posterior cingulate activation during moral dilemma in adolescents. Hum Brain Mapp 2008; 29:910-21. [PMID: 17636560 PMCID: PMC6870564 DOI: 10.1002/hbm.20436] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Neuroimaging research examining correlates of adolescent behavioral maturation has focused largely on issues related to higher cognitive development. Currently few studies have explored neural correlates of emotional reactivity in adolescent groups. In this study, we sought to examine the nature of posterior cingulate activation during situations of moral dilemma in normal adolescents. We focused on this region because of emerging evidence that suggests its role in emotionally self-relevant mental processing. Ten healthy teenagers, aged from 14 to 16 years, underwent three fMRI sequences designed to examine (i) brain responses during moral dilemma; (ii) brain responses during passive viewing of the moral dilemma outcome; and (iii); "deactivation" during a simple cognitive task compared with resting-state activity. Our main finding was that during moral dilemma, all subjects showed significant activation of the posterior cingulate cortex, and more variable activation of the medial frontal cortex and angular gyrus. Interestingly, these findings were replicated in each subject using the passive viewing task, suggesting that the previous pattern was not specific to moral reasoning or decision making. Finally, six of the ten subjects showed deactivation of the same posterior cingulate region during the cognitive task, indicating some commonality of function between posterior cingulate activity during moral dilemmas and rest. We propose that these posterior cingulate changes may relate to basic neuronal activities associated with processing self-relevant emotional stimuli. Given the high single-subject reproducibility of posterior cingulate activations, our findings may contribute to further characterize adolescent emotional reactivity in developmental neuroimaging studies.
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Affiliation(s)
- Jesus Pujol
- Institut d'Alta Tecnologia-PRBB, CRC Corporació Sanitària, Barcelona, Spain.
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Quante M, Hille S, Schofer MD, Lorenz J, Hauck M. Noxious counterirritation in patients with advanced osteoarthritis of the knee reduces MCC but not SII pain generators: A combined use of MEG and EEG. J Pain Res 2008; 1:1-8. [PMID: 21197282 PMCID: PMC3004616 DOI: 10.2147/jpr.s3996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chronic pain is mainly a result of two processes: peripheral and central sensitization, which can result in neuroplastic changes. Previous psychophysical studies suggested a decrease of the so-called pain-inhibiting-pain effect (DNIC) in chronic pain patients. We aimed to study the DNIC effect on the neuronal level using magnetoencephalography and electroencephalography in 12 patients suffering from advanced unilateral knee osteoarthritis (OA). DNIC was induced in patients by provoking the typical OA pain by a slightly hyperextended joint position, while they received short electrical pain stimuli. Although the patients did not report a reduction of electrical pain perception, the cingulate gyrus showed a decrease of activation during provoked OA pain, while activity in the secondary somatosensory cortex did not change. Based on much stronger DNIC induction at comparable intensities of an acute counterirritant pain in healthy subjects this result suggests a deficit of DNIC in OA patients. We suggest that the strength of DNIC is subject to neuronal plasticity of descending inhibitory pain systems and diminishes during the development of a chronic pain condition.
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Affiliation(s)
- Markus Quante
- Specialist Centre for Spinal Surgery, Hospital Neustadt, Neustadt in Holstein, Germany
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Biswal S, Resnick DL, Hoffman JM, Gambhir SS. Molecular Imaging: Integration of Molecular Imaging into the Musculoskeletal Imaging Practice. Radiology 2007; 244:651-71. [PMID: 17709823 DOI: 10.1148/radiol.2443060295] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic musculoskeletal diseases such as arthritis, malignancy, and chronic injury and/or inflammation, all of which may produce chronic musculoskeletal pain, often pose challenges for current clinical imaging methods. The ability to distinguish an acute flare from chronic changes in rheumatoid arthritis, to survey early articular cartilage breakdown, to distinguish sarcomatous recurrence from posttherapeutic inflammation, and to directly identify generators of chronic pain are a few examples of current diagnostic limitations. There is hope that a growing field known as molecular imaging will provide solutions to these diagnostic puzzles. These techniques aim to depict, noninvasively, specific abnormal cellular, molecular, and physiologic events associated with these and other diseases. For example, the presence and mobilization of specific cell populations can be monitored with molecular imaging. Cellular metabolism, stress, and apoptosis can also be followed. Furthermore, disease-specific molecules can be targeted, and particular gene-related events can be assayed in living subjects. Relatively recent molecular and cellular imaging protocols confirm important advances in imaging technology, engineering, chemistry, molecular biology, and genetics that have coalesced into a multidisciplinary and multimodality effort. Molecular probes are currently being developed not only for radionuclide-based techniques but also for magnetic resonance (MR) imaging, MR spectroscopy, ultrasonography, and the emerging field of optical imaging. Furthermore, molecular imaging is facilitating the development of molecular therapies and gene therapy, because molecular imaging makes it possible to noninvasively track and monitor targeted molecular therapies. Implementation of molecular imaging procedures will be essential to a clinical imaging practice. With this in mind, the goal of the following discussion is to promote a better understanding of how such procedures may help address specific musculoskeletal issues, both now and in the years ahead.
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Affiliation(s)
- Sandip Biswal
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, 300 Pasteur Dr, S-062B, Stanford, CA 94305, USA.
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Ruehle BS, Handwerker HO, Lennerz JKM, Ringler R, Forster C. Brain activation during input from mechanoinsensitive versus polymodal C-nociceptors. J Neurosci 2006; 26:5492-9. [PMID: 16707801 PMCID: PMC6675308 DOI: 10.1523/jneurosci.2059-05.2006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
C-nociceptors mediating cutaneous pain in humans can be distinguished in mechano-heat-responsive units (CMH) and mechano-insensitive units (CMi). However, if sensitized in damaged tissue, CMi play an important role in inflammatory pain. CMi differ from CMH by higher electrical thresholds and by mediating the axon reflex. Using these properties, we established two stimulation paradigms: (1) transcutaneous stimulation (TCS) of low current density below the CMi threshold and (2) intracutaneous stimulation (ICS) of high current density that excites CMi. This was proven by the quantification of the axon-reflex flare. Applying these stimulation paradigms during functional magnetic resonance imaging, we investigated whether nociceptor stimulation that recruits CMi leads to different cerebral activation than stimuli that do not recruit CMi. Brain activation by CMi was inferred by subtraction. Both stimuli recruited multiple afferents other than CMi, and we expected a common network of regions involved in different aspects of pain perception and motor nocifensive reactions in both stimuli. ICS that additionally recruited CMi should activate regions with low acuity that are involved in pain memory and emotional attribution. Besides a common network of pain in both stimuli, TCS activated the supplementary motor area, motor thalamic nuclei, the ipsilateral insula, and the medial cingulate cortex. These regions contribute to a pain processing loop that coordinates the nocifensive motor reaction. CMi nociceptor activation did not cause relevant activation in this loop and does not seem to play a role in withdrawal. The posterior cingulate cortex was selectively activated by ICS and is apparently important for the processing of inflammatory pain.
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