1
|
Rajamanickam G, Lee ATH, Liao P. Role of Brain Derived Neurotrophic Factor and Related Therapeutic Strategies in Central Post-Stroke Pain. Neurochem Res 2024:10.1007/s11064-024-04175-z. [PMID: 38856889 DOI: 10.1007/s11064-024-04175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
Brain-derived neurotrophic factor (BDNF) is vital for synaptic plasticity, cell persistence, and neuronal development in peripheral and central nervous systems (CNS). Numerous intracellular signalling pathways involving BDNF are well recognized to affect neurogenesis, synaptic function, cell viability, and cognitive function, which in turn affects pathological and physiological aspects of neurons. Stroke has a significant psycho-socioeconomic impact globally. Central post-stroke pain (CPSP), also known as a type of chronic neuropathic pain, is caused by injury to the CNS following a stroke, specifically damage to the somatosensory system. BDNF regulates a broad range of functions directly or via its biologically active isoforms, regulating multiple signalling pathways through interactions with different types of receptors. BDNF has been shown to play a major role in facilitating neuroplasticity during post-stroke recovery and a pro-nociceptive role in pain development in the nervous system. BDNF-tyrosine kinase receptors B (TrkB) pathway promotes neurite outgrowth, neurogenesis, and the prevention of apoptosis, which helps in stroke recovery. Meanwhile, BDNF overexpression plays a role in CPSP via the activation of purinergic receptors P2X4R and P2X7R. The neuronal hyperexcitability that causes CPSP is linked with BDNF-TrkB interactions, changes in ion channels and inflammatory reactions. This review provides an overview of BDNF synthesis, interactions with certain receptors, and potential functions in regulating signalling pathways associated with stroke and CPSP. The pathophysiological mechanisms underlying CPSP, the role of BDNF in CPSP, and the challenges and current treatment strategies targeting BDNF are also discussed.
Collapse
Affiliation(s)
- Gayathri Rajamanickam
- Calcium Signalling Laboratory, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Andy Thiam Huat Lee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Ping Liao
- Calcium Signalling Laboratory, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
2
|
Lizi H, Jiaojiao K, Dan W, Shuyao W, Qingyuan W, Zijiang Y, Hua K. Non-invasive brain stimulation improves pain in patients with central post-stroke pain: a systematic review and meta-analysis. Top Stroke Rehabil 2024:1-16. [PMID: 38828896 DOI: 10.1080/10749357.2024.2359341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/18/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Central post-stroke pain (CPSP) significantly interferes with the quality of life and psychological well-being of stroke patients. Non-invasive brain stimulation (NIBS) has attracted significant attention as an emerging method for treating patients with CPSP. OBJECTIVE To compare the clinical efficacy of noninvasive brain stimulation on pain, and psychological status of patients with central post-stroke pain using meta-analysis. METHODS A computerized search of multiple databases was performed for identification of randomized controlled trials involving NIBS-led treatment of CPSP patients. Two researchers worked independently on literature screening, data extraction, and quality assessment. Research was conducted from inception of the database until October 2023. RevMan 5.0 and Stata 15.0 software were used to conduct statistical analysis. RESULTS Sixteen papers with 807 patients were finally included. The results showed that NIBS reduced patients' pain intensity [SMD = -0.39, 95% CI (-0.54, -0.24), p < 0.01] and was more effective in short-term CPSP patients. However, the included studies did not show a significant impact on psychological status, particularly depression. Subgroup analysis suggested that the M1 stimulation point was more effective than other stimulation points [SMD = -0.45, 95% CI (-0.65, -0.25), p < 0.001]. Other stimulation modalities also demonstrated favorable outcomes when compared to rTMS [SMD = -0.67, 95% CI (-1.09, -0.25), p < 0.01]. CONCLUSION NIBS has a positive impact on pain relief in patients with CPSP, but does not enhance patients' psychological well-being in terms of anxiety or depression. Furthermore, large-sample, high-quality, and multi-center RCTs are needed to explore the benefits of different stimulation durations and parameters in patients with CPSP. The current study has been registered with Prospero under the registration number CRD42023468419.
Collapse
Affiliation(s)
- Hu Lizi
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kou Jiaojiao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Dan
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Shuyao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Qingyuan
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yang Zijiang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kang Hua
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
3
|
Fan F, Yin T, Wu B, Zheng J, Deng J, Wu G, Hu S. The role of spinal neurons targeted by corticospinal neurons in central poststroke neuropathic pain. CNS Neurosci Ther 2024; 30:e14813. [PMID: 38887838 PMCID: PMC11183184 DOI: 10.1111/cns.14813] [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: 01/14/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Central poststroke pain (CPSP) is one of the primary sequelae following stroke, yet its underlying mechanisms are poorly understood. METHODS By lesioning the lateral thalamic nuclei, we first established a CPSP model that exhibits mechanical and thermal hypersensitivity. Innocuous mechanical stimuli following the thalamic lesion evoked robust neural activation in somatosensory corticospinal neurons (CSNs), as well as in the deep dorsal horn, where low threshold mechanosensory afferents terminate. In this study, we used viral-based mapping and intersectional functional manipulations to decipher the role of somatosensory CSNs and their spinal targets in the CPSP pathophysiology. RESULTS We first mapped the post-synaptic spinal targets of lumbar innervating CSNs using an anterograde trans-synaptic AAV1-based strategy and showed these spinal interneurons were activated by innocuous tactile stimuli post-thalamic lesion. Functionally, tetanus toxin-based chronic inactivation of spinal neurons targeted by CSNs prevented the development of CPSP. Consistently, transient chemogenetic silencing of these neurons alleviated established mechanical pain hypersensitivity and innocuous tactile stimuli evoked aversion linked to the CPSP. In contrast, chemogenetic activation of these neurons was insufficient to induce robust mechanical allodynia typically observed in the CPSP. CONCLUSION The CSNs and their spinal targets are required but insufficient for the establishment of CPSP hypersensitivity. Our study provided novel insights into the neural mechanisms underlying CPSP and potential therapeutic interventions to treat refractory central neuropathic pain conditions.
Collapse
Affiliation(s)
- Fenqqi Fan
- Department of Pain, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Tianze Yin
- Department of Pain, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Biwu Wu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiajun Zheng
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiaojiao Deng
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Gang Wu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Shukun Hu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| |
Collapse
|
4
|
Bu F, Li Y, Lan S, Yang T, He B, Dong P, Shen F, Cai H, Lu Y, Fei Y, Xu L, Qin X. Blocking Pannexin-1 Channels Alleviates Thalamic Hemorrhage-Induced Pain and Inflammatory Depolarization of Microglia in Mice. ACS Chem Neurosci 2023. [PMID: 37377340 DOI: 10.1021/acschemneuro.3c00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Central post-stroke pain (CPSP) is a neuropathic pain syndrome that frequently occurs following cerebral stroke. The pathogenesis of CPSP is mainly due to thalamic injury caused by ischemia and hemorrhage. However, its underlying mechanism is far from clear. In the present study, a thalamic hemorrhage (TH) model was established in young male mice by microinjection of 0.075 U of type IV collagenase into the unilateral ventral posterior lateral nucleus and ventral posterior medial nucleus of the thalamus. We found that TH led to microglial pannexin (Panx)-1, a large-pore ion channel, opening within the thalamus accompanied with thalamic tissue injury, pain sensitivities, and neurological deficit, which were significantly prevented by either intraperitoneal injection of the Panx1 blocker carbenoxolone or intracerebroventricular perfusion of the inhibitory mimetic peptide 10Panx. However, inhibition of Panx1 has no additive effect on pain sensitivities upon pharmacological depletion of microglia. Mechanistically, we found that carbenoxolone alleviated TH-induced proinflammatory factors transcription, neuronal apoptosis, and neurite disassembly within the thalamus. In summary, we conclude that blocking of microglial Panx1 channels alleviates CPSP and neurological deficit through, at least in part, reducing neural damage mediated by the inflammatory response of thalamic microglia after TH. Targeting Panx1 might be a potential strategy in the treatment of CPSP.
Collapse
Affiliation(s)
- Fan Bu
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Yuerong Li
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Shiming Lan
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Taiqin Yang
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Baokun He
- Laboratory of Molecular Pharmacology and Drug Discovery, Institute of Chinese Materia Medica, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Peng Dong
- Department of Neurosurgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Fengyan Shen
- Department of Anesthesiology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Haobin Cai
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Yunwei Lu
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| | - Yong Fei
- Department of Anesthesia and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, China
| | - Longsheng Xu
- Department of Anesthesia and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, China
| | - Xiude Qin
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518033, China
| |
Collapse
|
5
|
Barbosa LM, Valerio F, da Silva VA, Rodrigues ALDL, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Teixeira MJ, de Andrade DC. Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients. Neurophysiol Clin 2023; 53:102845. [PMID: 36822032 DOI: 10.1016/j.neucli.2023.102845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP. METHODS We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location. RESULTS We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non- neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 μV ±464 μV) than non-neuropathic (478 ±489) and no-pain (765 μV ± 880 μV) patients, p < 0.001. Short-interval intracortical inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6±11.6) compared to no-pain (0.8±0.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allodynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses. DISCUSSION CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to provide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.
Collapse
Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil; Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark.
| |
Collapse
|
6
|
Murphy HM, Fetter CM, Snow NJ, Chaves AR, Downer MB, Ploughman M. Lower corticospinal excitability and greater fatigue among people with multiple sclerosis experiencing pain. Mult Scler J Exp Transl Clin 2023; 9:20552173221143398. [PMID: 36636581 PMCID: PMC9830099 DOI: 10.1177/20552173221143398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Persons with multiple sclerosis (MS) frequently report pain that negatively affects their quality of life. Evidence linking pain and corticospinal excitability in MS is sparse. We aimed to (1) examine differences in corticospinal excitability in MS participants with and without pain and (2) explore predictors of pain. Methods Sixty-four participants rated their pain severity on a visual analog scale (VAS). Transcranial magnetic stimulation (TMS) and validated clinical instruments characterized corticospinal excitability and subjective disease features like mood and fatigue. We retrieved information on participants' prescriptions and disability status from their clinical records. Results Fifty-five percent of participants reported pain that affected their daily functioning. Persons with pain had significantly greater fatigue and lower area under the excitatory motor evoked potential (MEP) recruitment curve (eREC AUC), a measure of total corticospinal excitability. After controlling for age, disability status, and pain medications, increased fatigue and decreased eREC AUC together explained 40% of the variance in pain. Discussion Pain in MS is multifactorial and relates to both greater fatigue and lesser corticospinal excitability. Future work should better characterize relationships between these outcomes to develop targeted pain interventions such as neuromodulation. Summary We examined pain in MS. Individuals with pain had higher fatigue and lower corticospinal excitability than those without pain. These outcomes significantly predicted self-reported pain.
Collapse
Affiliation(s)
- Hannah M. Murphy
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Christopher M. Fetter
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Nicholas J. Snow
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Arthur R. Chaves
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Matthew B. Downer
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada,Michelle Ploughman, Recovery
& Performance Laboratory, Faculty of Medicine, Memorial University of
Newfoundland, LA Miller Centre, 100 Forest Road, St. John's, NL, A1A1E5, Canada.
| |
Collapse
|
7
|
Snow NJ, Kirkland MC, Downer MB, Murphy HM, Ploughman M. Transcranial magnetic stimulation maps the neurophysiology of chronic noncancer pain: A scoping review. Medicine (Baltimore) 2022; 101:e31774. [PMID: 36401490 PMCID: PMC9678597 DOI: 10.1097/md.0000000000031774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chronic noncancer pain is a global public health challenge. It is imperative to identify biological markers ("biomarkers") to understand the mechanisms underlying chronic pain and to monitor pain over time and after interventions. Transcranial magnetic stimulation (TMS) is a promising method for this purpose. OBJECTIVES To examine differences in TMS-based outcomes between persons with chronic pain and healthy controls (HCs) and/or before versus after pain-modulating interventions and relationships between pain measures and TMS outcomes; To summarize the neurophysiological mechanisms underlying chronic pain as identified by TMS. METHODS We searched the PubMed database for literature from January 1, 1985, to June 9, 2020, with the keywords "pain" and "transcranial magnetic stimulation." Eligible items included original studies of adult human participants with pain lasting for ≥ 6 months. We completed a narrative synthesis of the study findings stratified by chronic pain etiology (primary pain, neuropathic pain, and secondary musculoskeletal pain). RESULTS The search yielded 1265 records. The final 12 articles included 244 patients with chronic pain (192 females, aged 35-65 years) and 169 HCs (89 females, aged 28-59 years). Abnormalities in TMS outcomes that reflect GABAergic and glutamatergic activities were associated with many of the disorders studied and were distinct for each pain etiology. Chronic primary pain is characterized by reduced intracortical inhibition and corticospinal excitability, chronic neuropathic pain shows evidence of increased excitation and disinhibition, and chronic secondary musculoskeletal pain involves low corticospinal excitability. DISCUSSION TMS could be a useful tool for delineating the neurophysiological underpinnings of chronic pain syndromes.
Collapse
Affiliation(s)
- Nicholas Jacob Snow
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Megan Christine Kirkland
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Matthew Bruce Downer
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Hannah Margaret Murphy
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
- * Correspondence: Michelle Ploughman, Recovery and Performance Laboratory, Rehabilitation Research Unit of NL, Faculty of Medicine, Memorial University of Newfoundland & Labrador, Dr. Leonard A. Miller Centre, Room 400, 100 Forest Road, St. John’s, Newfoundland and Labrador A1A 1E5, Canada (e-mail: )
| |
Collapse
|
8
|
Tomeh A, Yusof Khan AHK, Wan Sulaiman WA. Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review. Front Aging Neurosci 2022; 14:897837. [PMID: 36225893 PMCID: PMC9549351 DOI: 10.3389/fnagi.2022.897837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a leading cause of morbidity and mortality among elderly populations worldwide. During the early phase of stroke, restoring blood circulation is of utmost importance to protect neurons from further injury. Once the initial condition is stabilized, various rehabilitation techniques can be applied to help stroke survivors gradually regain their affected functions. Among these techniques, transcranial magnetic stimulation (TMS) has emerged as a novel method to assess and modulate cortical excitability non-invasively and aid stroke survivors in the rehabilitation process. Different cortical regions have been targeted using TMS based on the underlying pathology and distorted function. Despite the lack of a standard operational procedure, repetitive TMS (rTMS) of the primary motor cortex (M1) is considered a promising intervention for post-stroke motor rehabilitation. However, apart from the motor response, mounting evidence suggests that M1 stimulation can be employed to treat other symptoms such as dysphagia, speech impairments, central post-stroke pain, depression, and cognitive dysfunction. In this mini-review, we summarize the therapeutic uses of rTMS stimulation over M1 in stroke survivors and discuss the potential mechanistic rationale behind it.
Collapse
Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
- *Correspondence: Wan Aliaa Wan Sulaiman,
| |
Collapse
|
9
|
Ameenudeen S, Kashif M, Banerjee S, Srinivasan H, Pandurangan AK, Waseem M. Cellular and Molecular Machinery of Neuropathic Pain: an Emerging Insight. CURRENT PHARMACOLOGY REPORTS 2022; 8:227-235. [PMID: 35646513 PMCID: PMC9125010 DOI: 10.1007/s40495-022-00294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Neuropathic pain (NP) has been ubiquitously characterized by lesion and its linked somatosensory system either the central nervous system (CNS) or peripheral nervous system (PNS) This PNS episode is the most prevalent site of NP origin and is found to be associated with afferent nerve fibers carrying pain signals from injured/trauma site to the CNS including the brain. Several kinds of pharmacotherapeutic drugs shuch as analgesics, anti-convulsants, and anti-depressants are being employed for the its possible interventions. The NP has been a great interest to follow different pathophysiological mechanisms which are often considered to correlate with the metabolic pathways and its mediated disease. There is paucity of knowledge to make such mechanism via NP. Recent Finding Most notably, recent pandemic outbreak of COVID-19 has also been reported in chronic pain mediated diabetes, inflammatory disorders, and cancers. There is an increasing incidence of NP and its complex mechanism has now led to identify the possible investigations of responsible genes and proteins via bioinformatics tools. The analysis might be more instrumental as collecting the genes from pain genetic database, analyzing the variants through differential gene expression (DEG) and constructing the protein–protein interaction (PPI) networks and thereby determining their upregulating and downregulating pathways. Summary This review sheds a bright light towards several mechanisms at both cellular and molecular level, correlation of NP-mediated disease mechanism and possible cell surface biomarkers (receptors), and identified genes could be more promising for their pharmacological targets.
Collapse
Affiliation(s)
- Shabnam Ameenudeen
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Mohd. Kashif
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Subhamoy Banerjee
- Department of Basic Science and Humanities, Institute of Engineering and Management, Sector V, Salt Lake, Kolkata, 700091 India
| | - Hemalatha Srinivasan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Ashok Kumar Pandurangan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Mohammad Waseem
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| |
Collapse
|
10
|
Quantitative and Fiber-Selective Evaluation for Central Poststroke Pain. Neural Plast 2022; 2022:1507291. [PMID: 35707518 PMCID: PMC9192306 DOI: 10.1155/2022/1507291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/24/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
The electrophysiological recording can be used to quantify the clinical features of central poststroke pain (CPSP) caused by different lesion locations. We aimed to explore the relationship between clinical features and lesion location in patients with CPSP using the current perception threshold (CPT) approach. Here, patients underwent the standardized CPT measure at five detection sites on both the contralesional and ipsilesional sides, using a constant alternating-current sinusoid waveform stimulus at three frequencies: 2000 Hz, 250 Hz, and 5 Hz. 57 CPSP patients were recruited in this cross-sectional study, including 13 patients with thalamic lesions and 44 patients with internal capsule lesions. Patients with a thalamic lesion had more frequent abnormal Aδ and C fibers than those with an internal capsule lesion (69.2% versus 36.4%, p value = 0.038; 53.8% versus 63.6%, p value = 0.038). The patients with internal capsule lesions had more frequent abnormal Aβ fibers than those with thalamic lesions (53.8% versus 63.6%, p value < 0.001). The sensory dysfunction in the patients with thalamic lesions was more likely to occur in the upper limbs (i.e., the shoulder (p value = 0.027) and the finger (p value = 0.040)). The lower limbs (i.e., the knee (p value = 0.040) and the toe (p value = 0.005)) were more likely to experience sensory dysfunction in the patients with internal capsule lesions. Hyperesthesia was more likely to occur in the thalamic patients, and hypoesthesia was more likely to occur in the patients with internal capsule lesions (p value < 0.001). In patients with thalamic lesions, Visual Analogue Scale (VAS) had a positive correlation with 5 Hz CPT on the shoulder (r = 0.010, p value = 0.005), 250 Hz CPT on the finger (r = 0.690, p value = 0.009) from the contralesional side, and 2000 Hz CPT on the knee (r = 0.690, p value = 0.009). In patients with internal capsule lesions, VAS had a positive correlation with 2000 Hz CPT on the knee (r = 0.312, p value = 0.039) and foot (r = 0.538, p value < 0.001). In conclusion, the abnormal fiber types, sensory dysfunction territory, and clinical signs of CPSP in thalamic stroke differ from those in internal capsule stroke. Implementation of the portable and convenient CPT protocol may help clarify the locations of different stroke lesions in various clinical settings.
Collapse
|
11
|
Benedetti B, Weidenhammer A, Reisinger M, Couillard-Despres S. Spinal Cord Injury and Loss of Cortical Inhibition. Int J Mol Sci 2022; 23:5622. [PMID: 35628434 PMCID: PMC9144195 DOI: 10.3390/ijms23105622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
After spinal cord injury (SCI), the destruction of spinal parenchyma causes permanent deficits in motor functions, which correlates with the severity and location of the lesion. Despite being disconnected from their targets, most cortical motor neurons survive the acute phase of SCI, and these neurons can therefore be a resource for functional recovery, provided that they are properly reconnected and retuned to a physiological state. However, inappropriate re-integration of cortical neurons or aberrant activity of corticospinal networks may worsen the long-term outcomes of SCI. In this review, we revisit recent studies addressing the relation between cortical disinhibition and functional recovery after SCI. Evidence suggests that cortical disinhibition can be either beneficial or detrimental in a context-dependent manner. A careful examination of clinical data helps to resolve apparent paradoxes and explain the heterogeneity of treatment outcomes. Additionally, evidence gained from SCI animal models indicates probable mechanisms mediating cortical disinhibition. Understanding the mechanisms and dynamics of cortical disinhibition is a prerequisite to improve current interventions through targeted pharmacological and/or rehabilitative interventions following SCI.
Collapse
Affiliation(s)
- Bruno Benedetti
- Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria; (B.B.); (A.W.); (M.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), 5020 Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Annika Weidenhammer
- Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria; (B.B.); (A.W.); (M.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), 5020 Salzburg, Austria
| | - Maximilian Reisinger
- Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria; (B.B.); (A.W.); (M.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), 5020 Salzburg, Austria
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria; (B.B.); (A.W.); (M.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), 5020 Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| |
Collapse
|
12
|
Barbosa LM, da Silva VA, de Lima Rodrigues AL, Mendes Fernandes DTR, de Oliveira RAA, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Lemos MD, Peyron R, Garcia-Larrea L, Teixeira MJ, de Andrade DC. Dissecting central post-stroke pain: a controlled symptom-psychophysical characterization. Brain Commun 2022; 4:fcac090. [PMID: 35528229 PMCID: PMC9070496 DOI: 10.1093/braincomms/fcac090] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non- neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far.
We compared 39 patients with definite central neuropathic post-stroke pain with two matched- control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke.
While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (p<0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n=32, p<0.001), tingling (66.7%, n= 26, p<0.001) and evoked by cold (64.1%, n=25, p<0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (p<0.001), which also presented higher levels of deafferentation (p<0.012) with more asymmetric cold and warm detection thresholds compared to controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was less than 41% of the contralateral threshold) odds ratio was 12 (95%CI: 3.8-41.6) for neuropathic pain. Additionally, cold detection threshold/ warm detection threshold ratio correlated with the presence of neuropathic pain (ρ=-0.4, p< 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ=-0.4; p=0.008) and heat pain thresholds (ρ=0.5; p=0.003), burning pain with mechanical detection (ρ= -0.4; p=0.015) and mechanical pain thresholds (ρ=-0.4, p<0.013), evoked pain with mechanical pain threshold (ρ= -0.3; p=0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain.
These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials.
Collapse
Affiliation(s)
| | | | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Marcelo Delboni Lemos
- Department of Radiology, LIM-44, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Roland Peyron
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Luis Garcia-Larrea
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Department of Neurology, LIM-62, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
| |
Collapse
|
13
|
Garcia-Larrea L, Quesada C. Cortical stimulation for chronic pain: from anecdote to evidence. Eur J Phys Rehabil Med 2022; 58:290-305. [PMID: 35343176 PMCID: PMC9980528 DOI: 10.23736/s1973-9087.22.07411-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidural stimulation of the motor cortex (eMCS) was devised in the 1990's, and has now largely supplanted thalamic stimulation for neuropathic pain relief. Its mechanisms of action involve activation of multiple cortico-subcortical areas initiated in the thalamus, with involvement of endogenous opioids and descending inhibition toward the spinal cord. Evidence for clinical efficacy is now supported by at least seven RCTs; benefits may persist up to 10 years, and can be reasonably predicted by preoperative use of non-invasive repetitive magnetic stimulation (rTMS). rTMS first developed as a means of predicting the efficacy of epidural procedures, then as an analgesic method on its own right. Reasonable evidence from at least six well-conducted RCTs favors a significant analgesic effect of high-frequency rTMS of the motor cortex in neuropathic pain (NP), and less consistently in widespread/fibromyalgic pain. Stimulation of the dorsolateral frontal cortex (DLPFC) has not proven efficacious for pain, so far. The posterior operculo-insular cortex is a new and attractive target but evidence remains inconsistent. Transcranial direct current stimulation (tDCS) is applied upon similar targets as rTMS and eMCS; it does not elicit action potentials but modulates the neuronal resting membrane state. tDCS presents practical advantages including low cost, few safety issues, and possibility of home-based protocols; however, the limited quality of most published reports entails a low level of evidence. Patients responsive to tDCS may differ from those improved by rTMS, and in both cases repeated sessions over a long time may be required to achieve clinically significant relief. Both invasive and non-invasive procedures exert their effects through multiple distributed brain networks influencing the sensory, affective and cognitive aspects of chronic pain. Their effects are mainly exerted upon abnormally sensitized pathways, rather than on acute physiological pain. Extending the duration of long-term benefits remains a challenge, for which different strategies are discussed in this review.
Collapse
Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France - .,University Hospital Pain Center (CETD), Neurological Hospital, Hospices Civils de Lyon, Lyon, France -
| | - Charles Quesada
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Physiotherapy, Sciences of Rehabilitation Institute (ISTR), University Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
14
|
Chiang MC, Hsueh HW, Yeh TY, Cheng YY, Kao YH, Chang KC, Feng FP, Chao CC, Hsieh ST. Maladaptive motor cortical excitability and connectivity in polyneuropathy with neuropathic pain. Eur J Neurol 2022; 29:1465-1476. [PMID: 35020255 DOI: 10.1111/ene.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sensory symptoms, especially neuropathic pain, are common in polyneuropathy. Conventional diagnostic tools can evaluate structural or functional impairment of nerves but cannot reveal mechanisms of neuropathic pain. Changes in the brain after polyneuropathy may play roles in the genesis of neuropathic pain. METHODS This cross-sectional study investigated changes of cortical excitability within left primary motor cortex (M1) by measuring resting motor thresholds, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and afferent inhibition between polyneuropathy patients and controls, and investigated the correlates of these parameters with neuropathic pain and the M1 structural and functional connectivity assessed by diffusion tractography imaging and functional MRI. RESULTS Thirty-three painful and 15 non-painful neuropathic patients and 21 controls were enrolled. There were no differences in intraepidermal nerve fiber density, nerve conduction study, thermal thresholds, or autonomic functional tests between patients with and without neuropathic pain. Compared to controls, neuropathic patients exhibited similar resting motor thresholds or afferent inhibition, but attenuated SICI and augmented ICF, especially in painful patients. Changes of intracortical excitability in neuropathic patients were correlated with intensities of neuropathic pain, and different presentations of SICI and ICF were noted between patients with and without thermal paresthesia. Additionally, short latency afferent inhibition at interstimulus intervals of 20 ms was associated with structural connectivity of left M1 with brain areas associated with pain perception. CONCLUSIONS Maladaptive cortical excitability with altered structural connectivity in left M1 developed after peripheral nerve degeneration and was associated with neuropathic pain and sensory symptoms in polyneuropathy.
Collapse
Affiliation(s)
- Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ti-Yen Yeh
- Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Yin Cheng
- Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hui Kao
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Fang-Ping Feng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences.,Graduate Institute of Clinical Medicine.,Center of Precision Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
15
|
Betancur DFA, Tarragó MDGL, Torres ILDS, Fregni F, Caumo W. Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures. Front Neurol 2021; 12:678198. [PMID: 34484097 PMCID: PMC8416310 DOI: 10.3389/fneur.2021.678198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/02/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction: The physiopathology of central post-stroke pain (CPSP) is poorly understood, which may contribute to the limitations of diagnostic and therapeutic advancements. Thus, the current systematic review was conducted to examine, from an integrated perspective, the cortical neurophysiological changes observed via transcranial magnetic stimulation (TMS), focusing on the structural damage, and clinical symptoms in patients with CPSP. Methods: The literature review included the databases EMBASE, PubMed, and ScienceDirect using the following search terms by MeSH or Entree descriptors: [("Cerebral Stroke") AND ("Pain" OR "Transcranial Magnetic Stimulation") AND ("Transcranial Magnetic Stimulation")] (through September 29, 2020). A total of 297 articles related to CPSP were identified. Of these, only four quantitatively recorded cortical measurements. Results: We found four studies with different methodologies and results of the TMS measures. According to the National Institutes of Health (NIH) guidelines, two studies had low methodological quality and the other two studies had satisfactory methodological quality. The four studies compared the motor threshold (MT) of the stroke-affected hemisphere with the unaffected hemisphere or with healthy controls. Two studies assessed other cortical excitability measures, such as cortical silent period (CSP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). The main limitations in the interpretation of the results were the heterogeneity in parameter measurements, unknown cortical excitability measures as potential prognostic markers, the lack of a control group without pain, and the absence of consistent and validated diagnosis criteria. Conclusion: Despite the limited number of studies that prevented us from conducting a meta-analysis, the dataset of this systematic review provides evidence to improve the understanding of CPSP physiopathology. Additionally, these studies support the construction of a framework for diagnosis and will help improve the methodological quality of future research in somatosensory sequelae following stroke. Furthermore, they offer a way to integrate dysfunctional neuroplasticity markers that are indirectly assessed by neurophysiological measures with their correlated clinical symptoms.
Collapse
Affiliation(s)
- Daniel Fernando Arias Betancur
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Iraci Lucena da Silva Torres
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation: Pre-clinical Investigations Research Group, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics, and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
16
|
Lu J, Guo X, Yan M, Yuan X, Chen S, Wang Y, Zhu J, Huang S, Shen H, Li H, Xue Q, Fang Q, Ni J, Gan L, Zhao H, Lu H, Chen G. P2X4R Contributes to Central Disinhibition Via TNF-α/TNFR1/GABAaR Pathway in Post-stroke Pain Rats. THE JOURNAL OF PAIN 2021; 22:968-980. [PMID: 33677111 DOI: 10.1016/j.jpain.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 12/20/2022]
Abstract
Central post-stroke pain (CPSP) is a disabling condition in stroke patients. It is a type of neuropathic pain for which the mechanism and relevant drug pathways remain unknown. Inflammatory response and central disinhibition have been suggested recently. Our previous research has shown targeting P2X4 receptors (P2X4R) may be effective in the treatment of CPSP, but the downstream pathway of the P2X4R has not been studied. In this study, we found the increase in tumor necrosis factor alpha (TNF-α) level and endocytosis of surface gamma-aminobutyric acid a receptors (GABAaR) in CPSP, and these effects were inhibited by blocking P2X4R. Furthermore, antagonizing TNF-α can increase surface GABAaR expression and mechanical pain threshold. Meanwhile, knocking down TNFR1 but not TNFR2 reversed the endocytosis of surface GABAaR and alleviated mechanical allodynia. Thus, the neuropathic pain was mediated, in part, through P2X4R/TNF-α/TNFR1/GABAaR signaling, which was induced after stroke. PERSPECTIVE: P2X4R regulates the pathophysiological mechanism of CPSP through central disinhibition mediated by TNF-α/TNFR1. Our results suggest that modulation of P2X4R-TNF-α/TNFR1-GABAaR signaling could provide a new therapeutic strategy to treat CPSP.
Collapse
Affiliation(s)
- Jiajie Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoning Guo
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Manyun Yan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaqing Yuan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shujun Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yiqing Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Juehua Zhu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shicun Huang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jianqiang Ni
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lei Gan
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Haifeng Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
17
|
Brain imaging signature of neuropathic pain phenotypes in small-fiber neuropathy: altered thalamic connectome and its associations with skin nerve degeneration. Pain 2021; 162:1387-1399. [PMID: 33239524 DOI: 10.1097/j.pain.0000000000002155] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT Small-fiber neuropathy (SFN) has been traditionally considered as a pure disorder of the peripheral nervous system, characterized by neuropathic pain and degeneration of small-diameter nerve fibers in the skin. Previous functional magnetic resonance imaging studies revealed abnormal activations of pain networks, but the structural basis underlying such maladaptive functional alterations remains elusive. We applied diffusion tensor imaging to explore the influences of SFN on brain microstructures. Forty-one patients with pathology-proven SFN with reduced skin innervation were recruited. White matter connectivity with the thalamus as the seed was assessed using probabilistic tractography of diffusion tensor imaging. Patients with SFN had reduced thalamic connectivity with the insular cortex and the sensorimotor areas, including the postcentral and precentral gyri. Furthermore, the degree of skin nerve degeneration, measured by intraepidermal nerve fiber density, was associated with the reduction of connectivity between the thalamus and pain-related areas according to different neuropathic pain phenotypes, specifically, the frontal, cingulate, motor, and limbic areas for burning, electrical shocks, tingling, mechanical allodynia, and numbness. Despite altered white matter connectivity, there was no change in white matter integrity assessed with fractional anisotropy. Our findings indicate that alterations in structural connectivity may serve as a biomarker of maladaptive brain plasticity that contributes to neuropathic pain after peripheral nerve degeneration.
Collapse
|
18
|
Park JG, Hong BY, Park HY, Yoo YJ, Yoon MJ, Kim JS, Lim SH. Alteration of White Matter in Patients with Central Post-Stroke Pain. J Pers Med 2021; 11:417. [PMID: 34063462 PMCID: PMC8156708 DOI: 10.3390/jpm11050417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
A stroke may be followed by central post-stroke pain (CPSP), which is characterized by chronic neuropathic pain. The exact mechanism has not yet been fully uncovered. We investigated alterations in the white matters in patients with CPSP, compared with stroke patients without CPSP and normal controls. Our retrospective cross-sectional, case-control study participants were assigned to three groups: CPSP (stroke patients with CPSP (n = 17)); stroke control (stroke patients without CPSP (n = 26)); and normal control (normal subjects (n = 34)). The investigation of white matter for CPSP was focused on the values of fiber numbers (FN) and fractional anisotrophy (FA) for spinothalamic tract (STT), anterior thalamic radiation (ATR), superior thalamic radiation (STR) and posterior thalamic radiation (PTR), and corticospinal tract (CST) was measured. The FA for the STT and STR of the CPSP group were lower than those for the stroke control and normal control groups. The FA of CST and ATR did not differ between the CPSP and stroke groups, but both differed from the normal control. The FA of PTR in the stroke control group differed from the normal control group, but not from the CPSP group. The FN of CST, STT, ATR, and STR for the CPSP and stroke control groups did not differ from each other, but both differed from those of normal controls. FN of PTR did not differ between the CPSP and normal control groups. The alterations in the spinothalamic tract and superior thalamic radiation after stroke would play a role in the pathogenesis of CPSP.
Collapse
Affiliation(s)
- Jung Geun Park
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Joon-Sung Kim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| |
Collapse
|
19
|
Forstenpointner J, Berry D, Baron R, Borsook D. The cornucopia of central disinhibition pain - An evaluation of past and novel concepts. Neurobiol Dis 2020; 145:105041. [PMID: 32800994 DOI: 10.1016/j.nbd.2020.105041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/18/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Central disinhibition (CD), as applied to pain, decreases thresholds of endogenous systems. This provokes onset of spontaneous or evoked pain in an individual beyond the ability of the nervous system to inhibit pain resulting from a disease or tissue damage. The original CD concept as proposed by Craig entails a shift from the lateral pain pathway (i.e. discriminative pain processing) towards the medial pain pathway (i.e. emotional pain processing), within an otherwise neurophysiological intact environment. In this review, the original CD concept as proposed by Craig is extended by the primary "nociceptive pathway damage - CD" concept and the secondary "central pathway set point - CD". Thereby, the original concept may be transferred into anatomical and psychological non-functional conditions. We provide examples for either primary or secondary CD concepts within different clinical etiologies as well as present surrogate models, which directly mimic the underlying pathophysiology (A-fiber block) or modulate the CD pathway excitability (thermal grill). The thermal grill has especially shown promising advancements, which may be useful to examine CD pathway activation in the future. Therefore, within this topical review, a systematic review on the thermal grill illusion is intended to stimulate future research. Finally, the authors review different mechanism-based treatment approaches to combat CD pain.
Collapse
Affiliation(s)
- Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Delany Berry
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
The Experience of Post-Stroke Pain and The Impact on Quality of Life: An Integrative Review. Behav Sci (Basel) 2020; 10:bs10080128. [PMID: 32784720 PMCID: PMC7464541 DOI: 10.3390/bs10080128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/19/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Many people experience post-stroke pain (PSP). It is a long-term consequence of stroke that commonly goes unrecognised and untreated. As a result, an integrative review is needed to identify the primary factors that affect PSP and determine the impact on quality of life (QOL). Methods: An integrative review using a quantitatively led data synthesis, supported by qualitative evidence, was conducted. Results: Fourteen studies were identified and 2415 (968 females, 1447 males) people were included. Five primary themes were identified as effecting the experience of PSP; anxiety, depression, fatigue, cognitive function and physical function. Anxiety, depression and fatigue increase PSP. Pain, depression, fatigue and reduced physical function lower QOL. Conclusions: It is essential that clinicians recognise PSP in order to optimize QOL and function post-stroke. Further research is needed to employ a strategy to identify and objectively quantify PSP and its impact on QOL.
Collapse
|
21
|
Ageing as a risk factor for cerebral ischemia: Underlying mechanisms and therapy in animal models and in the clinic. Mech Ageing Dev 2020; 190:111312. [PMID: 32663480 DOI: 10.1016/j.mad.2020.111312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
Age is the only one non-modifiable risk of cerebral ischemia. Advances in stroke medicine and behavioral adaptation to stroke risk factors and comorbidities was successful in decreasing stroke incidence and increasing the number of stroke survivors in western societies. Comorbidities aggravates the outcome after cerebral ischemia. However, due to the increased in number of elderly, the incidence of stroke has increased again paralleled by an increase in the number of stroke survivors, many with severe disabilities, that has led to an increased economic and social burden in society. Animal models of stroke often ignore age and comorbidities frequently associated with senescence. This might explain why drugs working nicely in animal models fail to show efficacy in stroke survivors. Since stroke afflicts mostly the elderly comorbid patients, it is highly desirable to test the efficacy of stroke therapies in an appropriate animal stroke model. Therefore, in this review, we make parallels between animal models of stroke und clinical data and summarize the impact of ageing and age-related comorbidities on stroke outcome.
Collapse
|
22
|
Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou GM, Tsivgoulis G, Zis P. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 2020; 37:3278-3291. [PMID: 32451951 PMCID: PMC7467424 DOI: 10.1007/s12325-020-01388-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 01/30/2023]
Abstract
Introduction Central post-stroke pain (CPSP) is defined as the neuropathic pain that arises either acutely or in the chronic phase of a cerebrovascular event and is a result of central lesions of the somatosensory tract. The aim of this systematic review and meta-analysis was to establish the prevalence of CPSP, to describe its characteristics, and to discuss the associated management challenges. Methods After a systematic Medline search, we identified 69 papers eligible to be included. Results The pooled prevalence of CPSP in patients with stroke at any location was 11% (95% CI 7–18%), which can increase to more than 50% in the subgroups of patients with medullary or thalamic strokes. CPSP onset coincides with stroke occurrence in 26% of patients (95% CI 18–35%); CPSP manifests within a month since symptom onset in 31% of patients (95% CI 22–42%), and occurs between the first month and the first year in 41% of patients (95% CI 33.9–49.0%). CPSP develops more than 12 months after stroke onset in 5% of patients (95% CI 3–8%). Conclusions Clinicians should look for any evidence of central neuropathic pain for at least 12 months after stroke. Both pharmacological and non-pharmacological interventions can be used for the management of CPSP. Lamotrigine has the strongest evidence (Level II of evidence, derived from small randomized controlled trials) for being effective in the management of CPSP. Future research should focus on well-designed trials of pharmacological and non-pharmacological interventions aiming to relief CPSP, which is a very common but often neglected pain syndrome. Electronic supplementary material The online version of this article (10.1007/s12325-020-01388-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andreas Liampas
- Academic Directorate of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Athina Vadalouca
- Pain and Palliative Care Center, Athens Medical Center, Athens, Greece
| | | | | | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|