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Spinoni M, Porpora MG, Muzii L, Grano C. Pain Severity and Depressive Symptoms in Endometriosis Patients: Mediation of Negative Body Awareness and Interoceptive Self-Regulation. THE JOURNAL OF PAIN 2024; 25:104640. [PMID: 39032583 DOI: 10.1016/j.jpain.2024.104640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Endometriosis-related pain may be associated with depressive symptoms. Although a growing body of evidence supports this association, the underlying mechanisms are still largely unclear. Impaired perceptions of bodily external and internal stimuli may be involved in this process. This study aims to assess the mediating role of 2 facets of interoception-the awareness of negative body signals and interoceptive self-regulation-in the association between pain severity and depressive symptoms among women with endometriosis. A total of 301 patients who reported a diagnosis of endometriosis were recruited from an endometriosis and chronic pelvic pain outpatient university clinic and through patient associations and completed self-reported instruments. A parallel mediation analysis was conducted. Almost half of women (48.2%) reported depressive symptoms above the self-rating scale cutoff values. Pain severity significantly predicted depressive symptoms (β = .39, 95% bootstrap confidence interval [CI] [.719, 1.333]). Negative body awareness (β = .121, 95% bootstrap CI [.174, .468]) and interoceptive self-regulation (β = .05, 95% bootstrap CI [.035, .252]) partially mediated this relationship. Our findings indicated that pain may interfere with the perception of the body as a source of calmness and safety, limiting the individual's ability to effectively regulate emotions. Future research should further explore these mechanisms and evaluate the efficacy of interventions focusing on interoceptive sensibility to enhance the psychological well-being of endometriosis patients. PERSPECTIVE: This article investigates for the first time the potential role of 2 facets of interoceptive sensibility in the relationship between pain severity and depressive symptoms in women with endometriosis. These findings may contribute to advancing knowledge about the mechanisms involved in the complex pain-depression cycle.
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Affiliation(s)
- Marta Spinoni
- Department of Psychology, Sapienza University, Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Grano
- Department of Psychology, Sapienza University, Rome, Italy.
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Erlenwein J, Kästner A, Gram M, Falla D, Drewes AM, Przemeck M, Petzke F. Pain chronification impacts whole-brain functional connectivity in women with hip osteoarthritis during pain stimulation. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1073-1085. [PMID: 37158606 DOI: 10.1093/pm/pnad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Previous neuroimaging studies have shown that patients with chronic pain display altered functional connectivity across distributed brain areas involved in the processing of nociceptive stimuli. The aim of the present study was to investigate how pain chronification modulates whole-brain functional connectivity during evoked clinical and tonic pain. METHODS Patients with osteoarthritis of the hip (n = 87) were classified into 3 stages of pain chronification (Grades I-III, Mainz Pain Staging System). Electroencephalograms were recorded during 3 conditions: baseline, evoked clinical hip pain, and tonic cold pain (cold pressor test). The effects of both factors (recording condition and pain chronification stage) on the phase-lag index, as a measure of neuronal connectivity, were examined for different frequency bands. RESULTS In women, we found increasing functional connectivity in the low-frequency range (delta, 0.5-4 Hz) across pain chronification stages during evoked clinical hip pain and tonic cold pain stimulation. In men, elevated functional connectivity in the delta frequency range was observed in only the tonic cold pain condition. CONCLUSIONS Across pain chronification stages, we found that widespread cortical networks increase their synchronization of delta oscillations in response to clinical and experimental nociceptive stimuli. In view of previous studies relating delta oscillations to salience detection and other basic motivational processes, our results hint at these mechanisms playing an important role in pain chronification, mainly in women.
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Affiliation(s)
- Joachim Erlenwein
- Department of Anesthesiology, Pain Clinic, University Medical Centre, Georg-August-University of Goettingen, 37075 Goettingen, Germany
| | - Anne Kästner
- Department of Anesthesiology, Pain Clinic, University Medical Centre, Georg-August-University of Goettingen, 37075 Goettingen, Germany
| | - Mikkel Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Clinical Institute, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Michael Przemeck
- Department of Anesthesiology and Intensive Care, Annastift, 30625 Hannover, Germany
| | - Frank Petzke
- Department of Anesthesiology, Pain Clinic, University Medical Centre, Georg-August-University of Goettingen, 37075 Goettingen, Germany
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Gao F, Li JJ, Liu JY, Li YJ, Cong XY, Talifu Z, Zhang X. Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity: an observational case-control study. Neural Regen Res 2023; 18:582-586. [DOI: 10.4103/1673-5374.350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Othman E, Werner P, Saxen F, Fiedler MA, Al-Hamadi A. An Automatic System for Continuous Pain Intensity Monitoring Based on Analyzing Data from Uni-, Bi-, and Multi-Modality. SENSORS (BASEL, SWITZERLAND) 2022; 22:4992. [PMID: 35808487 PMCID: PMC9269799 DOI: 10.3390/s22134992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023]
Abstract
Pain is a reliable indicator of health issues; it affects patients' quality of life when not well managed. The current methods in the clinical application undergo biases and errors; moreover, such methods do not facilitate continuous pain monitoring. For this purpose, the recent methodologies in automatic pain assessment were introduced, which demonstrated the possibility for objectively and robustly measuring and monitoring pain when using behavioral cues and physiological signals. This paper focuses on introducing a reliable automatic system for continuous monitoring of pain intensity by analyzing behavioral cues, such as facial expressions and audio, and physiological signals, such as electrocardiogram (ECG), electromyogram (EMG), and electrodermal activity (EDA) from the X-ITE Pain Dataset. Several experiments were conducted with 11 datasets regarding classification and regression; these datasets were obtained from the database to reduce the impact of the imbalanced database problem. With each single modality (Uni-modality) experiment, we used a Random Forest [RF] baseline method, a Long Short-Term Memory (LSTM) method, and a LSTM using a sample weighting method (called LSTM-SW). Further, LSTM and LSTM-SW were used with fused modalities (two modalities = Bi-modality and all modalities = Multi-modality) experiments. Sample weighting was used to downweight misclassified samples during training to improve the performance. The experiments' results confirmed that regression is better than classification with imbalanced datasets, EDA is the best single modality, and fused modalities improved the performance significantly over the single modality in 10 out of 11 datasets.
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Affiliation(s)
- Ehsan Othman
- Department of Neuro-Information Technology, Institute for Information Technology and Communications, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany; (P.W.); (F.S.); (M.-A.F.); (A.A.-H.)
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Kim D, Chae Y, Park HJ, Lee IS. Effects of Chronic Pain Treatment on Altered Functional and Metabolic Activities in the Brain: A Systematic Review and Meta-Analysis of Functional Neuroimaging Studies. Front Neurosci 2021; 15:684926. [PMID: 34290582 PMCID: PMC8287208 DOI: 10.3389/fnins.2021.684926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
Previous studies have identified altered brain changes in chronic pain patients, however, it remains unclear whether these changes are reversible. We summarized the neural and molecular changes in patients with chronic pain and employed a meta-analysis approach to quantify the changes. We included 75 studies and 11 of these 75 studies were included in the activation likelihood estimation (ALE) analysis. In the 62 functional magnetic resonance imaging (fMRI) studies, the primary somatosensory and motor cortex (SI and MI), thalamus, insula, and anterior cingulate cortex (ACC) showed significantly decreased activity after the treatments compared to baseline. In the 13 positron emission tomography (PET) studies, the SI, MI, thalamus, and insula showed significantly increased glucose uptake, blood flow, and opioid-receptor binding potentials after the treatments compared to baseline. A meta-analysis of fMRI studies in patients with chronic pain, during pain-related tasks, showed a significant deactivation likelihood cluster in the left medial posterior thalamus. Further studies are warranted to understand brain reorganization in patients with chronic pain compared to the normal state, in terms of its relationship with symptom reduction and baseline conditions.
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Affiliation(s)
- Dongwon Kim
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - In-Seon Lee
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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Hama A, Yano M, Sotogawa W, Fujii R, Awaga Y, Natsume T, Hayashi I, Takamatsu H. Pharmacological modulation of brain activation to non-noxious stimulation in a cynomolgus macaque model of peripheral nerve injury. Mol Pain 2021; 17:17448069211008697. [PMID: 33853400 PMCID: PMC8053757 DOI: 10.1177/17448069211008697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In vivo neuroimaging could be utilized as a noninvasive tool for elaborating the CNS mechanism of chronic pain and for elaborating mechanisms of potential analgesic therapeutics. A model of unilateral peripheral neuropathy was developed in the cynomolgus macaque, a species that is phylogenetically close to humans. Nerve entrapment was induced by placing a 4 mm length of polyvinyl cuff around the left common sciatic nerve. Prior to nerve injury, stimulation of the foot with a range of non-noxious von Frey filaments (1, 4, 8, 15, and 26 g) did not evoke brain activation as observed with functional magnetic resonance imaging (fMRI). Two weeks after injury, stimulation of the ipsilateral foot with non-noxious filaments activated the contralateral insula/secondary somatosensory cortex (Ins/SII) and anterior cingulate cortex (ACC). By contrast, no activation was observed with stimulation of the contralateral foot. Robust bilateral activation of thalamus was observed three to five weeks after nerve injury. Treatment with the clinical analgesic pregabalin reduced evoked activation of Ins/SII, thalamus and ACC whereas treatment with the NK1 receptor antagonist aprepitant reduced activation of the ipsilateral (left) thalamus. Twelve to 13 weeks after nerve injury, treatment with pregabalin reduced evoked activation of all regions of interest (ROI). By contrast, brain activation persisted in most ROI, except the ACC, following aprepitant treatment. Activation of the contralateral Ins/SII and bilateral thalamus was observed six months after nerve injury and pregabalin treatment suppressed activation of these nuclei. The current findings demonstrated persistent changes in CNS neurons following nerve injury as suggested by activation with non-painful mechanical stimulation. Furthermore, it was possible to functionally distinguish between a clinically efficacious analgesic drug, pregabalin, from a drug that has not demonstrated significant clinical analgesic efficacy, aprepitant. In vivo neuroimaging in the current nonhuman model could enhance translatability.
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Affiliation(s)
- Aldric Hama
- Hamamatsu Pharma Research Inc., Hamamatsu, Japan
| | - Mizuho Yano
- Hamamatsu Pharma Research Inc., Hamamatsu, Japan
| | | | | | - Yuji Awaga
- Hamamatsu Pharma Research Inc., Hamamatsu, Japan
| | | | - Ikuo Hayashi
- Hamamatsu Pharma Research USA, Inc., San Diego, CA, USA
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Distinct neural networks subserve placebo analgesia and nocebo hyperalgesia. Neuroimage 2021; 231:117833. [PMID: 33549749 DOI: 10.1016/j.neuroimage.2021.117833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 12/19/2022] Open
Abstract
Neural networks involved in placebo analgesia and nocebo hyperalgesia processes have been widely investigated with neuroimaging methods. However, few studies have directly compared these two processes and it remains unclear whether common or distinct neural circuits are involved. To address this issue, we implemented a coordinate-based meta-analysis and compared neural representations of placebo analgesia (30 studies; 205 foci; 677 subjects) and nocebo hyperalgesia (22 studies; 301 foci; 401 subjects). Contrast analyses confirmed placebo-specific concordance in the right ventral striatum, and nocebo-specific concordance in the dorsal anterior cingulate cortex (dACC), left posterior insula and left parietal operculum during combined pain anticipation and administration stages. Importantly, no overlapping regions were found for these two processes in conjunction analyses, even when the threshold was low. Meta-analytic connectivity modeling (MACM) and resting-state functional connectivity (RSFC) analyses on key regions further confirmed the distinct brain networks underlying placebo analgesia and nocebo hyperalgesia. Together, these findings indicate that the placebo analgesia and nocebo hyperalgesia processes involve distinct neural circuits, which supports the view that the two phenomena may operate via different neuropsychological processes.
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Xu A, Larsen B, Henn A, Baller EB, Scott JC, Sharma V, Adebimpe A, Basbaum AI, Corder G, Dworkin RH, Edwards RR, Woolf CJ, Eickhoff SB, Eickhoff CR, Satterthwaite TD. Brain Responses to Noxious Stimuli in Patients With Chronic Pain: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2032236. [PMID: 33399857 PMCID: PMC7786252 DOI: 10.1001/jamanetworkopen.2020.32236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Functional neuroimaging is a valuable tool for understanding how patients with chronic pain respond to painful stimuli. However, past studies have reported heterogenous results, highlighting opportunities for a quantitative meta-analysis to integrate existing data and delineate consistent associations across studies. OBJECTIVE To identify differential brain responses to noxious stimuli in patients with chronic pain using functional magnetic resonance imaging (fMRI) while adhering to current best practices for neuroimaging meta-analyses. DATA SOURCES All fMRI experiments published from January 1, 1990, to May 28, 2019, were identified in a literature search of PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, PsycINFO, and SCOPUS. STUDY SELECTION Experiments comparing brain responses to noxious stimuli in fMRI between patients and controls were selected if they reported whole-brain results, included at least 10 patients and 10 healthy control participants, and used adequate statistical thresholding (voxel-height P < .001 or cluster-corrected P < .05). Two independent reviewers evaluated titles and abstracts returned by the search. In total, 3682 abstracts were screened, and 1129 full-text articles were evaluated. DATA EXTRACTION AND SYNTHESIS Thirty-seven experiments from 29 articles met inclusion criteria for meta-analysis. Coordinates reporting significant activation differences between patients with chronic pain and healthy controls were extracted. These data were meta-analyzed using activation likelihood estimation. Data were analyzed from December 2019 to February 2020. MAIN OUTCOMES AND MEASURES A whole-brain meta-analysis evaluated whether reported differences in brain activation in response to noxious stimuli between patients and healthy controls were spatially convergent. Follow-up analyses examined the directionality of any differences. Finally, an exploratory (nonpreregistered) region-of-interest analysis examined differences within the pain network. RESULTS The 37 experiments from 29 unique articles included a total of 511 patients and 433 controls (944 participants). Whole-brain meta-analyses did not reveal significant differences between patients and controls in brain responses to noxious stimuli at the preregistered statistical threshold. However, exploratory analyses restricted to the pain network revealed aberrant activity in patients. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, preregistered, whole-brain analyses did not reveal aberrant fMRI activity in patients with chronic pain. Exploratory analyses suggested that subtle, spatially diffuse differences may exist within the pain network. Future work on chronic pain biomarkers may benefit from focus on this core set of pain-responsive areas.
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Affiliation(s)
- Anna Xu
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Alina Henn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen University, Aachen, Germany
| | - Erica B. Baller
- Department of Psychiatry, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard University, Boston, Massachusetts
| | - J. Cobb Scott
- Department of Psychiatry, University of Pennsylvania, Philadelphia
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA (Veterans Affairs) Medical Center, Philadelphia, Pennsylvania
| | - Vaishnavi Sharma
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Azeez Adebimpe
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | | | - Gregory Corder
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts
| | - Simon B. Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour Sections, Research Centre Jülich, Jülich, Germany
| | - Claudia R. Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour Sections, Research Centre Jülich, Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Peng KP, May A. Targeting migraine treatment with neuroimaging-Pharmacological neuroimaging in headaches. PROGRESS IN BRAIN RESEARCH 2020; 255:327-342. [PMID: 33008512 DOI: 10.1016/bs.pbr.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The current review provides a recapitulation of recent advances in pharmacological neuroimaging in headache, a promising tool to understanding of how a drug works in the brain and how it may lead to new insights of disease mechanisms of headache. RESULTS Pharmacological positron emission tomography with radioligand-labeled medication may provide evidence whether and where a medication binds in the brain but is still mostly restricted to animal work. Pharmacological functional MRI using task-specific approaches identified central modulation patterns as a consequence of attack and preventative headache medication, which may be distinct to a specific drug mechanism. Pharmacological neuroimaging and specifically in combination with functional imaging is a promising tool to better understand not only certain medications but also certain disease mechanisms. SUMMARY Pharmacological imaging techniques have advanced over the last few years and showed great potential of providing new insights into drug pharmacodynamics and disease mechanism. There are still limitations and challenges to be overcome.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Salduker S, Allers E, Bechan S, Hodgson RE, Meyer F, Meyer H, Smuts J, Vuong E, Webb D. Practical approach to a patient with chronic pain of uncertain etiology in primary care. J Pain Res 2019; 12:2651-2662. [PMID: 31564957 PMCID: PMC6731975 DOI: 10.2147/jpr.s205570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic pain of uncertain etiology often presents a challenge to both patients and their health care providers. It is a complex condition influenced by structural and physiological changes in the peripheral and central nervous systems, and it directly influences, and is modulated by, psychological well-being and personality style, mood, sleep, activity level and social circumstances. Consequently, in order to effectively treat the pain, all of these need to be evaluated and addressed. An effective management strategy takes a multidisciplinary biopsychosocial approach, with review of all current medications and identification and careful withdrawal of those that may actually be contributing to ongoing pain. The management approach is primarily nonpharmacological, with carefully considered addition of medication, beginning with pain-modulating treatments, if necessary. In this article, we present a primary care approach to the assessment and management of a patient with chronic pain where the cause cannot be identified.
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Affiliation(s)
| | - Eugene Allers
- Glynview Multiprofessional Practice, Gauteng, South Africa
| | - Sudha Bechan
- Department of Anaesthesiology, Head Clinical Unit, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa
| | - R Eric Hodgson
- Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Fanie Meyer
- Optima Psychiatric Hospital, Bloemfontein, South Africa
| | - Helgard Meyer
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa.,Wilgers MR & Medical Centre, Pretoria, South Africa
| | - Johan Smuts
- Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Eileen Vuong
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - David Webb
- Houghton House Group, Gauteng, South Africa
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Mouraux A, Iannetti GD. The search for pain biomarkers in the human brain. Brain 2019; 141:3290-3307. [PMID: 30462175 PMCID: PMC6262221 DOI: 10.1093/brain/awy281] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 01/22/2023] Open
Abstract
Non-invasive functional brain imaging is used more than ever to investigate pain in health and disease, with the prospect of finding new means to alleviate pain and improve patient wellbeing. The observation that several brain areas are activated by transient painful stimuli, and that the magnitude of this activity is often graded with pain intensity, has prompted researchers to extract features of brain activity that could serve as biomarkers to measure pain objectively. However, most of the brain responses observed when pain is present can also be observed when pain is absent. For example, similar brain responses can be elicited by salient but non-painful auditory, tactile and visual stimuli, and such responses can even be recorded in patients with congenital analgesia. Thus, as argued in this review, there is still disagreement on the degree to which current measures of brain activity exactly relate to pain. Furthermore, whether more recent analysis techniques can be used to identify distributed patterns of brain activity specific for pain can be only warranted using carefully designed control conditions. On a more general level, the clinical utility of current pain biomarkers derived from human functional neuroimaging appears to be overstated, and evidence for their efficacy in real-life clinical conditions is scarce. Rather than searching for biomarkers of pain perception, several researchers are developing biomarkers to achieve mechanism-based stratification of pain conditions, predict response to medication and offer personalized treatments. Initial results with promising clinical perspectives need to be further tested for replicability and generalizability.
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Affiliation(s)
- André Mouraux
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Gian Domenico Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.,Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome, Italy
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Shidahara Y, Natsume T, Awaga Y, Ogawa S, Yamoto K, Okamoto S, Hama A, Hayashi I, Takamatsu H, Magata Y. Distinguishing analgesic drugs from non-analgesic drugs based on brain activation in macaques with oxaliplatin-induced neuropathic pain. Neuropharmacology 2019; 149:204-211. [PMID: 30817933 DOI: 10.1016/j.neuropharm.2019.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/28/2019] [Accepted: 02/24/2019] [Indexed: 11/16/2022]
Abstract
The antineoplastic agent oxaliplatin is a first-line treatment for colorectal cancer. However, neuropathic pain, characterized by hypersensitivity to cold, emerges soon after treatment. In severe instances, dose reduction or curtailing treatment may be necessary. While a number of potential treatments for oxaliplatin-induced neuropathic pain have been proposed based on preclinical findings, few have demonstrated efficacy in randomized, placebo-controlled clinical studies. This failure could be related, in part, to the use of rodents as the primary preclinical species, as there are a number of distinctions in pain-related mechanisms between rodents and humans. Also, an indicator of preclinical pharmacological efficacy less subjective than behavioral endpoints that is translatable to clinical usage is lacking. Three days after oxaliplatin treatment in Macaca fascicularis, a significantly reduced response latency to cold (10 °C) water was observed, indicating cold hypersensitivity. Cold-evoked bilateral activation of the secondary somatosensory (SII) and insular (Ins) cortex was observed with functional magnetic resonance imaging. Duloxetine alleviated cold hypersensitivity and significantly attenuated activation in both SII and Ins. By contrast, neither clinically used analgesics pregabalin nor tramadol affected cold hypersensitivity and cold-evoked activation of SII and Ins. The current findings suggest that suppressing SII and Ins activation leads to antinociception, and, therefore, could be used as a non-behavioral indicator of analgesic efficacy in patients with oxaliplatin-induced neuropathic pain.
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Affiliation(s)
- Yuka Shidahara
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Takahiro Natsume
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Yūji Awaga
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Shin'ya Ogawa
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Kurumi Yamoto
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Shinichi Okamoto
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan
| | - Aldric Hama
- Hamamatsu Pharma Research, Inc., Hamamatsu, Shizuoka Prefecture, Japan.
| | - Ikuo Hayashi
- Hamamatsu Pharma Research, USA, Inc., San Diego, CA, USA
| | | | - Yasuhiro Magata
- Department of Molecular Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
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Leggio M, Olivito G. Topography of the cerebellum in relation to social brain regions and emotions. HANDBOOK OF CLINICAL NEUROLOGY 2018; 154:71-84. [PMID: 29903453 DOI: 10.1016/b978-0-444-63956-1.00005-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the last few decades, an increasing number of studies have focused on better characterizing the cerebellar functions beyond motor control, including emotional and social domains. Anatomic and functional evidence strongly contributes to delineating the cerebellar functional subdivisions and their integration with cerebral functional networks strictly related to emotional regulation and social functioning, thus suggesting a model of cerebellar organization that resembles that of the cerebral cortex. Overcoming the traditional segregation of cerebrocerebellar networks in sensorimotor/cognitive functional modules, during emotional/social processes, the cerebellar activity reflects a domain-specific mentalizing functionality that is strongly connected with corresponding mentalizing networks in the cerebrum. Additionally, the cerebrocerebellar organization has been shown to have a specific functional and maturational trajectory that is only in part dependent on a structural maturational process and that is protracted from an early stage of life through adolescence and adulthood, when the mature control networks involve both segregation and integration of the brain regions that comprise them. Altogether, these findings underscore the importance of regional functional differences within the cerebellum in relation to emotional and social processing and raise questions about the clinical implication of cerebellar injury on emotional/social behaviors, both in the developing and the adult brain.
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Affiliation(s)
- Maria Leggio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.
| | - Giusy Olivito
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
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Negron A. Supporting asylum seekers and refugees who suffer chronic pain: an experience. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2017. [DOI: 10.1108/ijmhsc-02-2016-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Refugees and asylum seekers often present complex health needs, including chronic pain, related to traumatic experiences. To help them manage their pain, the Wellbeing and Self-Care Service provides health advice, pain education, soft tissue manual therapies and training in self-help techniques. The paper aims to discuss these issues.
Design/methodology/approach
A 0-10 pain scale (0= no pain, 10= very severe pain) is used to record reported intensity of pain before and after treatment. Change is analysed by comparing the position of a tick on the scale before and after therapy. In follow-up appointments, attendees were asked whether they were practicing self-help techniques; if they experienced improvement, and if so, how long it lasted; and whether they had reduced the use of painkillers.
Findings
From April 2014 to March 2015, 192 people were seen in 524 therapeutic encounters (63 per cent females, 37 per cent males). In total, 173 (90 per cent) were asylum seekers and refugees. Of the refugees and asylum seekers, 40 per cent were torture survivors. After treatment, 53 per cent of the 192 people treated showed a major reduction of pain, and 39 per cent a moderate reduction. In follow-up encounters, 87 per cent reported improvement (⩾2 weeks, 46 per cent), 70 per cent reported a reduction in the use of painkillers and 83 per cent reported that they practiced self-help techniques to different degrees.
Originality/value
Soft tissue manual therapies combined with education and training that emphasise communication and active patient participation in the healing process are non-invasive therapeutic approaches that can confer temporary relief to refugees and asylum seekers suffering chronic pain.
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Wada A, Shizukuishi T, Kikuta J, Yamada H, Watanabe Y, Imamura Y, Shinozaki T, Dezawa K, Haradome H, Abe O. Altered structural connectivity of pain-related brain network in burning mouth syndrome—investigation by graph analysis of probabilistic tractography. Neuroradiology 2017; 59:525-532. [DOI: 10.1007/s00234-017-1830-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/22/2017] [Indexed: 12/16/2022]
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Misra G, Wang WE, Archer DB, Roy A, Coombes SA. Automated classification of pain perception using high-density electroencephalography data. J Neurophysiol 2016; 117:786-795. [PMID: 27903639 DOI: 10.1152/jn.00650.2016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022] Open
Abstract
The translation of brief, millisecond-long pain-eliciting stimuli to the subjective perception of pain is associated with changes in theta, alpha, beta, and gamma oscillations over sensorimotor cortex. However, when a pain-eliciting stimulus continues for minutes, regions beyond the sensorimotor cortex, such as the prefrontal cortex, are also engaged. Abnormalities in prefrontal cortex have been associated with chronic pain states, but conventional, millisecond-long EEG paradigms do not engage prefrontal regions. In the current study, we collected high-density EEG data during an experimental paradigm in which subjects experienced a 4-s, low- or high-intensity pain-eliciting stimulus. EEG data were analyzed using independent component analyses, EEG source localization analyses, and measure projection analyses. We report three novel findings. First, an increase in pain perception was associated with an increase in gamma and theta power in a cortical region that included medial prefrontal cortex. Second, a decrease in lower beta power was associated with an increase in pain perception in a cortical region that included the contralateral sensorimotor cortex. Third, we used machine learning for automated classification of EEG data into low- and high-pain classes. Theta and gamma power in the medial prefrontal region and lower beta power in the contralateral sensorimotor region served as features for classification. We found a leave-one-out cross-validation accuracy of 89.58%. The development of biological markers for pain states continues to gain traction in the literature, and our findings provide new information that advances this body of work.NEW & NOTEWORTHY The development of a biological marker for pain continues to gain traction in literature. Our findings show that high- and low-pain perception in human subjects can be classified with 89% accuracy using high-density EEG data from prefrontal cortex and contralateral sensorimotor cortex. Our approach represents a novel neurophysiological paradigm that advances the literature on biological markers for pain.
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Affiliation(s)
- Gaurav Misra
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Wei-En Wang
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Arnab Roy
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
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Gentile G, Frauger E, Giocanti A, Pauly V, Orleans V, Amaslidou D, Thirion X, Micallef J. Caractéristiques des sujets sous traitement de substitution vus en médecine générale d’après l’enquête nationale OPEMA 2013. Therapie 2016; 71:307-13. [DOI: 10.1016/j.therap.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
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Gilligan CJ, Borsook D. The Promise of Effective Pain Treatment Outcomes: Rallying Academic Centers to Lead the Charge. PAIN MEDICINE 2015. [PMID: 26219090 DOI: 10.1111/pme.12772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher J Gilligan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Borsook
- Department of Anesthesia, Center for Pain and the Brain, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Bourke JH, Langford RM, White PD. The common link between functional somatic syndromes may be central sensitisation. J Psychosom Res 2015; 78:228-36. [PMID: 25598410 DOI: 10.1016/j.jpsychores.2015.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/23/2014] [Accepted: 01/04/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Functional somatic syndromes are common and disabling conditions that all include chronic pain, and which may be related to central nervous system sensitisation. Here, we address the concept of central sensitisation as a physiological basis for the functional somatic syndromes. METHODS A narrative review of the current literature on central sensitisation and physiological studies in the functional somatic syndromes. RESULTS Central sensitisation may be a common neurophysiological process that is able to explain non-painful as well as painful symptoms in these disorders. Furthermore, central sensitisation may represent an endophenotypic vulnerability to the development of these syndromes that potentially explains why they cluster together. CONCLUSIONS Further research is needed to verify these findings, including prospective studies and the standardisation of combined methods of investigation in the study of central sensitisation in functional somatic syndromes. In turn, this may lead to new explanatory mechanisms and treatments being evaluated. Our conclusions add to the debate over the nomenclature of these syndromes but importantly also provide an explanation for our patients.
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Affiliation(s)
- Julius H Bourke
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK.
| | - Richard M Langford
- Pain and Anaesthesia Research Centre, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Peter D White
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK
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Cleve M, Gussew A, Reichenbach JR. In vivo detection of acute pain-induced changes of GABA+ and Glx in the human brain by using functional 1H MEGA-PRESS MR spectroscopy. Neuroimage 2014; 105:67-75. [PMID: 25462698 DOI: 10.1016/j.neuroimage.2014.10.042] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 02/01/2023] Open
Abstract
In vivo(1)H MR spectroscopic detection of pain associated metabolic changes in the human brain may allow for an objective evaluation of the perceived pain intensity and assessment of the involved neurotransmitters. Ultimately, it may lead to a deeper understanding of the mechanisms that underlie neuronal pain processing. The present study reports results of time-resolved measurements of acute heat pain induced changes of the excitatory (Glx) and inhibitory (GABA+) neurotransmitter turnover in the anterior cingulate cortex (ACC) and occipital cortex (OC) by using (1)H MEGA-PRESS spectroscopy. In ACC and OC, the ratio Glx/tCr increased by median values of 21.5% (p < 0.001) and 15.7% (p < 0.001), respectively. At the same time, GABA+/tCr decreased by median values of 15.1% (p = 0.114) in ACC and 12.7% (p < 0.001) in OC. To our knowledge, this study demonstrates for the first time the possibility of quantifying pain-induced neurotransmitter changes in the brain by using functional (1)H MEGA-PRESS. The increase of Glx/tCr may be ascribed to an elevated glutamatergic turnover, while the decrease of GABA+/tCr may reflect reduced activity of the inhibitory system in ACC and OC during pain processing.
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Affiliation(s)
- Marianne Cleve
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3 (Gebäude 5, MRT am Steiger), 07743 Jena, Germany.
| | - Alexander Gussew
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3 (Gebäude 5, MRT am Steiger), 07743 Jena, Germany.
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3 (Gebäude 5, MRT am Steiger), 07743 Jena, Germany.
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21
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Hansen TM, Olesen AE, Simonsen CW, Drewes AM, Frøkjær JB. Cingulate metabolites during pain and morphine treatment as assessed by magnetic resonance spectroscopy. J Pain Res 2014; 7:269-76. [PMID: 24899823 PMCID: PMC4038455 DOI: 10.2147/jpr.s61193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Experimental investigation of cerebral mechanisms underlying pain and analgesia are important in the development of methods for diagnosis and treatment of pain. The aim of the current study was to explore brain metabolites in response to pain and treatment with morphine. Methods Proton magnetic resonance spectroscopy of the anterior cingulate cortex was performed in 20 healthy volunteers (13 males and seven females, aged 24.9±2.6 years) during rest and acute pain before and during treatment with 30 mg of oral morphine or placebo in a randomized, double-blinded, cross-over study design. Pain was evoked by skin stimulation applied to the right upper leg using a contact heat-evoked potential stimulator. Results Data from 12 subjects were valid for analysis. Painful stimulation induced an increase in N-acetylaspartate/creatine compared with rest (F=5.5, P=0.04). During treatment with morphine, painful stimulation induced decreased glutamate/creatine (F=7.3, P=0.02), myo-inositol/creatine (F=8.38, P=0.02), and N-acetylaspartate/creatine (F=13.8, P=0.004) concentrations, whereas an increase in the pain-evoked N-acetylaspartate/creatine concentration (F=6.1, P=0.04) was seen during treatment with placebo. Conclusion This explorative study indicates that neuronal metabolites in the anterior cingulate cortex, such as N-acetylaspartate, glutamate, and myo-inositol, could be related to the physiology of pain and treatment with morphine. This experimental method has the potential to enable the study of brain metabolites involved in pain and its treatment, and may in the future be used to provide further insight into these mechanisms.
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Affiliation(s)
- Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University, Aalborg, Denmark
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark
| | | | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark ; Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Yamashita A, Hamada A, Suhara Y, Kawabe R, Yanase M, Kuzumaki N, Narita M, Matsui R, Okano H, Narita M. Astrocytic activation in the anterior cingulate cortex is critical for sleep disorder under neuropathic pain. Synapse 2014; 68:235-47. [DOI: 10.1002/syn.21733] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/09/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Akira Yamashita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Asami Hamada
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Yuki Suhara
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Rui Kawabe
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Makoto Yanase
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Naoko Kuzumaki
- Department of Physiology; Keio University School of Medicine; 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan
| | - Michiko Narita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Ryosuke Matsui
- Department of Molecular and Systems Biology; Graduate School of Biostudies, Kyoto University; Yoshida Sakyo-ku Kyoto 606-8501 Japan
| | - Hideyuki Okano
- Department of Physiology; Keio University School of Medicine; 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan
| | - Minoru Narita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
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Abstract
PURPOSE OF REVIEW The current review gives an overview about recent advances in neuroimaging studies with specific emphasis on pharmacological modulation of pain and headache. Further, we want to highlight how imaging methods have changed our understanding of chronic pain and discuss how pharmacological MRI could lead to new insights into underlying mechanisms of headache and pain. RECENT FINDINGS Several studies from different imaging laboratories have highlighted the outstanding role of imaging in getting a deeper insight regarding the central mechanisms of drugs. Neuroimaging techniques start to unravel how analgesic drugs, antidepressants or NSAIDs act on pain perception and in particular on central pain processes. Furthermore, the studies included in this review show how context dependent drugs act and how differently they reveal their action in the human brain. SUMMARY Imaging techniques give us the opportunity to gain a better understanding of drug processes in the central nervous system and help to understand where drugs reveal their therapeutic effect. While some substances work on the emotional-affective component of pain, others modulate sensory-discriminative pain pathways. Especially in the field of headache research, still a lot has to be done to understand how preventatives and acute medication modulate the human brain. Future studies should also replicate and extend recent findings.
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Cortright DN, Matson DJ, Broom DC. New frontiers in assessing pain and analgesia in laboratory animals. Expert Opin Drug Discov 2013; 3:1099-108. [PMID: 23506182 DOI: 10.1517/17460441.3.9.1099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Translating promising analgesic compounds into reliable pain therapeutics in humans is made particularly challenging by the difficulty in measuring the pain quantitatively. This problem is manifest not only in clinical settings in which patient pain assessments involve mostly subjective measures but also in preclinical settings wherein laboratory animals, most commonly rodents, are typically evaluated in stimulus-evoked response tests. OBJECTIVE Given the limitations of traditional pain tests, we sought out new approaches to measure pain, and analgesia, in laboratory animals. METHODS We reviewed the peer reviewed literature to identify pain tests that could be utilized in preclinical settings to understand the effects of new and established analgesics. RESULTS/CONCLUSIONS The tests identified include weight bearing differential, suppression of feeding, reduction in locomotor activity, gait analysis, conditioning models and functional MRI. Although the pharmacology of known and new analgesics has not been broadly established in these models, they hold the promise of better predictive utility for the discovery of pain relievers.
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Brain structural and psychometric alterations in chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1958-64. [PMID: 23392554 DOI: 10.1007/s00586-013-2692-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/25/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Chronic low back pain (CLBP) is one of the most important pain disorders with increasing social and economic implications. Given that CLBP is a multidimensional process associated with comorbidities such as anxiety and depression, treatment of chronic low back pain is still a challenge. Advancement of in vivo brain imaging technologies has revealed increasing insights into the etiology and pathogenesis of chronic pain; however, the exact mechanisms of chronification of LBP remain still unclear. The purpose of the present study was to analyse the neurostructural alterations in CLBP and to evaluate the role of comorbidities and their neurostructural underpinnings. METHODS In the present study we investigated a well-characterized group of 14 patients with CLBP and 14 healthy controls applying structural MRI and psychometric measures. Using an improved algorithm for brain normalization (DARTEL) we performed a voxel-based morphometry (VBM) approach. Correlation analyses were performed to evaluate the role of anxiety and depression in neurostructural alterations observed in CLBP. RESULTS The psychometric measures revealed significantly higher scores on depression and anxiety in the patient population. VBM analysis showed significant decreases in grey matter density in areas associated with pain processing and modulation, i.e. the dorsolateral prefrontal cortex, the thalamus and the middle cingulate cortex. With respect to anxiety and depression scores, we did not observe any correlations to the structural data. CONCLUSIONS In the present study we found compelling evidence for alterations of grey matter architecture in CLBP in brain regions playing a major role in pain modulation and control. Our results fit the hypothesis of a "brain signature" in chronic pain conditions. The results of the psychometric assessment underline the importance of an interdisciplinary therapeutic approach including orthopedic, neurological and psychological evaluation and treatment.
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Imai S, Ikegami D, Yamashita A, Shimizu T, Narita M, Niikura K, Furuya M, Kobayashi Y, Miyashita K, Okutsu D, Kato A, Nakamura A, Araki A, Omi K, Nakamura M, James Okano H, Okano H, Ando T, Takeshima H, Ushijima T, Kuzumaki N, Suzuki T, Narita M. Epigenetic transcriptional activation of monocyte chemotactic protein 3 contributes to long-lasting neuropathic pain. Brain 2013; 136:828-43. [DOI: 10.1093/brain/aws330] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Mao J. Current challenges in translational pain research. Trends Pharmacol Sci 2012; 33:568-73. [PMID: 22959652 PMCID: PMC3482290 DOI: 10.1016/j.tips.2012.08.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/08/2012] [Accepted: 08/13/2012] [Indexed: 12/31/2022]
Abstract
The current gap between basic science research and the development of new analgesics presents a serious challenge for the future of pain medicine. This challenge is particularly difficult in the search for better treatment for comorbid chronic pain conditions because: (i) animal 'pain' models do not simulate multidimensional clinical pain conditions; (ii) animal behavioral testing does not assess subjective pain experience; (iii) preclinical data provide little assurance regarding the direction of new analgesic development; and (iv) clinical trials routinely use over-sanitized study populations and fail to capture the multidisciplinary consequences of comorbid chronic pain. Therefore, a paradigm shift in translational pain research is necessary to transform the current strategy from focusing on molecular switches of nociception to studying pain as a system-based integral response that includes psychosocial comorbidities. Several key issues of translational pain research are discussed in this review.
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Affiliation(s)
- Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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28
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Foerster BR, Petrou M, Edden RAE, Sundgren PC, Schmidt-Wilcke T, Lowe SE, Harte SE, Clauw DJ, Harris RE. Reduced insular γ-aminobutyric acid in fibromyalgia. ACTA ACUST UNITED AC 2012; 64:579-83. [PMID: 21913179 DOI: 10.1002/art.33339] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent scientific findings have reinvigorated interest in examining the role of γ-aminobutyric acid (GABA), the major inhibitory central nervous system neurotransmitter, in chronic pain conditions. Decreased inhibitory neurotransmission is a proposed mechanism in the pathophysiology of chronic pain syndromes such as fibromyalgia (FM). The purpose of this study was to test the hypothesis that decreased levels of insular and anterior cingulate GABA would be present in FM patients, and that the concentration of this neurotransmitter would be correlated with pressure-pain thresholds. METHODS Sixteen FM patients and 17 age- and sex-matched healthy controls underwent pressure-pain testing and a 3T proton magnetic resonance spectroscopy session in which the right anterior insula, right posterior insula, anterior cingulate, and occipital cortex were examined in subjects at rest. RESULTS GABA levels in the right anterior insula were significantly lower in FM patients compared with healthy controls (mean ± SD 1.17 ± 0.24 arbitrary institutional units versus 1.42 ± 0.32 arbitrary institutional units; P = 0.016). There was a trend toward increased GABA levels in the anterior cingulate of FM patients compared with healthy controls (P = 0.06). No significant differences between groups were detected in the posterior insula or occipital cortex (P > 0.05 for all comparisons). Within the right posterior insula, higher levels of GABA were positively correlated with pressure-pain thresholds in the FM patients (Spearman's rho = 0.63; P = 0.02). CONCLUSION Diminished inhibitory neurotransmission resulting from lower concentrations of GABA within the right anterior insula may play a role in the pathophysiology of FM and other central pain syndromes.
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Affiliation(s)
- Bradley R Foerster
- University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, Michigan, USA.
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Engaging consumers living in remote areas of Western Australia in the self-management of back pain: a prospective cohort study. BMC Musculoskelet Disord 2012; 13:69. [PMID: 22578207 PMCID: PMC3439262 DOI: 10.1186/1471-2474-13-69] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/20/2012] [Indexed: 01/09/2023] Open
Abstract
Background In Western Australia (WA), health policy recommends encouraging the use of active self-management strategies as part of the co-care of consumers with persistent low back pain (LBP). As many areas in WA are geographically isolated and health services are limited, implementing this policy into practice is critical if health outcomes for consumers living in geographically-isolated areas are to be improved. Methods In this prospective cohort study, 51 consumers (mean (SD) age 62.3 (±15.1) years) participated in an evidence-based interdisciplinary pain education program (modified Self Training Educative Pain Sessions: mSTEPS) delivered at three geographically isolated WA sites. Self report measures included LBP beliefs and attitudes (Back Pain Beliefs Questionnaire (BBQ); Fear Avoidance Beliefs Questionnaire (FABQ)), use of active and passive self-management strategies, and health literacy, and global perceived impression of usefulness (GPIU) recorded immediately pre-intervention (n = 51), same day post-intervention (BBQ; GPIU, n = 49) and 3 months post-intervention (n = 25). Results At baseline, consumers demonstrated adequate health literacy and elements of positive health behaviours, reflected by the use of more active than passive strategies in self-managing their persistent LBP. Immediately post-intervention, there was strong evidence for improvement in consumers’ general beliefs about LBP as demonstrated by an increase in BBQ scores (baseline [mean (SD): 25.8 (7.6)] to same day post-intervention [28.8 (7.2); P < 0.005], however this improvement was not sustained at 3 months post-intervention. The majority of consumers (86.4%) reported the intervention as very useful [rated on NRS as 7–10]. Conclusions To sustain improved consumer beliefs regarding LBP and encourage the adoption of more positive health behaviours, additional reinforcement strategies for consumers living in remote areas where service access and skilled workforce are limited are recommended. This study highlights the need for aligning health services and skilled workforce to improve the delivery of co-care for consumers living in geographically isolated areas.
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Borsook D, Becerra L. How close are we in utilizing functional neuroimaging in routine clinical diagnosis of neuropathic pain? Curr Pain Headache Rep 2012; 15:223-9. [PMID: 21369853 DOI: 10.1007/s11916-011-0187-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As with many disorders affecting the central nervous system, treatment of chronic pain is fraught with difficulties related to specific diagnosis and measures of treatment efficacy. Given the recent advances that brain-imaging techniques have contributed to our understanding of how chronic pain affects multiple aspects of brain function (including sensory, emotional, cognitive, and modulatory), opportunities to use these approaches in the clinic are clearly a focus of research laboratories around the world. The routine application of brain imaging as a clinical marker of disease state or therapeutic (drug) efficacy would significantly enhance the clinical process by providing objective measures for clinicians and patients.
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Affiliation(s)
- David Borsook
- Center for Pain and the Brain, c/o Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA.
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31
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Abstract
PURPOSE OF REVIEW The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes. RECENT FINDINGS First, peripheral or central sensitization may result in increased nociceptive input to the brain and also changes the processing of nociceptive information within the brain. Second, chronic nociceptive input from the periphery or from lesions within the central nervous system may result in cortical reorganization and maladaptive neuroplasticity within somatosensory and motor systems. Thirdly, there is evidence for pain-induced changes in large-scale neuronal network connectivity. Fourth, in patients with chronic pain, structural brain changes may occur. Finally, there is discussion that in chronic pain patients the endogenous pain-modulatory system may function aberrantly. SUMMARY Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
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32
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Abstract
This article examines the present, and potential future, impact of brain imaging on chronic pain. It is argued that novel theories of chronic pain are coming to the fore, specifically through brain imaging of the human brain in chronic pain. Such studies show that the brain reorganizes in relation to chronic pain, in a pattern specific to the type of clinical pain, and that brain networks and receptor targets are being identified and reverse translated to animal studies of their efficacy and mechanisms. Future studies need to integrate across human brain imaging techniques, as well as more intensive reverse translational methods.
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Affiliation(s)
- A Vania Apkarian
- Northwestern University, Feinberg School of Medicine, Department of Physiology, 303 E Chicago Avenue, Chicago, IL 60610, USA
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33
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Jain R, Jain S, Raison CL, Maletic V. Painful diabetic neuropathy is more than pain alone: examining the role of anxiety and depression as mediators and complicators. Curr Diab Rep 2011; 11:275-84. [PMID: 21611765 DOI: 10.1007/s11892-011-0202-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A wealth of information exists regarding the plight of patients suffering with diabetic peripheral neuropathic pain (DPNP). Although physical pain is certainly a primary challenge in the management of this condition, disorders associated with emotional pain-especially depression and anxiety-also greatly complicate the clinician's efforts to attain optimal outcomes for DPNP patients. This article reviews the high rate of comorbidity between DPNP and depression/anxiety with a focus on why this pattern of comorbidity exists and what can be done about it. To accomplish this, the many physiologic similarities between neuropathic pain and depression/anxiety are reviewed as a basis for better understanding how, and why, optimal treatment strategies use behavioral and pharmacologic modalities known to improve both physical pain and symptoms of depression and anxiety. We conclude by highlighting that screening, diagnosing, and optimally treating comorbid depression/anxiety not only improves quality of life, these but also positively impacts DPNP pain.
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Affiliation(s)
- Rakesh Jain
- Department of Psychiatry, Texas Tech Health Sciences Center Medical School at Permian Basin, Midland, TX, USA.
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34
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Abstract
Chronic migraine typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment. Results of electrophysiologic and functional imaging studies indicate that chronic migraine is associated with abnormalities in the brainstem that may be progressive. Additionally, chronic migraine is associated with a greater degree of impairment in cortical processing of sensory stimuli than is episodic migraine, perhaps due to a more pervasive or persistent cortical hyperexcitability. These findings fit with the model of migraine as a spectrum disorder, in which the clinical and pathophysiological features of migraine may progress over time. This progression is postulated to result from changes in nociceptive thresholds and ensuing central sensitization caused by recurrent migraine in susceptible individuals, for whom a variety of risk factors have been described. This may lead to changes in baseline neurologic function between episodes of headache, evident not only in electrophysiologic and functional imaging studies, but also as an increase in depression, anxiety, nonhead pain, fatigue, gastrointestinal disorders, and other somatic complaints that may occur after years of episodic migraine. From the current research and migraine models, a conceptualization of chronic migraine, in which relatively permanent and pervasive central changes that warrant novel and tolerable treatments have occurred, is emerging. This model also implies that prevention of chronic migraine is an important goal in the management of episodic migraine, particularly in individuals who exhibit risk factors for chronic transformation.
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Affiliation(s)
- Sheena K Aurora
- Swedish Headache Center, Swedish Neurosciences Institute, 1221 Madison Street, Seattle, WA 98116, USA.
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35
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Takemura Y, Yamashita A, Horiuchi H, Furuya M, Yanase M, Niikura K, Imai S, Hatakeyama N, Kinoshita H, Tsukiyama Y, Senba E, Matoba M, Kuzumaki N, Yamazaki M, Suzuki T, Narita M. Effects of gabapentin on brain hyperactivity related to pain and sleep disturbance under a neuropathic pain-like state using fMRI and brain wave analysis. Synapse 2011; 65:668-76. [PMID: 21162109 DOI: 10.1002/syn.20898] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 11/28/2010] [Indexed: 11/12/2022]
Abstract
Neuropathic pain is the most difficult pain to manage in the pain clinic, and sleep problems are common among patients with chronic pain including neuropathic pain. In the present study, we tried to visualize the intensity of pain by assessing neuronal activity and investigated sleep disturbance under a neuropathic pain-like state in mice using functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG)/electromyogram (EMG), respectively. Furthermore, we investigated the effect of gabapentin (GBP) on these phenomena. In a model of neuropathic pain, sciatic nerve ligation caused a marked decrease in the latency of paw withdrawal in response to a thermal stimulus only on the ipsilateral side. Under this condition, fMRI showed that sciatic nerve ligation produced a significant increase in the blood oxygenation level-dependent (BOLD) signal intensity in the pain matrix, which was significantly decreased 2 h after the i.p. injection of GBP. Based on the results of an EEG/EMG analysis, sciatic nerve-ligated animals showed a statistically significant increase in wakefulness and a decrease in non-rapid eye movement (NREM) sleep during the light phase, and the sleep disturbance was almost completely alleviated by a higher dose of GBP in nerve-ligated mice. These findings suggest that neuropathic pain associated with sleep disturbance can be objectively assessed by fMRI and EEG/EMG analysis in animal models. Furthermore, GBP may improve the quality of sleep as well as control pain in patients with neuropathic pain.
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Affiliation(s)
- Yoshinori Takemura
- Department of Toxicology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
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36
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Holschneider DP, Bradesi S, Mayer EA. The role of experimental models in developing new treatments for irritable bowel syndrome. Expert Rev Gastroenterol Hepatol 2011; 5:43-57. [PMID: 21309671 PMCID: PMC3124306 DOI: 10.1586/egh.10.88] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome (IBS) is characterized by chronic, recurrent abdominal pain and altered bowel habits and is currently defined by symptom criteria and the absence of detectable organic disease. The underlying pathophysiology remains incompletely understood. Despite considerable efforts by the scientific community and the pharmaceutical industry to develop novel pharmacological treatments aimed at chronic visceral pain, the traditional approach to identifying and evaluating novel drugs for this target have largely failed to translate into effective IBS treatments. However, several novel drugs aimed at normalizing bowel movements have produced clinical effects, not only on the primary target, but also on pain and discomfort. While some of the commonly used experimental animal models for the pain dimension of IBS have some face and construct validity, the predictive validity of most of the models is either unknown, or has been disappointing. A reverse translational approach is proposed, which is based on identification and characterization of brain endophenotypes in patients, followed by translation of these endophenotypes for pharmacological studies in rodent models.
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Affiliation(s)
- Daniel P Holschneider
- VA Greater Los Angeles Healthcare System, LA, CA, USA,Departments of Psychiatry and the Behavioral Sciences, Neurology, Cell & Neurobiology, Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sylvie Bradesi
- VA Greater Los Angeles Healthcare System, LA, CA, USA,UCLA Center for Neurobiology of Stress, Departments of Medicine, Physiology and Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA,Author for correspondence:
| | - Emeran A Mayer
- VA Greater Los Angeles Healthcare System, LA, CA, USA,UCLA Center for Neurobiology of Stress, Departments of Medicine, Physiology and Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
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37
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Borsook D, Sava S, Becerra L. The pain imaging revolution: advancing pain into the 21st century. Neuroscientist 2010; 16:171-85. [PMID: 20400714 DOI: 10.1177/1073858409349902] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The great advances in brain imaging techniques over the last few decades have determined a shift in our understanding of chronic pain conditions and opened the door for new opportunities to develop better diagnoses and perhaps better drug treatments. Neuroimaging has helped shape the concept of chronic pain from a disease affecting mainly the somatosensory system, to a condition in which emotional, cognitive, and modulatory areas of the brain are affected, in addition to degenerative processes. All these contribute to the development and maintenance of pain symptoms and comorbid features, including alterations in anxiety, depression, and cognitive processes. In this article the authors review the current understanding of the brain changes in chronic pain and the developments made possible by the use of various brain imaging techniques. They also discuss the possible applications of brain imaging to developing a "pain phenotype" that could aid in diagnostic and treatment choices of chronic pain conditions.
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Affiliation(s)
- David Borsook
- Department of Radiology, Children's Hospital Boston, Waltham, MA 02453, USA
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38
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Gussew A, Rzanny R, Güllmar D, Scholle HC, Reichenbach JR. 1H-MR spectroscopic detection of metabolic changes in pain processing brain regions in the presence of non-specific chronic low back pain. Neuroimage 2010; 54:1315-23. [PMID: 20869447 DOI: 10.1016/j.neuroimage.2010.09.039] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/13/2010] [Accepted: 09/15/2010] [Indexed: 12/16/2022] Open
Abstract
Reliable detection of metabolic changes in the brain in vivo induced by chronic low back pain may provide improved understanding of neurophysiological mechanisms underlying the manifestation of chronic pain. In the present study, absolute concentrations of N-acetyl-aspartate (NAA), creatine (Cr), total choline (tCho), myo-inositol (mI), glutamate (Glu) and glutamine (Gln) were measured in three different pain processing cortical regions (anterior insula, anterior cingulate cortex, and thalamus) of ten patients with non-specific chronic low back pain by means of proton MR spectroscopy ((1)H-MRS) and compared to matched healthy controls. Significant decrease of Glu was observed in the anterior cingulate cortex of patients. Patients also revealed a trend of decreasing Gln concentrations in all investigated brain areas. Reductions of NAA were observed in the patient group in anterior insula and in anterior cingulated cortex, whereas mI was reduced in anterior cingulated cortex and in thalamus of patients. Reduced concentrations of Glu and Gln may indicate disordered glutamatergic neurotransmission due to prolonged pain perception, whereas decrease of NAA and mI may be ascribed to neuron and glial cell loss. No significant changes were found for Cr. The morphological evaluation of anatomic brain data revealed a significantly decreased WM volume of 17% (p<0.05) as well as a non significant trend for GM volume increase in the anterior insula of patients.
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Affiliation(s)
- Alexander Gussew
- Department of Diagnostic and Interventional Radiology I, Jena University Hospital, Jena, Germany.
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39
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Stroman PW, Coe BC, Munoz DP. Influence of attention focus on neural activity in the human spinal cord during thermal sensory stimulation. Magn Reson Imaging 2010; 29:9-18. [PMID: 20850240 DOI: 10.1016/j.mri.2010.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/28/2010] [Accepted: 07/13/2010] [Indexed: 02/04/2023]
Abstract
Perceptions of sensation and pain in healthy people are believed to be the net result of sensory input and descending modulation from brainstem and cortical regions depending on emotional and cognitive factors. Here, the influence of attention on neural activity in the spinal cord during thermal sensory stimulation of the hand was investigated with functional magnetic resonance imaging by systematically varying the participants' attention focus across and within repeated studies. Attention states included (1) attention to the stimulus by rating the sensation and (2) attention away from the stimulus by performing various mental tasks of watching a movie and identifying characters, detecting the direction of coherently moving dots within a randomly moving visual field and answering mentally-challenging questions. Functional MRI results spanning the cervical spinal cord and brainstem consistently demonstrated that the attention state had a significant influence on the activity detected in the cervical spinal cord, as well as in brainstem regions involved with the descending analgesia system. These findings have important implications for the detection and study of pain, and improved characterization of the effects of injury or disease.
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Affiliation(s)
- Patrick W Stroman
- Department of Diagnostic Radiology, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada K7L 2V7.
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40
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Maihöfner C, Nickel FT, Seifert F. [Neuropathic pain and neuroplasticity in functional imaging studies]. Schmerz 2010; 24:137-45. [PMID: 20376602 DOI: 10.1007/s00482-010-0902-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neuropathic pain syndromes are characterised by the occurrence of spontaneous ongoing and stimulus-induced pain. Stimulus-induced pain (hyperalgesia and allodynia) may result from sensitisation processes in the peripheral (primary hyperalgesia) or central (secondary hyperalgesia) nervous system. The underlying pathophysiological mechanisms at the nociceptor itself and at spinal synapses have become better understood. However, the cerebral processing of hyperalgesia and allodynia is still controversially discussed. In recent years, neuroimaging methods (functional magnetic resonance imaging, fMRI; magnetoencephalography, MEG; positron emission tomography, PET) have provided new insights into the aberrant cerebral processing of neuropathic pain. The present paper reviews different cerebral mechanisms contributing to chronicity processes in neuropathic pain syndromes. These mechanisms include reorganisation of cortical somatotopic maps in sensory or motor areas (highly relevant for phantom limb pain and CRPS), increased activity in primary nociceptive areas, recruitment of new cortical areas usually not activated by nociceptive stimuli and aberrant activity in brain areas normally involved in descending inhibitory pain networks. Moreover, there is evidence from PET studies for changes of excitatory and inhibitory transmitter systems. Finally, advanced methods of structural brain imaging (voxel-based morphometry, VBM) show significant structural changes suggesting that chronic pain syndromes may be associated with neurodegeneration.
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Affiliation(s)
- C Maihöfner
- Neurologische Klinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 , Erlangen, Deutschland.
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41
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Affiliation(s)
- Brian M Berman
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21207, USA.
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42
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Stoodley CJ, Schmahmann JD. Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing. Cortex 2010; 46:831-44. [PMID: 20152963 PMCID: PMC2873095 DOI: 10.1016/j.cortex.2009.11.008] [Citation(s) in RCA: 952] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 09/25/2009] [Accepted: 10/31/2009] [Indexed: 11/18/2022]
Abstract
Patients with cerebellar damage often present with the cerebellar motor syndrome of dysmetria, dysarthria and ataxia, yet cerebellar lesions can also result in the cerebellar cognitive affective syndrome (CCAS), including executive, visual spatial, and linguistic impairments, and affective dysregulation. We have hypothesized that there is topographic organization in the human cerebellum such that the anterior lobe and lobule VIII contain the representation of the sensorimotor cerebellum; lobules VI and VII of the posterior lobe comprise the cognitive cerebellum; and the posterior vermis is the anatomical substrate of the limbic cerebellum. Here we analyze anatomical, functional neuroimaging, and clinical data to test this hypothesis. We find converging lines of evidence supporting regional organization of motor, cognitive, and limbic behaviors in the cerebellum. The cerebellar motor syndrome results when lesions involve the anterior lobe and parts of lobule VI, interrupting cerebellar communication with cerebral and spinal motor systems. Cognitive impairments occur when posterior lobe lesions affect lobules VI and VII (including Crus I, Crus II, and lobule VIIB), disrupting cerebellar modulation of cognitive loops with cerebral association cortices. Neuropsychiatric disorders manifest when vermis lesions deprive cerebro-cerebellar-limbic loops of cerebellar input. We consider this functional topography to be a consequence of the differential arrangement of connections of the cerebellum with the spinal cord, brainstem, and cerebral hemispheres, reflecting cerebellar incorporation into the distributed neural circuits subserving movement, cognition, and emotion. These observations provide testable hypotheses for future investigations.
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Affiliation(s)
- Catherine J Stoodley
- Ataxia Unit, Cognitive/Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA.
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43
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Abstract
Pain is a complex subjective phenomenon that so far cannot be objectively quantified by any standardized procedure. This fact renders it also difficult to measure the efficacy of analgesic drugs. In recent years the application of functional magnetic resonance imaging (fMRI) has significantly increased our current knowledge about the brain physiological correlates of pain in humans. The technique is non-invasive and detects the increased blood flow into neuronally active brain regions based on the so-called BOLD (blood oxygenation level dependent) effect of T2-weighted MRI. This paper gives an overview of the application of pharmacological fMRI (phfMRI) as an approach to evaluate the efficacy of analgesics. In contrast to EEG- and MEG-based methods phfMRI allows more flexibility in the design of experimental paradigms and stimulus protocols to account for the diversity of clinical pain types (inflammatory pain, tactile allodynia etc.) or their dependence upon psychological circumstances (anxiety, depression, stress) in which pain occurs. However, in order to specifically refer results from phfMRI to the neuronal processes underlying pain, future research needs to increase the understanding of the mechanisms underlying the neurovascular coupling reaction represented by the BOLD technique. The same applies for the influence of cerebrovascular diseases on the BOLD response.
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44
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Gussew A, Rzanny R, Erdtel M, Scholle HC, Kaiser WA, Mentzel HJ, Reichenbach JR. Time-resolved functional 1H MR spectroscopic detection of glutamate concentration changes in the brain during acute heat pain stimulation. Neuroimage 2009; 49:1895-902. [PMID: 19761852 DOI: 10.1016/j.neuroimage.2009.09.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/27/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022] Open
Abstract
Non-invasive in vivo detection of cortical neurotransmitter concentrations and their changes in the presence of pain may help to better understand the biochemical principles of pain processing in the brain. In the present study acute heat pain related changes of the excitatory neurotransmitter glutamate were investigated in the anterior insular cortex of healthy volunteers by means of time-resolved functional proton magnetic resonance spectroscopy ((1)H-MRS). Dynamic metabolite changes were estimated with a temporal resolution of five seconds by triggering data acquisition to the time course of the cyclic stimulus application. An overall increase of glutamate concentration up to 18% relative to the reference non-stimulus condition was observed during the application of short pain stimuli.
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Affiliation(s)
- Alexander Gussew
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3 (MRT) 07743, Jena, Germany.
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45
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Mao J. Translational pain research: achievements and challenges. THE JOURNAL OF PAIN 2009; 10:1001-11. [PMID: 19628433 DOI: 10.1016/j.jpain.2009.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/29/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED The achievements in both preclinical and clinical pain research over the past 4 decades have led to significant progress in clinical pain management. However, pain research still faces enormous challenges and there remain many obstacles in the treatment of clinical pain, particularly chronic pain. Translational pain research needs to involve a number of important areas including: 1) bridging the gap between pain research and clinical pain management; 2) developing objective pain-assessment tools; 3) analyzing current theories of pain mechanisms and their relevance to clinical pain; 4) exploring new tools for both preclinical and clinical pain research; and 5) coordinating research efforts among basic scientists, clinical investigators, and pain-medicine practitioners. These issues are discussed in this article in light of the achievements and challenges of translational pain research. PERSPECTIVE The subjective nature of clinical pain calls for innovative research approaches. As translational pain research emerges as an important field in pain medicine, it will play a unique role in improving clinical pain management through coordinated bidirectional research approaches between bedside and bench.
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Affiliation(s)
- Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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46
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Sava S, Lebel AA, Leslie DS, Drosos A, Berde C, Becerra L, Borsook D. Challenges of functional imaging research of pain in children. Mol Pain 2009; 5:30. [PMID: 19531255 PMCID: PMC2702328 DOI: 10.1186/1744-8069-5-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/16/2009] [Indexed: 11/10/2022] Open
Abstract
Functional imaging has revolutionized the neurosciences. In the pain field it has dramatically altered our understanding of how the brain undergoes significant functional, anatomical and chemical changes in patients with chronic pain. However, most studies have been performed in adults. Because functional imaging is non-invasive and can be performed in awake individuals, applications in children have become more prevalent, but only recently in the pain field. Measures of changes in the brains of children have important implications in understanding neural plasticity in response to acute and chronic pain in the developing brain. Such findings may have implications for treatments in children affected by chronic pain and provide novel insights into chronic pain syndromes in adults. In this review we summarize this potential and discuss specific concerns related to the imaging of pain in children.
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Affiliation(s)
- Simona Sava
- P.A.I.N. Group, Department of Radiology, Children's Hospital Boston, Massachuesetts, USA.
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47
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Medial prefrontal cortex activity is predictive for hyperalgesia and pharmacological antihyperalgesia. J Neurosci 2009; 29:6167-75. [PMID: 19439594 DOI: 10.1523/jneurosci.4654-08.2009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Sodium channel blockers are known for reducing pain and hyperalgesia. In the present study we investigated changes in cerebral processing of secondary mechanical hyperalgesia induced by pharmacological modulation with systemic lidocaine. An experimental electrical pain model was used in combination with functional magnetic resonance imaging. After induction of pin-prick hyperalgesia lidocaine or placebo was administered systemically using a double-blinded design. A 2 x 2 factorial analysis was performed. The factors were (1) sensitization to pain (levels: pin-prick hyperalgesia and normal pin-prick pain) and (2) pharmacological modulation (levels: lidocaine and placebo). A main effect of (1) sensitization was found in bilateral secondary somatosensory cortex (S2), insula, anterior cingulate gyrus (ACC), medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex (dlPFC), parietal association cortex (PA), thalamus and contralateral midbrain. A main effect of (2) pharmacological modulation was found in bilateral S2, insula, ACC, mPFC, dlPFC, PA, midbrain and contralateral primary motor cortex, and thalamus. Interaction of pharmacological modulation and sensitization to pin-prick pain with activity increase during hyperalgesia and placebo was found in mPFC, posterior cingulate gyrus and thalamus. However, only activity in mPFC was inversely correlated to area of hyperalgesia during placebo and antihyperalgesic treatment effect. Furthermore, the difference of mPFC activity during hyperalgesia and placebo versus hyperalgesia and lidocaine correlated inversely with the change of the weighted hyperalgesic area (as a factor of area and rated pain intensity). We conclude that activity in mPFC correlates inversely with individual extent of central hyperalgesia and predicts individual pharmacological antihyperalgesic treatment response.
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48
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Chizh BA, Priestley T, Rowbotham M, Schaffler K. Predicting therapeutic efficacy — Experimental pain in human subjects. ACTA ACUST UNITED AC 2009; 60:243-54. [DOI: 10.1016/j.brainresrev.2008.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2008] [Indexed: 02/05/2023]
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49
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The rebirth of neuroscience in psychosomatic medicine, Part II: clinical applications and implications for research. Psychosom Med 2009; 71:135-51. [PMID: 19196806 DOI: 10.1097/psy.0b013e318198a11f] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
During the second half of the last century, biopsychosocial research in psychosomatic medicine largely ignored the brain. Neuroscience has started to make a comeback in psychosomatic medicine research and promises to advance the field in important ways. In this paper we briefly review select brain imaging research findings in psychosomatic medicine in four key areas: cardiovascular regulation, visceral pain in the context of functional gastrointestinal disorders, acute and chronic somatic pain and placebo. In each area, there is a growing literature that is beginning to define a network of brain areas that participate in the functions in question. Evidence to date suggests that cortical and subcortical areas that are involved in emotion and emotion regulation play an important role in each domain. Neuroscientific research is therefore validating findings from previous psychosomatic research and has the potential to extend knowledge by delineating the biological mechanisms that link mind and body more completely and with greater specificity. We conclude with a discussion of the implications of this work for how research in psychosomatic medicine is conducted, the ways in which neuroscientific advances can lead to new clinical applications in psychosomatic contexts, the implications of this work for the field of medicine more generally, and the priorities for research in the next 5 to 10 years.
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