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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The effects of virtual reality neuroscience-based therapy on clinical and neuroimaging outcomes in patients with chronic back pain: a randomized clinical trial. Pain 2024:00006396-990000000-00549. [PMID: 38466872 DOI: 10.1097/j.pain.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/06/2024] [Indexed: 03/13/2024]
Abstract
ABSTRACT Chronic pain remains poorly managed. The integration of immersive technologies (ie, virtual reality [VR]) with neuroscience-based principles may provide effective pain treatment by targeting cognitive and affective neural processes that maintain pain and therefore potentially changing neurobiological circuits associated with pain chronification and amplification. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (waitlist control; n = 30) in a 2-arm randomized clinical trial (NCT04468074). We also conducted pre-treatment and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared with the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs pre-treatment, with effects persisting at 2-week follow-up. These improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved by VRNT, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with increases in dorsomedial prefrontal functional connectivity with the superior somatomotor, anterior prefrontal and visual cortices, and decreased white matter fractional anisotropy in the corpus callosum adjacent to the anterior cingulate, relative to the control condition. Thus, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly through changes in somatosensory and prefrontal brain networks.
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Affiliation(s)
- Marta Čeko
- Institute of Cognitive Science, University of Colorado, Boulder, CO, United States
| | | | - Lynn Webster
- U.S. Center for Policy, Scientific Affairs, Dr. Vince Clinical Research, Salt Lake City, UT, United States
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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2
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Mei YD, Gao H, Chen WF, Zhu W, Gu C, Zhang JP, Tao JM, Hua XY. Research on the multidimensional brain remodeling mechanisms at the level of brain regions, circuits, and networks in patients with chronic lower back pain caused by lumbar disk herniation. Front Neurosci 2024; 18:1357269. [PMID: 38516315 PMCID: PMC10956359 DOI: 10.3389/fnins.2024.1357269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Chronic lower back pain (cLBP), frequently attributed to lumbar disk herniation (LDH), imposes substantial limitations on daily activities. Despite its prevalence, the neural mechanisms underlying lower back pain remain incompletely elucidated. Functional magnetic resonance imaging (fMRI) emerges as a non-invasive modality extensively employed for investigating neuroplastic changes in neuroscience. In this study, task-based and resting-state fMRI methodologies are employed to probe the central mechanisms of lower back pain. Methods The study included 71 chronic lower back pain patients (cLBP group) due to LDH and 80 age, gender, and education-matched healthy volunteers (HC group). The subjects are mainly middle-aged and elderly individuals. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Scores (JOA) were recorded. Resting-state and task-based fMRI data were collected. Results/discussion No significant differences were observed in age, gender, and education level between the two groups. In the cLBP group during task execution, there was diffuse and reduced activation observed in the primary motor cortex and supplementary motor area. Additionally, during resting states, notable changes were detected in brain regions, particularly in the frontal lobe, primary sensory area, primary motor cortex, precuneus, and caudate nucleus, accompanied by alterations in Amplitude of Low Frequency Fluctuation, Regional Homogeneity, Degree Centrality, and functional connectivity. These findings suggest that chronic lower back pain may entail reduced excitability in sensory-motor areas during tasks and heightened activity in the sensory-motor network during resting states, along with modified functional connectivity in various brain regions.
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Affiliation(s)
- Yuan-Dong Mei
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Hang Gao
- Department of Rehabilitation, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Fei Chen
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Wei Zhu
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Chen Gu
- Department of Hand Surgery, the Second People’s Hospital of Changshu, Changshu, China
| | - Jun-Peng Zhang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji-Ming Tao
- Department of Rehabilitation, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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3
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Yang L, Liu Q, Zhao Y, Lin N, Huang Y, Wang Q, Yang K, Wei R, Li X, Zhang M, Hao L, Wang H, Pan Z. DExH-box helicase 9 modulates hippocampal synapses and regulates neuropathic pain. iScience 2024; 27:109016. [PMID: 38327775 PMCID: PMC10847742 DOI: 10.1016/j.isci.2024.109016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/07/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
Experimental studies have shown that neuropathic pain impairs hippocampal synaptic plasticity. Here, we sought to determine the underlying mechanisms responsible for synaptic changes in neuropathic painful mouse hippocampal neurons. Beyond demonstrating proof-of-concept for the location of DExH-box helicase 9 (DHX9) in the nucleus, we found that it did exist in the cytoplasm and DHX9 depletion resulted in structural and functional changes at synapses in the hippocampus. A decrease of DHX9 was observed in the hippocampus after peripheral nerve injury; overexpression of DHX9 in the hippocampus significantly alleviated the nociceptive responses and improved anxiety behaviors. Mimicking DHX9 decrease evoked spontaneous pain behavioral symptoms and anxiety emotion in naïve mice. Mechanistically, we found that DHX9 bound to dendrin (Ddn) mRNA, which may have altered the level of synaptic- and dendritic-associated proteins. The data suggest that DHX9 contributes to synapses in hippocampal neurons and may modulate neuropathic pain and its comorbidity aversive emotion.
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Affiliation(s)
- Li Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Qiaoqiao Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Yaxuan Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Ninghua Lin
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
| | - Yue Huang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Qihui Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Kehui Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Runa Wei
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Xiaotong Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Ming Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Lingyun Hao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Hongjun Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
| | - Zhiqiang Pan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu 221004, China
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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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5
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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The Effects of Virtual Reality Neuroscience-based Therapy on Clinical and Neuroimaging Outcomes in Patients with Chronic Back Pain: A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.24.23293109. [PMID: 37546872 PMCID: PMC10402228 DOI: 10.1101/2023.07.24.23293109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Chronic pain remains poorly managed. The integration of innovative immersive technologies (i.e., virtual reality (VR)) with recent neuroscience-based principles that position the brain as the key organ of chronic pain may provide a more effective pain treatment than traditional behavioral therapies. By targeting cognitive and affective processes that maintain pain and potentially directly changing neurobiological circuits associated with pain chronification and amplification, VR-based pain treatment has the potential for significant and long-lasting pain relief. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (n = 30) in a 2-arm randomized clinical trial ( NCT04468074) . We also conducted pre- and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared to the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs. pre-treatment, with effects persisting at 2-week follow-up. The improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with modest increases in functional connectivity of the somatomotor and default mode networks and decreased white matter fractional anisotropy in the corpus callosum adjacent to anterior cingula, relative to the control condition. This, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly via changes in somatosensory and prefrontal brain networks.
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6
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Liu Y, Li A, Bair-Marshall C, Xu H, Jee HJ, Zhu E, Sun M, Zhang Q, Lefevre A, Chen ZS, Grinevich V, Froemke RC, Wang J. Oxytocin promotes prefrontal population activity via the PVN-PFC pathway to regulate pain. Neuron 2023; 111:1795-1811.e7. [PMID: 37023755 PMCID: PMC10272109 DOI: 10.1016/j.neuron.2023.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/02/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023]
Abstract
Neurons in the prefrontal cortex (PFC) can provide top-down regulation of sensory-affective experiences such as pain. Bottom-up modulation of sensory coding in the PFC, however, remains poorly understood. Here, we examined how oxytocin (OT) signaling from the hypothalamus regulates nociceptive coding in the PFC. In vivo time-lapse endoscopic calcium imaging in freely behaving rats showed that OT selectively enhanced population activity in the prelimbic PFC in response to nociceptive inputs. This population response resulted from the reduction of evoked GABAergic inhibition and manifested as elevated functional connectivity involving pain-responsive neurons. Direct inputs from OT-releasing neurons in the paraventricular nucleus (PVN) of the hypothalamus are crucial to maintaining this prefrontal nociceptive response. Activation of the prelimbic PFC by OT or direct optogenetic stimulation of oxytocinergic PVN projections reduced acute and chronic pain. These results suggest that oxytocinergic signaling in the PVN-PFC circuit constitutes a key mechanism to regulate cortical sensory processing.
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Affiliation(s)
- Yaling Liu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna Li
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA
| | - Chloe Bair-Marshall
- Skirball Institute for Biomolecular Medicine, New York University Grossman School of Medicine, New York, NY, USA; Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA; Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY, USA
| | - Helen Xu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA
| | - Hyun Jung Jee
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA
| | - Elaine Zhu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA
| | - Mengqi Sun
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA
| | - Arthur Lefevre
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Zhe Sage Chen
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA; Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Robert C Froemke
- Skirball Institute for Biomolecular Medicine, New York University Grossman School of Medicine, New York, NY, USA; Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA; Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, USA; Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA; Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA.
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Branco P, Berger S, Abdullah T, Vachon-Presseau E, Cecchi G, Apkarian AV. Predicting placebo analgesia in patients with chronic pain using natural language processing: a preliminary validation study. Pain 2023; 164:1078-1086. [PMID: 36524810 PMCID: PMC10106359 DOI: 10.1097/j.pain.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Patients with chronic pain show large placebo effects in clinical trials, and inert pills can lead to clinically meaningful analgesia that can last from days to weeks. Whether the placebo response can be predicted reliably, and how to best predict it, is still unknown. We have shown previously that placebo responders can be identified through the language content of patients because they speak about their life, and their pain, after a placebo treatment. In this study, we examine whether these language properties are present before placebo treatment and are thus predictive of placebo response and whether a placebo prediction model can also dissociate between placebo and drug responders. We report the fine-tuning of a language model built based on a longitudinal treatment study where patients with chronic back pain received a placebo (study 1) and its validation on an independent study where patients received a placebo or drug (study 2). A model built on language features from an exit interview from study 1 was able to predict, a priori, the placebo response of patients in study 2 (area under the curve = 0.71). Furthermore, the model predicted as placebo responders exhibited an average of 30% pain relief from an inert pill, compared with 3% for those predicted as nonresponders. The model was not able to predict who responded to naproxen nor spontaneous recovery in a no-treatment arm, suggesting specificity of the prediction to placebo. Taken together, our initial findings suggest that placebo response is predictable using ecological and quick measures such as language use.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sara Berger
- Responsible and Inclusive Technology (Exploratory Sciences Division), IBM Research, Yorktown Heights, NY, United States
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - Taha Abdullah
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Etienne Vachon-Presseau
- Faculty of Dentistry and Department of Anesthesia, McGill University, Montréal, QC, Canada
- Alan Edwards Center for Research on Pain (AECRP), McGill University, Montréal, QC, Canada
| | - Guillermo Cecchi
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Singh SP, Guindon J, Mody PH, Ashworth G, Kopel J, Chilakapati S, Adogwa O, Neugebauer V, Burton MD. Pain and aging: A unique challenge in neuroinflammation and behavior. Mol Pain 2023; 19:17448069231203090. [PMID: 37684099 PMCID: PMC10552461 DOI: 10.1177/17448069231203090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.
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Affiliation(s)
- Shishu Pal Singh
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Josee Guindon
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Prapti H Mody
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Gabriela Ashworth
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sai Chilakapati
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Volker Neugebauer
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
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9
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Pinto CB, Bielefeld J, Barroso J, Yip B, Huang L, Schnitzer T, Apkarian AV. Chronic pain domains and their relationship to personality, abilities, and brain networks. Pain 2023; 164:59-71. [PMID: 35612403 PMCID: PMC9582040 DOI: 10.1097/j.pain.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/23/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Chronic pain is a multidimensional pathological state. Recent evidence suggests that specific brain properties and patients' psychological and physical traits are distorted in chronic pain patients. However, the relationship between these alterations and pain dimensions remains poorly understood. Here, we first evaluated multiple dimensions of chronic pain by assessing a broad battery of pain-related questionnaire scores (23 outcomes) of 107 chronic low back pain patients and identified 3 distinct chronic pain domains: magnitude, affect & disability, and quality. Second, we investigated the pain domains relationship with measures of personality, social interaction, psychological traits, and ability traits (77 biopsychosocial & ability [biopsy&ab] outcomes). Pain magnitude (out-of-sample [OOS]
) is associated with emotional control, attention, and working memory, with higher pain scores showing lower capacity to regulate and adapt behaviorally. Pain affect & disability (OOS
associated with anxiety, catastrophizing and social relationships dysfunction. Pain quality did not relate significantly to biopsy&ab variables. Third, we mapped these 3 pain domains to brain functional connectivity. Pain magnitude mainly associated with the sensorimotor and the cingulo-opercular networks (OOS
). Pain affect & disability related to frontoparietal and default mode networks (OOS
. Pain quality integrated sensorimotor, auditory, and cingulo-opercular networks (OOS
). Mediation analysis could link functional connectivity and biopsy&ab models to respective pain domains. Our results provide a global overview of the complexity of chronic pain, showing how underlying distinct domains of the experience map to different biopsy&ab correlates and underlie unique brain network signatures.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joana Barroso
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Byron Yip
- Departments of Physical Medicine and Rehabilitation
| | - Lejian Huang
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Thomas Schnitzer
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
- Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
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10
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Pinto AM, Geenen R, Wager TD, Lumley MA, Häuser W, Kosek E, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, López-Solà M, Luís M, Marques TR, Mease PJ, Palavra F, Rhudy JL, Uddin LQ, Castilho P, Jacobs JWG, da Silva JAP. Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia. Nat Rev Rheumatol 2023; 19:44-60. [PMID: 36471023 DOI: 10.1038/s41584-022-00873-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/09/2022]
Abstract
Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Coimbra, Portugal
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Coimbra, Portugal
- University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Coimbra, Portugal
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Altrecht Psychosomatic Medicine Eikenboom, Zeist, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Lisbon, Portugal
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Beersheba, Israel
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Coimbra, Portugal
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Coimbra, Portugal
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit, Paediatric Hospital, Coimbra Hospital and University Centre, Coimbra, Portugal
- University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, Coimbra, Portugal
| | - Jamie L Rhudy
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - Lucina Q Uddin
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Coimbra, Portugal.
- Rheumatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
- University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, Coimbra, Portugal.
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11
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Brain-specific genes contribute to chronic but not to acute back pain. Pain Rep 2022; 7:e1018. [PMID: 35975136 PMCID: PMC9371560 DOI: 10.1097/pr9.0000000000001018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Back pain is the leading cause of disability worldwide. Although most back pain cases are acute, 20% of acute pain patients experience chronic back pain symptoms. It is unclear whether acute pain and chronic pain have similar or distinct underlying genetic mechanisms. Objectives To characterize the molecular and cellular pathways contributing to acute and chronic pain states. Methods Cross-sectional observational genome-wide association study. Results A total of 375,158 individuals from the UK Biobank cohort were included in the discovery of genome-wide association study. Of those, 70,633 (19%) and 32,209 (9%) individuals met the definition of chronic and acute back pain, respectively. A total of 355 single nucleotide polymorphism grouped into 13 loci reached the genome-wide significance threshold (5x10-8) for chronic back pain, but none for acute. Of these, 7 loci were replicated in the Nord-Trøndelag Health Study (HUNT) cohort (19,760 chronic low back pain cases and 28,674 pain-free controls). Single nucleotide polymorphism heritability was 4.6% (P=1.4x10-78) for chronic back pain and 0.81% (P=1.4x10-8) for acute back pain. Similar differences in heritability estimates between acute and chronic back pain were found in the HUNT cohort: 3.4% (P=0.0011) and 0.6% (P=0.851), respectively. Pathway analyses, tissue-specific heritability enrichment analyses, and epigenetic characterization suggest a substantial genetic contribution to chronic but not acute back pain from the loci predominantly expressed in the central nervous system. Conclusion Chronic back pain is substantially more heritable than acute back pain. This heritability is mostly attributed to genes expressed in the brain.
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12
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Teixidó-Abiol L, de Arriba-Arnau A, Seguí Montesinos J, Herradón Gil-Gallardo G, Sánchez-López MJ, De Sanctis Briggs V. Psychopathological and Personality Pro file in Chronic Nononcologic Nociceptive and Neuropathic pain: Cross-sectional Comparative Study. Int J Psychol Res (Medellin) 2022; 15:51-67. [PMID: 37274511 PMCID: PMC10233962 DOI: 10.21500/20112084.5631] [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] [Received: 10/07/2021] [Accepted: 05/10/2022] [Indexed: 06/06/2023] Open
Abstract
Introduction Adaptation to chronic non-oncologic pain is associated with the development of psychopathology and personality disorders, creating severity, chronicity, poorer treatment response, and exacerbations in patients with neuropathy. Objective To identify the psychopathological and personality profiles of patients with chronic nociceptive and neuropathic pain and their association with pain progression and intensity. Method A cross-sectional, descriptive and comparative study was conducted in the Pain Treatment Unit of Hospital Universitari Sagrat Cor, with systematic randomized recruitment for 25 months; 115 patients were evaluated using the Hamilton Depression and Anxiety Rating Scale (HAM-D, HAM-A) and the Millon Clinical MultiaxialInventory-III (MCMI-III). Results The neuropathic group achieved significantly higher scores for pain intensity and depressive and anxiety symptoms. With greater magnitude and frequency, the neuropathic group related pain intensity and progression with depressive/anxiety symptoms, clinical syndromes, and personality patterns. Both groups revealed tendencies towards a compulsive personality pattern, followed by narcissistic, histrionic, and schizoid patterns. Conclusions When treating chronic pain, the presence of various psychopathological indicators requires an individualized strategy.
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Affiliation(s)
- Laura Teixidó-Abiol
- Servicio de Psiquiatría y Unidad del dolor, Servicio de Anestesiología, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud; CEINDO Escuela Internacional de Doctorado, Universitat Abat Oliba CEU, CEU Universities, Madrid y Barcelona, España.CEU UniversitiesMadrid y BarcelonaEspaña
| | - Aida de Arriba-Arnau
- Servicio de Psiquiatría, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirón- salud, Barcelona, España.Hospital Universitari Sagrat CorBarcelonaEspaña
| | - Juan Seguí Montesinos
- Servicio de Psiquiatría, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirón- salud, Barcelona, España.Hospital Universitari Sagrat CorBarcelonaEspaña
| | - Gonzalo Herradón Gil-Gallardo
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, España.Facultad de FarmaciaCEU UniversitiesMadridEspaña
| | - María José Sánchez-López
- Servicio de Biblioteca, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona, España.Hospital Universitari Sagrat Cor
| | - Vicente De Sanctis Briggs
- Unidad del dolor, Servicio de Anestesiología, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona, España.BarcelonaEspaña
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13
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Zhao R, Su Q, Song Y, Yang Q, Wang S, Zhang J, Qin W, Yu C, Liang M. Brain-activation-based individual identification reveals individually unique activation patterns elicited by pain and touch. Neuroimage 2022; 260:119436. [PMID: 35788043 DOI: 10.1016/j.neuroimage.2022.119436] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
Pain is subjective and perceived differently in different people. However, individual differences in pain-elicited brain activations are largely overlooked and often discarded as noises. Here, we used a brain-activation-based individual identification procedure to investigate the uniqueness of the activation patterns within the whole brain or brain regions elicited by nociceptive (laser) and tactile (electrical) stimuli in each of 62 healthy participants. Specifically, brain activation patterns were used as "fingerprints" to identify each individual participant within and across sensory modalities, and individual identification accuracy was calculated to measure each individual's identifiability. We found that individual participants could be successfully identified using their brain activation patterns elicited by nociceptive stimuli, tactile stimuli, or even across modalities. However, different participants had different identifiability; importantly, the within-pain, but not within-touch or cross-modality, individual identifiability obtained from three brain regions (i.e., the left superior frontal gyrus, the middle temporal gyrus and the insular gyrus) were inversely correlated with the scores of Pain Vigilance and Awareness Questionnaire (i.e., how a person is alerted to pain) across participants. These results suggest that each individual has a unique pattern of brain responses to nociceptive stimuli which contains both modality-nonspecific and pain-specific information and may be associated with pain-related behaviors shaped by his/her own personal experiences and highlight the importance of a transition from group-level to individual-level characterization of brain activity in neuroimaging studies.
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Affiliation(s)
- Rui Zhao
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China; Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qian Su
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin 300060, China
| | - YingChao Song
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China
| | - QingQing Yang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China; Department of Radiology, Zhejiang University School of Medicine First Affiliated Hospital, Zhejiang 310009, China
| | - Sijia Wang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China
| | - Juan Zhang
- Department of Prosthodontics, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chunshui Yu
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, 300070, China.
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14
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Sun J, Zheng YB, Liu L, Li SQ, Zhao YM, Zhu XM, Que JY, Li MZ, Liu WJ, Yuan K, Yan W, Liu XG, Chang SH, Chen X, Gao N, Shi J, Bao YP, Lu L. The Impact of Quarantine on Pain Sensation among the General Population in China during the COVID-19 Pandemic. Brain Sci 2022; 12:brainsci12010079. [PMID: 35053822 PMCID: PMC8773642 DOI: 10.3390/brainsci12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
During the pandemic era, quarantines might potentially have negative effects and disproportionately exacerbate health condition problems. We conducted this cross-sectional, national study to ascertain the prevalence of constant pain symptoms and how quarantines impacted the pain symptoms and identify the factors associated with constant pain to further guide reducing the prevalence of chronic pain for vulnerable people under the pandemic. The sociodemographic data, quarantine conditions, mental health situations and pain symptoms of the general population were collected. After adjusting for potential confounders, long-term quarantine (≥15 days) exposures were associated with an increased risk of constant pain complaints compared to those not under a quarantine (Odds Ratio (OR): 1.26; 95% Confidence Interval (CI): 1.03, 1.54; p = 0.026). Risk factors including unemployment (OR: 1.55), chronic disease history (OR: 2.38) and infection with COVID-19 (OR: 2.15), and any of mental health symptoms including depression, anxiety, insomnia and PTSD (OR: 5.44) were identified by a multivariable logistic regression. Additionally, mediation analysis revealed that the effects of the quarantine duration on pain symptoms were mediated by mental health symptoms (indirect effects: 0.075, p < 0.001). These results advocated that long-term quarantine measures were associated with an increased risk of experiencing pain, especially for vulnerable groups with COVID-19 infection and with mental health symptoms. The findings also suggest that reducing mental distress during the pandemic might contribute to reducing the burden of pain symptoms and prioritizing interventions for those experiencing a long-term quarantine.
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Affiliation(s)
- Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Shui-Qing Li
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
| | - Yi-Miao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- School of Public Health, Peking University, Beijing 100191, China
| | - Xi-Mei Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Jian-Yu Que
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Ming-Zhe Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
| | - Wei-Jian Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Xiao-Guang Liu
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
| | - Su-Hua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Xuan Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Nan Gao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (Y.-P.B.); (L.L.)
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- Correspondence: (Y.-P.B.); (L.L.)
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15
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Disrupted population coding in the prefrontal cortex underlies pain aversion. Cell Rep 2021; 37:109978. [PMID: 34758316 PMCID: PMC8696988 DOI: 10.1016/j.celrep.2021.109978] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
The prefrontal cortex (PFC) regulates a wide range of sensory experiences. Chronic pain is known to impair normal neural response, leading to enhanced aversion. However, it remains unknown how nociceptive responses in the cortex are processed at the population level and whether such processes are disrupted by chronic pain. Using in vivo endoscopic calcium imaging, we identify increased population activity in response to noxious stimuli and stable patterns of functional connectivity among neurons in the prelimbic (PL) PFC from freely behaving rats. Inflammatory pain disrupts functional connectivity of PFC neurons and reduces the overall nociceptive response. Interestingly, ketamine, a well-known neuromodulator, restores the functional connectivity among PL-PFC neurons in the inflammatory pain model to produce anti-aversive effects. These results suggest a dynamic resource allocation mechanism in the prefrontal representations of pain and indicate that population activity in the PFC critically regulates pain and serves as an important therapeutic target. Li et al. reveal that inflammatory pain disrupts the functional connectivity of neurons in the prelimbic prefrontal cortex (PL-PFC) and the overall nociceptive response. Ketamine, meanwhile, restores the functional connectivity of neurons in the PL-PFC in the inflammatory pain state to produce anti-aversive effects.
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16
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Liu X, Xie Z, Li S, He J, Cao S, Xiao Z. PRG-1 relieves pain and depressive-like behaviors in rats of bone cancer pain by regulation of dendritic spine in hippocampus. Int J Biol Sci 2021; 17:4005-4020. [PMID: 34671215 PMCID: PMC8495398 DOI: 10.7150/ijbs.59032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
Rationale: Pain and depression, which tend to occur simultaneously and share some common neural circuits and neurotransmitters, are highly prevalent complication in patients with advanced cancer. Exploring the underlying mechanisms is the cornerstone to prevent the comorbidity of chronic pain and depression in cancer patients. Plasticity-related gene 1 (PRG-1) protein regulates synaptic plasticity and brain functional reorganization during neuronal development or after cerebral lesion. Purinergic P2X7 receptor has been proposed as a therapeutic target for various pain and neurological disorders like depression in rodents. In this study, we investigated the roles of PRG-1 in the hippocampus in the comorbidity of pain and depressive-like behaviors in rats with bone cancer pain (BCP). Methods: The bone cancer pain rat model was established by intra-tibial cell inoculation of SHZ-88 mammary gland carcinoma cells. The animal pain behaviors were assessed by measuring the thermal withdrawal latency values by using radiant heat stimulation and mechanical withdrawal threshold by using electronic von Frey anesthesiometer, and depressive-like behavior was assessed by sucrose preference test and forced swim test. Alterations in the expression levels of PRG-1 and P2X7 receptor in hippocampus were separately detected by using western blot, immunofluorescence and immunohistochemistry analysis. The effects of intra-hippocampal injection of FTY720 (a PRG-1/PP2A interaction activator), PRG-1 overexpression or intra-hippocampal injection of A438079 (a selective competitive P2X7 receptor antagonist) were also observed. Results: Carcinoma intra-tibia injection caused thermal hyperalgesia, mechanical allodynia and depressive-like behaviors in rats, and also induced the deactivation of neurons and dendritic spine structural anomalies in the hippocampus. Western blot, immunofluorescence and immunohistochemistry analysis showed an increased expression of PRG-1 and P2X7 receptor in the hippocampus of BCP rats. Intra-hippocampal injection of FTY720 or A438079 attenuated both pain and depressive-like behaviors. Furthermore, overexpression of PRG-1 in hippocampus has similar analgesic efficacy to FTY720. In addition, they rescued neuron deactivation and dendritic spine anomalies. Conclusion: The results suggest that both PRG-1 and P2X7 receptor in the hippocampus play important roles in the development of pain and depressive-like behaviors in bone cancer condition in rats by dendritic spine regulation via P2X7R/PRG-1/PP2A pathway.
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Affiliation(s)
- Xingfeng Liu
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563000, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563000, China
| | - Zhuo Xie
- Graduate School, Zunyi Medical University, Zunyi 563000, China
| | - Site Li
- Graduate School, Zunyi Medical University, Zunyi 563000, China
| | - Jingxin He
- Graduate School, Zunyi Medical University, Zunyi 563000, China
| | - Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Zhi Xiao
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563000, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563000, China
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17
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Chen ZS. Decoding pain from brain activity. J Neural Eng 2021; 18. [PMID: 34608868 DOI: 10.1088/1741-2552/ac28d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022]
Abstract
Pain is a dynamic, complex and multidimensional experience. The identification of pain from brain activity as neural readout may effectively provide a neural code for pain, and further provide useful information for pain diagnosis and treatment. Advances in neuroimaging and large-scale electrophysiology have enabled us to examine neural activity with improved spatial and temporal resolution, providing opportunities to decode pain in humans and freely behaving animals. This topical review provides a systematical overview of state-of-the-art methods for decoding pain from brain signals, with special emphasis on electrophysiological and neuroimaging modalities. We show how pain decoding analyses can help pain diagnosis and discovery of neurobiomarkers for chronic pain. Finally, we discuss the challenges in the research field and point to several important future research directions.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, Department of Neuroscience and Physiology, Neuroscience Institute, Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY 10016, United States of America
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18
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Reddan MC. Recommendations for the Development of Socioeconomically-Situated and Clinically-Relevant Neuroimaging Models of Pain. Front Neurol 2021; 12:700833. [PMID: 34557144 PMCID: PMC8453079 DOI: 10.3389/fneur.2021.700833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Pain is a complex, multidimensional experience that emerges from interactions among sensory, affective, and cognitive processes in the brain. Neuroimaging allows us to identify these component processes and model how they combine to instantiate the pain experience. However, the clinical impact of pain neuroimaging models has been limited by inadequate population sampling - young healthy college students are not representative of chronic pain patients. The biopsychosocial approach to pain management situates a person's pain within the diverse socioeconomic environments they live in. To increase the clinical relevance of pain neuroimaging models, a three-fold biopsychosocial approach to neuroimaging biomarker development is recommended. The first level calls for the development of diagnostic biomarkers via the standard population-based (nomothetic) approach with an emphasis on diverse sampling. The second level calls for the development of treatment-relevant models via a constrained person-based (idiographic) approach tailored to unique individuals. The third level calls for the development of prevention-relevant models via a novel society-based (social epidemiologic) approach that combines survey and neuroimaging data to predict chronic pain risk based on one's socioeconomic conditions. The recommendations in this article address how we can leverage pain's complexity in service of the patient and society by modeling not just individuals and populations, but also the socioeconomic structures that shape any individual's expectations of threat, safety, and resource availability.
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Affiliation(s)
- Marianne C. Reddan
- Department of Psychology, Stanford University, Stanford, CA, United States
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19
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Apkarian AV. The Necessity of Methodological Advances in Pain Research: Challenges and Opportunities. FRONTIERS IN PAIN RESEARCH 2021; 2:634041. [PMID: 35295518 PMCID: PMC8915640 DOI: 10.3389/fpain.2021.634041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Apkar Vania Apkarian
- Department of Physiology, Anesthesiology, Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Apkar Vania Apkarian
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20
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Quantitative language features identify placebo responders in chronic back pain. Pain 2021; 162:1692-1704. [PMID: 33433145 DOI: 10.1097/j.pain.0000000000002175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although placebo effect sizes in clinical trials of chronic pain treatments have been increasing, it remains unknown if characteristics of individuals' thoughts or previous experiences can reliably infer placebo pill responses. Research using language to investigate emotional and cognitive processes has recently gained momentum. Here, we quantified placebo responses in chronic back pain using more than 300 semantic and psycholinguistic features derived from patients' language. This speech content was collected in an exit interview as part of a clinical trial investigating placebo analgesia (62 patients, 42 treated; 20 not treated). Using a nested leave-one-out cross-validated approach, we distinguished placebo responders from nonresponders with 79% accuracy using language features alone; a subset of these features-semantic distances to identity and stigma and the number of achievement-related words-also explained 46% of the variance in placebo analgesia. Importantly, these language features were not due to generic treatment effects and were associated with patients' specific baseline psychological traits previously shown to be predictive of placebo including awareness and personality characteristics, explaining an additional 31% of the variance in placebo analgesia beyond that of personality. Initial interpretation of the features suggests that placebo responders differed in how they talked about negative emotions and the extent that they expressed awareness to various aspects of their experiences; differences were also seen in time spent talking about leisure activities. These results indicate that patients' language is sufficient to identify a placebo response and implie that specific speech features may be predictive of responders' previous treatment.
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21
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Köbe T, Binette AP, Vogel JW, Meyer PF, Breitner JCS, Poirier J, Villeneuve S. Vascular risk factors are associated with a decline in resting-state functional connectivity in cognitively unimpaired individuals at risk for Alzheimer's disease: Vascular risk factors and functional connectivity changes. Neuroimage 2021; 231:117832. [PMID: 33549747 DOI: 10.1016/j.neuroimage.2021.117832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Resting-state functional connectivity is suggested to be cross-sectionally associated with both vascular burden and Alzheimer's disease (AD) pathology. However, evidence is lacking regarding longitudinal changes in functional connectivity. This study includes 247 cognitively unimpaired individuals with a family history of sporadic AD (185 women/ 62 men; mean [SD] age of 63 [5.3] years). Plasma total-, HDL-, and LDL-cholesterol and systolic and diastolic blood pressure were measured at baseline. Global (whole-brain) brain functional connectivity and connectivity from canonical functional networks were computed from resting-state functional MRI obtained at baseline and ~3.5 years of annual follow-ups, using a predefined functional parcellation. A subsample underwent Aβ- and tau-PET (n=91). Linear mixed-effects models demonstrated that global functional connectivity increased over time across the entire sample. In contrast, higher total-cholesterol and LDL-cholesterol levels were associated with greater reduction of functional connectivity in the default-mode network over time. In addition, higher diastolic blood pressure was associated with global functional connectivity reduction. The associations were similar when the analyses were repeated using two other functional brain parcellations. Aβ and tau deposition in the brain were not associated with changes in functional connectivity over time in the subsample. These findings provide evidence that vascular burden is associated with a decrease in functional connectivity over time in older adults with elevated risk for AD. Future studies are needed to determine if the impact of vascular risk factors on functional brain changes precede the impact of AD pathology on functional brain changes.
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Affiliation(s)
- Theresa Köbe
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada; German Center for Neurodegenerative Diseases (DZNE), 01307, Dresden, Germany.
| | - Alexa Pichet Binette
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada
| | - Jacob W Vogel
- Montreal Neurological Institute, McGill University, H3A 2B4, Montreal, QC, Canada
| | - Pierre-François Meyer
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada
| | - John C S Breitner
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada
| | - Judes Poirier
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada
| | - Sylvia Villeneuve
- Department of Psychiatry, McGill University, H3A 1A1, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Studies on Prevention of Alzheimer's Disease (StoP-AD) Centre, H4H 1R3, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, H3A 2B4, Montreal, Quebec, Canada.
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22
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Xiong B, Zhang W, Zhang L, Huang X, Zhou W, Zou Q, Manyande A, Wang J, Tian Y, Tian X. Hippocampal glutamatergic synapses impairment mediated novel-object recognition dysfunction in rats with neuropathic pain. Pain 2020; 161:1824-1836. [PMID: 32701842 DOI: 10.1097/j.pain.0000000000001878] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive impairment is one of the most common complications associated with chronic pain. Almost 20% of chronic pain patients suffer from cognitive impairment, which may substantially influence their quality of life. Levels of major excitatory neurotransmitters in the central nervous system and alterations in the glutamatergic system may influence cognitive function and the pain sensory pathway. In this study, we adopted the spared nerve injury model to establish the progress of chronic pain and investigated the mechanism underlying the cognitive aspect related to it. At behavioral level, using the novel-object recognition test, mechanical hypersensitivity was observed in peripheral nerve-injured rats because they exhibited recognition deficits. We showed a dramatic decrease in hippocampal glutamate concentration using nuclear magnetic resonance and reduced glutamatergic synaptic transmission using whole-cell recordings. These were associated with deficient hippocampal long-term potentiation induced by high-frequency stimulation of the Schaffer collateral afferent. Ultra-high-performance liquid chromatography revealed lower levels of D-serine in the hippocampus of the spared nerve injury rats and that D-serine treatment could restore synaptic plasticity and cognitive dysfunction. The reduction of excitatory synapses was also increased by administering D-serine. These findings suggest that chronic pain has a critical effect on synaptic plasticity linked to cognitive function and may built up a new target for the development of cognitive impairment under chronic pain conditions.
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Affiliation(s)
- Bingrui Xiong
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Wen Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Longqing Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xian Huang
- Department of Physiology, School of Basic Medicine and Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenchang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Zou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, United Kingdom
| | - Jie Wang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Center for Magnetic Resonance, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Yuke Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuebi Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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23
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Zhang L, Zhou L, Ren Q, Mokhtari T, Wan L, Zhou X, Hu L. Evaluating Cortical Alterations in Patients With Chronic Back Pain Using Neuroimaging Techniques: Recent Advances and Perspectives. Front Psychol 2019; 10:2527. [PMID: 31798496 PMCID: PMC6868051 DOI: 10.3389/fpsyg.2019.02527] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022] Open
Abstract
Chronic back pain (CBP) is a leading cause of disability and results in considerable socio-economic burdens worldwide. Although CBP patients are commonly diagnosed and treated with a focus on the “end organ dysfunction” (i.e., peripheral nerve injuries or diseases), the evaluation of CBP remains flawed and problematic with great challenges. Given that the peripheral nerve injuries or diseases are insufficient to define the etiology of CBP in some cases, the evaluation of alterations in the central nervous system becomes particularly necessary and important. With the development of advanced neuroimaging techniques, extensive studies have been carried out to identify the cortical abnormalities in CBP patients. Here, we provide a comprehensive overview on a series of novel findings from these neuroimaging studies to improve our understanding of the cortical abnormalities originated in the disease. First, CBP patients normally exhibit central sensitization to external painful stimuli, which is indexed by increased pain sensitivity and brain activations in pain-related brain regions. Second, long-term suffering from chronic pain leads to emotional disorders, cognitive impairments, and the abnormalities of the relevant brain networks among CBP patients. Third, CBP is associated with massive cortical reorganization, including structural, functional, and metabolic brain changes. Overall, a deep insight into the neural mechanisms underlying the development and outcome of CBP through more sophisticated neuroimaging investigations could not only improve our current understanding of the etiology of CBP but also facilitate the diagnosis and treatment of CBP based on precision medicine.
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Affiliation(s)
- Li Zhang
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China.,Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Lili Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qiaoyue Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Tahmineh Mokhtari
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wan
- Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaolin Zhou
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China.,Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.,PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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