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Kim HC, Chang MC, Oh SH, Lee SB, Yang SY, Shin DA. Thermal Grill Illusion in Chronic Lower Back Pain: A Case-Control Study. J Pain Res 2023; 16:1573-1579. [PMID: 37220633 PMCID: PMC10200102 DOI: 10.2147/jpr.s403387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose This study aimed to use thermal grill illusion (TGI), an experimental model of pain processing and central mechanisms, to evaluate the perception of TGI-related sensations or pain in patients with chronic lower back pain (CLBP). Patients and Methods The perception of TGI (warmth/heat, cold, unpleasantness, pain, burning, stinging, and prickling) was examined in 66 patients with CLBP and compared with that in 22 healthy participants. The visual analog scale (VAS) scores for CLBP, Oswestry Disability Index (ODI), and 12-Item Short Form Survey (SF-12) scores were obtained from the included patients with CLBP. Results The CLBP group showed a less intense perception of TGI for sensations of warmth/heat, unpleasantness, and pain than the control group. The CLBP group felt burning sensations lesser than the control (2.77 vs 4.55, P=0.016). In the CLBP group, there were significant correlations between the ODI and the degree of unpleasantness (r=0.381, P=0.002) and prickling sensation (r=0.263, P=0.033). There were also significant correlations between the mental component score of the SF-12 and the degree of warmth/heat (r=-0.246, P=0.046), unpleasantness (r=-0.292, P=0.017), pain (r=-0.292, P=0.017), and burning sensations (r=-0.280, P=0.023). Conclusion Our results may be useful for clinicians to evaluate the effectiveness of drugs or interventions to manage centralized LBP.
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Affiliation(s)
- Hyung Cheol Kim
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Sung Han Oh
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Su Bin Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Young Yang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Flowers M, Leung A, Schiehser DM, Metzger-Smith V, Delano-Wood L, Sorg S, Kunnel A, Wong A, Vaninetti M, Golshan S, Lee R. Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions. Mol Pain 2021; 17:17448069211037881. [PMID: 34365850 PMCID: PMC8358489 DOI: 10.1177/17448069211037881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = -3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = -3.46, p < 0.001), right premotor cortex (T = -3.30, p < 0.01), left premotor cortex (T = -3.84, p < 0.001), and left parietal cortex (T = -3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.
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Affiliation(s)
- Matthew Flowers
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Albert Leung
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Valerie Metzger-Smith
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Scott Sorg
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Alphonsa Kunnel
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Angeline Wong
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Vaninetti
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Shahrokh Golshan
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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3
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Dualé C, Macian N, Giron F, Pickering G. Non-specific analgesia during a clinical trial in fibromyalgia. Eur J Clin Invest 2020; 50:e13337. [PMID: 32585738 DOI: 10.1111/eci.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND When patients suffering from fibromyalgia undergo a therapeutic trial, a non-negligible part of analgesia is not explained by the drug itself. The mechanisms of this non-specific effect need to be understood. MATERIALS AND METHODS We undertook secondary analyses of a double-blind randomized trial in fibromyalgia patients in which 100 mg/day milnacipran was not found superior to placebo. Data from 49 patients belonging to both groups were pooled. Both before treatment and one month after treatment, all patients underwent a CaNTAB® neuropsychological test (related to spatial planning, reaction time, decision-making and risk-taking, and ability to name objects), and measurements of sensation and pain thresholds to heat and cold, supraliminal heat pain threshold, punctuate mechanical pain threshold and temporal summation, mechanical allodynia to skin brushing, and response to conditioned pain modulation. We studied the baseline predictors of analgesia and the indicators of change associated to analgesia separately. A stepwise approach was used to select the factors to enter into the final ANCOVAs, in which age, body mass index, treatment group and pain at baseline were covariates. RESULTS No baseline predictor of non-specific analgesia other than pain at baseline was found to be predictive. Conversely, several neuropsychological (higher performance) or psychophysical (lower sensitivity) changes correlated with analgesia in unadjusted analyses. Multivariable analyses identified increases in warm/heat thermal thresholds and an increased ability to name objects, as factors associated with analgesia. CONCLUSIONS The changes observed concomitantly to non-specific pain analgesia might be related to mild changes in brain functioning, based on convergent literature data.
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Affiliation(s)
- Christian Dualé
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.,INSERM, Clermont-Ferrand, France
| | - Nicolas Macian
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
| | - Fatiha Giron
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
| | - Gisèle Pickering
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.,INSERM, Clermont-Ferrand, France.,Université Clermont-Auvergne, Clermont-Ferrand, France
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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: 6] [Impact Index Per Article: 1.5] [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.
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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
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5
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Posada-Quintero HF, Kong Y, Nguyen K, Tran C, Beardslee L, Chen L, Guo T, Cong X, Feng B, Chon KH. Using electrodermal activity to validate multilevel pain stimulation in healthy volunteers evoked by thermal grills. Am J Physiol Regul Integr Comp Physiol 2020; 319:R366-R375. [PMID: 32726157 DOI: 10.1152/ajpregu.00102.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have tested the feasibility of thermal grills, a harmless method to induce pain. The thermal grills consist of interlaced tubes that are set at cool or warm temperatures, creating a painful "illusion" (no tissue injury is caused) in the brain when the cool and warm stimuli are presented collectively. Advancement in objective pain assessment research is limited because the gold standard, the self-reporting pain scale, is highly subjective and only works for alert and cooperative patients. However, the main difficulty for pain studies is the potential harm caused to participants. We have recruited 23 subjects in whom we induced electric pulses and thermal grill (TG) stimulation. The TG effectively induced three different levels of pain, as evidenced by the visual analog scale (VAS) provided by the subjects after each stimulus. Furthermore, objective physiological measurements based on electrodermal activity showed a significant increase in levels as stimulation level increased. We found that VAS was highly correlated with the TG stimulation level. The TG stimulation safely elicited pain levels up to 9 out of 10. The TG stimulation allows for extending studies of pain to ranges of pain in which other stimuli are harmful.
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Affiliation(s)
| | | | | | - Cara Tran
- University of Connecticut, Storrs, Connecticut
| | - Luke Beardslee
- Emory University School of Medicine Department of Surgery, Atlanta, Georgia
| | - Longtu Chen
- University of Connecticut, Storrs, Connecticut
| | | | | | - Bin Feng
- University of Connecticut, Storrs, Connecticut
| | - Ki H Chon
- University of Connecticut, Storrs, Connecticut
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6
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Leung A. Addressing chronic persistent headaches after MTBI as a neuropathic pain state. J Headache Pain 2020; 21:77. [PMID: 32560626 PMCID: PMC7304149 DOI: 10.1186/s10194-020-01133-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
An increasing number of patients with chronic persistent post-traumatic headache (PPTH) after mild traumatic brain injury (MTBI) are being referred to headache or pain specialists as conventional treatment options for primary headache disorders have not been able to adequately alleviate their debilitating headache symptoms. Evolving clinical and mechanistic evidences support the notation that chronic persistent MTBI related headaches (MTBI-HA) carry the hallmark characteristics of neuropathic pain. Thus, in addition to conventional treatment options applicable to non-traumatic primary headache disorders, other available treatment modalities for neuropathic pain should be considered. In this comprehensive review article, the author reveals the prevalence of MTBI-HA and its clinical manifestation, discusses existing clinical and mechanistic evidence supporting the classification of chronic persistent MTBI-HA as a neuropathic pain state, and explores current available treatment options and future directions of therapeutic research related to MTBI-HA.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, Center for Pain Medicine, UCSD School of Medicine, La Jolla, USA.
- Center for Pain and Headache Research, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92126, USA.
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7
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Leung A, Yang E, Lim M, Metzger-Smith V, Theilmann R, Song D, Lin L, Tsai A, Lee R. Pain-related white matter tract abnormalities in mild traumatic brain injury patients with persistent headache. Mol Pain 2018; 14:1744806918810297. [PMID: 30324850 PMCID: PMC6311536 DOI: 10.1177/1744806918810297] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The occurrence of debilitating chronic persistent (24/7) headache after mild traumatic brain injury represents a central neuropathic pain state. Previous studies suggest that this chronic headache state can be attributed to altered supraspinal modulatory functional connectivity in both resting and evoked pain states. Abnormalities in the myelin sheaths along the supraspinal superior longitudinal fasciculus and anterior thalamic radiation are frequently associated with alteration in pain modulation related to functional connectivity deficit with the prefrontal cortex. This study assessed the correlated axonal injury-related white matter tract abnormality underlying these previously observed prefrontal functional connectivity deficits by comparing the fractional anisotropy, axial diffusivity, and radial diffusivity of brain white matter in patients with mild traumatic brain injury-related headache to healthy controls. Result Diffusion tensor imaging data from patients (N = 12, average age ± SD = 35.0 ± 8.0 years old, 10 male) with mild traumatic brain injury-headache were compared with images acquired from healthy controls. The mild traumatic brain injury cohort demonstrated two areas of significant (P < 0.01, F value >16, cluster size >50 voxels) white matter tract abnormalities closely related to pain affective and modulatory functions in (1) the left superior longitudinal fasciculus which connects the prefrontal cortices with the parietal cortices and (2) the right anterior thalamic radiation connecting the prefrontal cortices with the anterior cingulate cortex. In addition, a significant (P < 0.01) decrease in axial diffusivity and increase in radial diffusivity at the superior longitudinal fasciculus cluster were noted in the mild traumatic brain injury cohort. Conclusion The identified white matter tract abnormalities may represent a state of Wallerian degeneration which correlates with the functional connectivity deficit in pain modulation and can contribute to the development of the chronic persistent headache in the patients with mild traumatic brain injury.
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Affiliation(s)
- Albert Leung
- 1 Division of Pain Medicine, Department of Anesthesiology, The University of California, San Diego, CA, USA.,2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Eric Yang
- 3 The University of California, San Diego, CA, USA
| | - Michael Lim
- 3 The University of California, San Diego, CA, USA
| | | | - Rebecca Theilmann
- 4 Department of Radiology, The University of California, San Diego, CA, USA
| | - David Song
- 2 Veteran Affairs San Diego Healthcare System, CA, USA.,5 Department of Neuroscience, The University of California, San Diego, CA, USA
| | - Lisa Lin
- 2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Alice Tsai
- 2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Roland Lee
- 2 Veteran Affairs San Diego Healthcare System, CA, USA.,4 Department of Radiology, The University of California, San Diego, CA, USA
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8
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Leung A, Metzger-Smith V, He Y, Cordero J, Ehlert B, Song D, Lin L, Shahrokh G, Tsai A, Vaninetti M, Rutledge T, Polston G, Sheu R, Lee R. Left Dorsolateral Prefrontal Cortex rTMS in Alleviating MTBI Related Headaches and Depressive Symptoms. Neuromodulation 2017; 21:390-401. [DOI: 10.1111/ner.12615] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Albert Leung
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Yifan He
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - James Cordero
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Brandon Ehlert
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - David Song
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Neuroscience; The University of California; San Diego, La Jolla, CA, USA
| | - Lisa Lin
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Alice Tsai
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Michael Vaninetti
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Thomas Rutledge
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Psychiatric; The University of California; San Diego, La Jolla, CA, USA
| | - Greg Polston
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Robert Sheu
- Naval Medical Center San Diego; San Diego, CA, USA
| | - Roland Lee
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Radiology; The University of California; San Diego, La Jolla, CA, USA
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9
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Jutzeler CR, Warner FM, Wanek J, Curt A, Kramer JLK. Thermal grill conditioning: Effect on contact heat evoked potentials. Sci Rep 2017; 7:40007. [PMID: 28079118 PMCID: PMC5228159 DOI: 10.1038/srep40007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/30/2016] [Indexed: 12/19/2022] Open
Abstract
The ‘thermal grill illusion’ (TGI) is a unique cutaneous sensation of unpleasantness, induced through the application of interlacing warm and cool stimuli. While previous studies have investigated optimal parameters and subject characteristics to evoke the illusion, our aim was to examine the modulating effect as a conditioning stimulus. A total of 28 healthy control individuals underwent three testing sessions on separate days. Briefly, 15 contact heat stimuli were delivered to the right hand dorsum, while the left palmar side of the hand was being conditioned with either neutral (32 °C), cool (20 °C), warm (40 °C), or TGI (20/40 °C). Rating of perception (numeric rating scale: 0–10) and evoked potentials (i.e., N1 and N2P2 potentials) to noxious contact heat stimuli were assessed. While cool and warm conditioning decreased cortical responses to noxious heat, TGI conditioning increased evoked potential amplitude (N1 and N2P2). In line with other modalities of unpleasant conditioning (e.g., sound, visual, and olfactory stimulation), cortical and possibly sub-cortical modulation may underlie the facilitation of contact heat evoked potentials.
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Affiliation(s)
- Catherine R Jutzeler
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,ICORD, University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Freda M Warner
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,ICORD, University of British Columbia, Vancouver, BC, Canada
| | - Johann Wanek
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - John L K Kramer
- ICORD, University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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10
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Boettger MK, Ditze G, Bär KJ, Krüdewagen EM, Schaible HG. Humans, but not animals, perceive the thermal grill illusion as painful. Behav Brain Res 2016; 313:172-176. [DOI: 10.1016/j.bbr.2016.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/01/2023]
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11
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Leung A, Shukla S, Yang E, Canlas B, Kadokana M, Heald J, Davani A, Song D, Lin L, Polston G, Tsai A, Lee R. Diminished supraspinal pain modulation in patients with mild traumatic brain injury. Mol Pain 2016; 12:12/0/1744806916662661. [PMID: 27531671 PMCID: PMC4989585 DOI: 10.1177/1744806916662661] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/12/2016] [Indexed: 12/13/2022] Open
Abstract
Background Chronic pain conditions are highly prevalent in patients with mild traumatic brain injury. Supraspinal diffuse axonal injury is known to dissociate brain functional connectivity in these patients. The effect of this dissociated state on supraspinal pain network is largely unknown. A functional magnetic resonance imaging study was conducted to compare the supraspinal pain network in patients with mild traumatic brain injury to the gender and age-matched healthy controls with the hypothesis that the functional connectivities of the medial prefrontal cortices, a supraspinal pain modulatory region to other pain-related sensory discriminatory and affective regions in the mild traumatic brain injury subjects are significantly reduced in comparison to healthy controls. Results The mild traumatic brain injury group (N = 15) demonstrated significantly (P < 0.01, cluster threshold > 150 voxels) less activities in the thalamus, pons, anterior cingulate cortex, insula, dorsolateral prefrontal cortex, and medial prefrontal cortices than the healthy control group (N = 15). Granger Causality Analyses (GCA) indicated while the left medial prefrontal cortices of the healthy control group cast a noticeable degree of outward (to affect) causality inference to multiple pain processing related regions, this outward inference pattern was not observed in the mild traumatic brain injury group. On the other hand, only patients’ bilateral anterior cingulate cortex received multiple inward (to be affected) causality inferences from regions including the primary and secondary somatosensory cortices and the inferior parietal lobe. Resting state functional connectivity analyses indicated that the medial prefrontal cortices of the mild traumatic brain injury group demonstrated a significantly (P < 0.01, F = 3.6, cluster size > 150 voxels) higher degree of functional connectivity to the inferior parietal lobe, premotor and secondary somatosensory cortex than the controls. Conversely, the anterior cingulate cortex of the healthy group demonstrated significantly (P < 0.01, F = 3.84, cluster size > 150 voxels) less degree of functional connectivities to the inferior parietal lobe and secondary somatosensory cortex than their mild traumatic brain injury counterparts. Conclusions In short, the current study demonstrates that patients with mild traumatic brain injury and headaches appear to have an altered state of supraspinal modulatory and affective functions related to pain perception.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Shivshil Shukla
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Eric Yang
- The University of California, San Diego, USA
| | | | | | - Jason Heald
- Drexel University, College of Medicine, Philadelphia, PA, USA
| | - Ariea Davani
- St. Louis School of Medicine, St. Louis, MO, USA
| | - David Song
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA Department of Neuroscience, The University of California, San Diego, CA, USA
| | - Lisa Lin
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Greg Polston
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Alice Tsai
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA Department of Radiology, The University of California, San Diego, CA, USA
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12
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Abstract
Supplemental Digital Content is Available in the Text. The thermal grill illusion is reduced in borderline personality disorder. This suggests that the deficits in pain perception in this group are of central origin. It is well documented that borderline personality disorder (BPD) is characterized by reduced pain sensitivity, which might be related to nonsuicidal self-injury and dissociative experiences in patients with BPD. However, it remains an open question whether this insensitivity relies at least partly on altered sensory integration or on an altered evaluation of pain or a combination of both. In this study, we used the thermal grill illusion (TGI), describing a painful sensation induced by the application of alternating cold and warm nonnoxious stimuli, in patients with either current or remitted BPD as well as matched healthy controls. Two additional conditions, applying warm or cold temperatures only, served as control. We further assessed thermal perception, discrimination, and pain thresholds. We found significantly reduced heat and cold pain thresholds for the current BPD group, as well as reduced cold pain thresholds for the remitted BPD group, as compared with the HC group. Current BPD patients perceived a less-intense TGI in terms of induced pain and unpleasantness, while their general ability to perceive this kind of illusion seemed to be unaffected. Thermal grill illusion magnitude was negatively correlated with dissociation and traumatization only in the current BPD patients. These results indicate that higher-order pain perception is altered in current BPD, which seems to normalize after remission. We discuss these findings against the background of neurophysiological evidence for the TGI in general and reduced pain sensitivity in BPD and suggest a relationship to alterations in N-methyl-D-aspartate neurotransmission.
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Scheuren R, Duschek S, Schulz A, Sütterlin S, Anton F. Blood pressure and the perception of illusive pain. Psychophysiology 2016; 53:1282-91. [DOI: 10.1111/psyp.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Raymonde Scheuren
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Duschek
- Institute of Psychology, UMIT-University for Health Sciences, Medical Informatics and Technology; Hall in Tirol Austria
| | - André Schulz
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College; Lillehammer Norway
- Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience; Oslo University Hospital-Rikshospitalet; Oslo Norway
| | - Fernand Anton
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
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Schaldemose EL, Horjales-Araujo E, Demontis D, Børglum AD, Svensson P, Finnerup NB. No association of polymorphisms in the serotonin transporter gene with thermal pain sensation in healthy individuals. Mol Pain 2014; 10:76. [PMID: 25472558 PMCID: PMC4364075 DOI: 10.1186/1744-8069-10-76] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022] Open
Abstract
Background Recent studies have suggested an association between genotypes affecting the expression of the serotonin transporter and thermal pain perception and the thermal grill. The aim of this study was to investigate differences in thermal and mechanical pain perception and the thermal grill in two groups of healthy volunteers according to their genotype, associated with either high (n = 40) or low (n = 40) expression of the serotonin transporter and according to gender. Cold and warm detection and pain thresholds, pressure pain threshold and cold, warm and pain sensations to single or alternating stimuli with cold (20°C) and warm (40°C) temperatures (known as the thermal grill) were determined. In addition, intensity of ongoing pain and area and intensity of pinprick hyperalgesia in the secondary hyperalgesic area following topical application of capsaicin and vehicle control (ethanol) were determined. Results No significant differences in detection and pain thresholds for cold and warm temperatures, presence of paradoxical heat sensation, pressure pain threshold and pain responses to suprathreshold thermal stimuli were observed. There was also no difference in capsaicin-evoked ongoing pain and secondary hyperalgesia between the two genotype groups (p >0.4), also when subdivided by gender (p >0.17). In addition, there were no significant differences in the perception of the thermal grill between the two genotypes (p >0.5), also when subdivided by gender. Conclusions Genotypes associated with high or low expression of the serotonin transporter were not associated with thermal pain thresholds, pressure pain threshold, pain after capsaicin application or responses to the thermal grill. The present results do not support that the investigated genotypes play a major role in thermal pain perception among healthy individuals.
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Affiliation(s)
- Ellen Lund Schaldemose
- Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark.
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Relationships between the paradoxical painful and nonpainful sensations induced by a thermal grill. Pain 2014; 155:2612-2617. [DOI: 10.1016/j.pain.2014.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/13/2014] [Accepted: 09/22/2014] [Indexed: 12/29/2022]
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