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Zhou Q, Li M, Fan Q, Chen F, Jiang G, Wang T, He Q, Fu S, Yin Y, Lin J, Yan J. Cerebral perfusion alterations in patients with trigeminal neuralgia as measured by pseudo-continuous arterial spin labeling. Front Neurosci 2022; 16:1065411. [PMID: 36601595 PMCID: PMC9807247 DOI: 10.3389/fnins.2022.1065411] [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: 10/09/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Accumulating evidence suggests that trigeminal neuralgia (TN) causes structural and functional alterations in the brain. However, only a few studies have focused on cerebral blood flow (CBF) changes in patients with TN. This study aimed to explore whether altered cerebral perfusion patterns exist in patients with TN and investigate the relationship between abnormal regional CBF (rCBF) and clinical characteristics of TN. Materials and methods This study included 28 patients with TN and 30 age- and sex-matched healthy controls (HCs) who underwent perfusion functional MRI (fMRI) of the brain using pseudo-continuous arterial spin labeling (pCASL) in the resting state. The regions of significantly altered CBF in patients with TN were detected using group comparison analyses. Then, the relationships between the clinical characteristics and abnormal rCBF were further investigated. Results Compared to the control group, patients with TN exhibited increased rCBF, primarily in the thalamus, middle frontal gyrus (MFG), and left insula. Furthermore, the CBF values of the thalamus were negatively correlated with the pain intensity of TN and positively correlated with pain duration in patients with TN. Conclusion Primary alterations in rCBF in patients with TN occurred in different brain regions related to pain, which are involved in cognitive-affective interaction, pain perception, and pain modulation. These results indicate that non-invasive resting cerebral perfusion imaging may contribute complementary information to further understanding the neuropathological mechanism underlying TN.
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Affiliation(s)
- Qianling Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qisen Fan
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Chen
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qinmeng He
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jinzhi Lin
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianhao Yan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China,*Correspondence: Jianhao Yan,
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Vamvakas A, Lawn T, Veronese M, Williams SCR, Tsougos I, Howard MA. Neurotransmitter receptor densities are associated with changes in regional Cerebral blood flow during clinical ongoing pain. Hum Brain Mapp 2022; 43:5235-5249. [PMID: 35796178 PMCID: PMC9812236 DOI: 10.1002/hbm.25999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/07/2022] [Accepted: 06/19/2022] [Indexed: 01/15/2023] Open
Abstract
Arterial spin labelling (ASL) plays an increasingly important role in neuroimaging pain research but does not provide molecular insights regarding how regional cerebral blood flow (rCBF) relates to underlying neurotransmission. Here, we integrate ASL with positron emission tomography (PET) and brain transcriptome data to investigate the molecular substrates of rCBF underlying clinically relevant pain states. Two data sets, representing acute and chronic ongoing pain respectively, were utilised to quantify changes in rCBF; one examining pre-surgical versus post-surgical pain, and the second comparing patients with painful hand Osteoarthritis to a group of matched controls. We implemented a whole-brain spatial correlation analysis to explore associations between change in rCBF (ΔCBF) and neurotransmitter receptor distributions derived from normative PET templates. Additionally, we utilised transcriptomic data from the Allen Brain Atlas to inform distributions of receptor expression. Both datasets presented significant correlations of ΔCBF with the μ-opioid and dopamine-D2 receptor expressions, which play fundamental roles in brain activity associated with pain experiences. ΔCBF also correlated with the gene expression distributions of several receptors involved in pain processing. Overall, this is the first study illustrating the molecular basis of ongoing pain ASL indices and emphasises the potential of rCBF as a biomarker in pain research.
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Affiliation(s)
- Alexandros Vamvakas
- Medical Physics Department, Medical SchoolUniversity of ThessalyLarisaGreece
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Timothy Lawn
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Steven C. R. Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ioannis Tsougos
- Medical Physics Department, Medical SchoolUniversity of ThessalyLarisaGreece
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Matthew A. Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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3
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Walker SM. Developmental Mechanisms of CPSP: Clinical Observations and Translational Laboratory Evaluations. Can J Pain 2021; 6:49-60. [PMID: 35910395 PMCID: PMC9331197 DOI: 10.1080/24740527.2021.1999796] [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] [Indexed: 11/02/2022] Open
Abstract
Understanding mechanisms that underly the transition from acute to chronic pain and identifying potential targets for preventing or minimizing this progression have specific relevance for chronic postsurgical pain (CPSP). Though it is clear that multiple psychosocial, family, and environmental factors may influence CPSP, this review will focus on parallels between clinical observations and translational laboratory studies investigating the acute and long-term effects of surgical injury on nociceptive pathways. This includes data related to alterations in sensitivity at different points along nociceptive pathways from the periphery to the brain; age- and sex-dependent mechanisms underlying the transition from acute to persistent pain; potential targets for preventive interventions; and the impact of prior surgical injury. Ongoing preclinical studies evaluating age- and sex-dependent mechanisms will also inform comparative efficacy and preclinical safety assessments of potential preventive pharmacological interventions aimed at reducing the risk of CPSP. In future clinical studies, more detailed and longitudinal peri-operative phenotyping with patient- and parent-reported chronic pain core outcomes, alongside more specialized evaluations of somatosensory function, modulation, and circuitry, may enhance understanding of individual variability in postsurgical pain trajectories and improve recognition and management of CPSP.
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Affiliation(s)
- Suellen M. Walker
- Clinical Neurosciences (Pain Research), Developmental Neurosciences, UCL GOS Institute of Child Health, London, UK; Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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4
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Genaro K, Prado WA. The role of the anterior pretectal nucleus in pain modulation: A comprehensive review. Eur J Neurosci 2021; 54:4358-4380. [PMID: 33909941 DOI: 10.1111/ejn.15255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
Descending pain modulation involves multiple encephalic sites and pathways that range from the cerebral cortex to the spinal cord. Behavioral studies conducted in the 1980s revealed that electrical stimulation of the pretectal area causes antinociception dissociation from aversive responses. Anatomical and physiological studies identified the anterior pretectal nucleus and its descending projections to several midbrain, pontine, and medullary structures. The anterior pretectal nucleus is morphologically divided into a dorsal part that contains a dense neuron population (pars compacta) and a ventral part that contains a dense fiber band network (pars reticulata). Connections of the two anterior pretectal nucleus parts are broad and include prominent projections to and from major encephalic systems associated with somatosensory processes. Since the first observation that acute or chronic noxious stimuli activate the anterior pretectal nucleus, it has been established that numerous mediators participate in this response through distinct pathways. Recent studies have confirmed that at least two pain inhibitory pathways are activated from the anterior pretectal nucleus. This review focuses on rodent anatomical, behavioral, molecular, and neurochemical data that have helped to identify mediators of the anterior pretectal nucleus and pathways related to its role in pain modulation.
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Affiliation(s)
- Karina Genaro
- Department of Anesthesiology, University of California, Irvine, CA, USA
| | - Wiliam A Prado
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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5
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Mouraux A, Bannister K, Becker S, Finn DP, Pickering G, Pogatzki-Zahn E, Graven-Nielsen T. Challenges and opportunities in translational pain research - An opinion paper of the working group on translational pain research of the European pain federation (EFIC). Eur J Pain 2021; 25:731-756. [PMID: 33625769 PMCID: PMC9290702 DOI: 10.1002/ejp.1730] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For decades, basic research on the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need. In this opinion paper bringing together pain researchers from very different disciplines, the opportunities and challenges of translational pain research are discussed. The many factors that may prevent the successful translation of bench observations into useful and effective clinical applications are reviewed, including interspecies differences, limited validity of currently available preclinical disease models of pain, and limitations of currently used methods to assess nociception and pain in non-human and human models of pain. Many paths are explored to address these issues, including the backward translation of observations made in patients and human volunteers into new disease models that are more clinically relevant, improved generalization by taking into account age and sex differences, and the integration of psychobiology into translational pain research. Finally, it is argued that preclinical and clinical stages of developing new treatments for pain can be improved by better preclinical models of pathological pain conditions alongside revised methods to assess treatment-induced effects on nociception in human and non-human animals. Significance: For decades, basic research of the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need.
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Affiliation(s)
- André Mouraux
- Institute of Neuroscience (IONS), UCLouvain, Brussels, Belgium
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - David P Finn
- Pharmacology and Therapeutics, Centre for Pain Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gisèle Pickering
- Department of Clinical Pharmacology, Inserm CIC 1405, University Hospital, CHU Clermont-Ferrand, France.,Fundamental and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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6
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Müller M, Wüthrich F, Federspiel A, Wiest R, Egloff N, Reichenbach S, Exadaktylos A, Jüni P, Curatolo M, Walther S. Altered central pain processing in fibromyalgia-A multimodal neuroimaging case-control study using arterial spin labelling. PLoS One 2021; 16:e0235879. [PMID: 33529254 PMCID: PMC7853499 DOI: 10.1371/journal.pone.0235879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
Fibromyalgia is characterized by chronic pain and a striking discrepancy between objective signs of tissue damage and severity of pain. Function and structural alterations in brain areas involved in pain processing may explain this feature. Previous case-control studies in fibromyalgia focused on acute pain processing using experimentally-evoked pain paradigms. Yet, these studies do not allow conclusions about chronic, stimulus-independent pain. Resting-state cerebral blood flow (rsCBF) acquired by arterial spin labelling (ASL) may be a more accurate marker for chronic pain. The objective was to integrate four different functional and structural neuroimaging markers to evaluate the neural correlate of chronic, stimulus-independent pain using a resting-state paradigm. In line with the pathophysiological concept of enhanced central pain processing we hypothesized that rsCBF is increased in fibromyalgia in areas involved in processing of acute pain. We performed an age matched case-control study of 32 female fibromyalgia patients and 32 pain-free controls and calculated group differences in rsCBF, resting state functional connectivity, grey matter volume and cortical thickness using whole-brain and region of interest analyses. We adjusted all analyses for depression and anxiety. As centrally acting drugs are likely to interfere with neuroimaging markers, we performed a subgroup analysis limited to patients not taking such drugs. We found no differences between cases and controls in rsCBF of the thalamus, the basal ganglia, the insula, the somatosensory cortex, the prefrontal cortex, the anterior cingulum and supplementary motor area as brain areas previously identified to be involved in acute processing in fibromyalgia. The results remained robust across all neuroimaging markers and when limiting the study population to patients not taking centrally acting drugs and matched controls. In conclusion, we found no evidence for functional or structural alterations in brain areas involved in acute pain processing in fibromyalgia that could reflect neural correlates of chronic stimulus-independent pain.
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Affiliation(s)
- Monika Müller
- University Clinic of Anesthesiology and Pain Medicine, Inselspital, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Clinic of Radiology, Inselspital, Bern, Switzerland
| | - Niklaus Egloff
- Department of Psychosomatic Medicine, University Clinic of Internal Medicine, Inselspital, Bern, Switzerland
| | - Stephan Reichenbach
- University Clinic of Rheumatology, Clinical Immunology and Allergology, Inselspital, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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7
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The medial temporal lobe in nociception: a meta-analytic and functional connectivity study. Pain 2020; 160:1245-1260. [PMID: 30747905 DOI: 10.1097/j.pain.0000000000001519] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent neuroimaging studies implicate the medial temporal lobe (MTL) in nociception and pain modulation. Here, we aim to identify which subregions of the MTL are involved in human pain and to test its connectivity in a cohort of chronic low-back pain patients (CBP). We conducted 2 coordinate-based meta-analyses to determine which regions within the MTL showed consistent spatial patterns of functional activation (1) in response to experimental pain in healthy participants and (2) in chronic pain compared with healthy participants. We followed PRISMA guidelines and performed activation likelihood estimate (ALE) meta-analyses. The first meta-analysis revealed consistent activation in the right anterior hippocampus (right antHC), parahippocampal gyrus, and amygdala. The second meta-analysis revealed consistently less activation in patients' right antHC, compared with healthy participants. We then conducted a seed-to-voxel resting state functional connectivity of the right antHC seed with the rest of the brain in 77 CBP and 79 age-matched healthy participants. We found that CBP had significantly weaker antHC functional connectivity to the medial prefrontal cortex compared with healthy participants. Taken together, these data indicate that the antHC has abnormally lower activity in chronic pain and reduced connectivity to the medial prefrontal cortex in CBP. Future studies should investigate the specific role of the antHC in the development and management of chronic pain.
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8
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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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9
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Abstract
Arterial Spin Labeling (ASL) is a perfusion-based functional magnetic resonance imaging technique that uses water in arterial blood as a freely diffusible tracer to measure regional cerebral blood flow (rCBF) noninvasively. To date its application to the study of pain has been relatively limited. Yet, ASL possesses key features that make it uniquely positioned to study pain in certain paradigms. For instance, ASL is sensitive to very slowly fluctuating brain signals (in the order of minutes or longer). This characteristic makes ASL particularly suitable to the evaluation of brain mechanisms of tonic experimental, post-surgical and ongoing/or continuously varying pain in chronic or acute pain conditions (whereas BOLD fMRI is better suited to detect brain responses to short-lasting or phasic/evoked pain). Unlike positron emission tomography or other perfusion techniques, ASL allows the estimation of rCBF without requiring the administration of radioligands or contrast agents. Thus, ASL is well suited for within-subject longitudinal designs (e.g., to study evolution of pain states over time, or of treatment effects in clinical trials). ASL is also highly versatile, allowing for novel paradigms exploring a flexible array of pain states, plus it can be used to simultaneously estimate not only pain-related alterations in perfusion but also functional connectivity. In conclusion, ASL can be successfully applied in pain paradigms that would be either challenging or impossible to implement using other techniques. Particularly when used in concert with other neuroimaging techniques, ASL can be a powerful tool in the pain imager's toolbox.
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10
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11
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12
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Keszthelyi D, Aziz Q, Ruffle JK, O'Daly O, Sanders D, Krause K, Williams SCR, Howard MA. Delineation between different components of chronic pain using dimension reduction - an ASL fMRI study in hand osteoarthritis. Eur J Pain 2018. [PMID: 29520913 PMCID: PMC6055802 DOI: 10.1002/ejp.1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adjunctive description of pain perception. In this exploratory study, we examine psychometric and neuroimaging data from 38 patients with painful osteoarthritis of the carpometacarpal joint. We had two aims: first, to utilize principal component analysis (PCA) as a dimension reduction strategy across multiple self‐reported endpoints of pain, cognitive and affective functioning; second, to investigate the relationship between identified dimensions and regional cerebral blood flow (rCBF) as an indirect measure of brain activity underpinning their ongoing pain experiences. Methods Psychometric data were collected using validated questionnaires. Quantitative estimates of rCBF were acquired using pseudo‐continuous arterial spin‐labelled functional magnetic resonance imaging. Results Two principal components were identified that accounted for 73% of data variance; one related to pain scores and a second to psychological traits. Voxel‐wise multiple regression analysis revealed a significant negative association between the ‘pain score’ component and rCBF to a right temporal lobe cluster, including the amygdala and the parahippocampal cortex. Conclusion We suggest this association may represent a coping mechanism that aims to reduce fear‐related pain‐anxiety. Further investigation of central brain processing mechanisms in osteoarthritis‐related pain may offer insights into more effective therapeutic strategies. Significance This study demonstrates that dimension reduction using PCA allows insight into pain perception and its affective components in relation to brain activation patterns in patients with painful hand osteoarthritis.
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Affiliation(s)
- D Keszthelyi
- Division of Gastroenterology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Q Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - J K Ruffle
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - O O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - D Sanders
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - K Krause
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - M A Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
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13
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Abstract
Persistent or chronic postsurgical pain (CPSP) has been defined as 'pain persisting beyond 2 months'. The cut-off limit of 2 months has been controversial, and some researchers argue for a 3-month period for the definition of CPSP. Multiple mechanisms, including both patient and surgical, have been shown to influence this transition. Patient factors include age, gender, anxiety, depression, somatisation, catastrophising, pre-existing pain anywhere and pain at the site of surgery. The various surgical factors include site and nature of surgery, infection, inflammation and repeat surgery. There is evidence that pre- or post-op chemotherapy and radiotherapy can also contribute towards the chronification of pain after surgery. The question of why pain following surgery or trauma persists long after the normal healing time is not yet fully explained by current evidence. This is frustrating to healthcare providers and intensely disappointing to the patients, many of whom suffer in silence for years. Genetics is now being shown to influence both the onset and the perpetuation of chronic pain in the susceptible patient. The main mechanisms are believed to be 'single nucleotide polymorphisms' (SNPs) and 'epigenetics', both of which will be discussed, with current and ongoing research and evidence, in this review. The influence of SNPs has not been replicated in recent studies and researchers advise caution in interpreting past studies. More research is needed to demonstrate the involvement of epigenetics as well as linking SNPs to the susceptible patient's journey.
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14
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Devonshire IM, Burston JJ, Xu L, Lillywhite A, Prior MJ, Watson DJG, Greenspon CM, Iwabuchi SJ, Auer DP, Chapman V. Manganese-enhanced magnetic resonance imaging depicts brain activity in models of acute and chronic pain: A new window to study experimental spontaneous pain? Neuroimage 2017. [PMID: 28633971 PMCID: PMC5607296 DOI: 10.1016/j.neuroimage.2017.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Application of functional imaging techniques to animal models is vital to understand pain mechanisms, but is often confounded by the need to limit movement artefacts with anaesthesia, and a focus on evoked responses rather than clinically relevant spontaneous pain and related hyperalgesia. The aim of the present study was to investigate the potential of manganese-enhanced magnetic resonance imaging (MEMRI) to measure neural responses during on-going pain that underpins hyperalgesia in pre-clinical models of nociception. As a proof of concept that MEMRI is sensitive to the neural activity of spontaneous, intermittent behaviour, we studied a separate positive control group undergoing a voluntary running wheel experiment. In the pain models, pain behaviour (weight bearing asymmetry and hindpaw withdrawal thresholds (PWTs)) was measured at baseline and following either intra-articular injection of nerve growth factor (NGF, 10µg/50µl; acute pain model, n=4 rats per group), or the chondrocyte toxin monosodium iodoacetate (MIA, 1mg/50µl; chronic model, n=8 rats per group), or control injection. Separate groups of rats underwent a voluntary wheel running protocol (n=8 rats per group). Rats were administered with paramagnetic ion Mn2+ as soluble MnCl2 over seven days (subcutaneous osmotic pump) to allow cumulative activity-dependent neural accumulation in the models of pain, or over a period of running. T1-weighted MR imaging at 7T was performed under isoflurane anaesthesia using a receive-only rat head coil in combination with a 72mm volume coil for excitation. The pain models resulted in weight bearing asymmetry (NGF: 20.0 ± 5.2%, MIA: 15 ± 3%), and a reduction in PWT in the MIA model (8.3 ± 1.5g) on the final day of assessment before undergoing MR imaging. Voxel-wise and region-based analysis of MEMRI data did not identify group differences in T1 signal. However, MnCl2 accumulation in the VTA, right Ce amygdala, and left cingulate was negatively correlated with pain responses (greater differences in weight bearing), similarly MnCl2 accumulation was reduced in the VTA in line with hyperalgesia (lower PWTs), which suggests reduced regional activation as a result of the intensity and duration of pain experienced during the 7 days of MnCl2 exposure. Motor cortex T1-weighted signal increase was associated with the distance ran in the wheel running study, while no between group difference was seen. Our data suggest that on-going pain related signal changes identified using MEMRI offers a new window to study the neural underpinnings of spontaneous pain in rats.
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Affiliation(s)
- I M Devonshire
- Arthritis Research UK Pain Centre, University of Nottingham, UK; School of Life Sciences, University of Nottingham, UK
| | - J J Burston
- Arthritis Research UK Pain Centre, University of Nottingham, UK; School of Life Sciences, University of Nottingham, UK
| | - L Xu
- Arthritis Research UK Pain Centre, University of Nottingham, UK; School of Life Sciences, University of Nottingham, UK
| | - A Lillywhite
- Arthritis Research UK Pain Centre, University of Nottingham, UK; School of Life Sciences, University of Nottingham, UK
| | - M J Prior
- Medical Imaging Unit, School of Medicine, University of Nottingham, UK
| | - D J G Watson
- School of Life Sciences, University of Nottingham, UK
| | - C M Greenspon
- School of Life Sciences, University of Nottingham, UK
| | - S J Iwabuchi
- Medical Imaging Unit, School of Medicine, University of Nottingham, UK; Neuroradiology, Nottingham University Hospitals Trust, Nottingham NG7 2UH, UK
| | - D P Auer
- Arthritis Research UK Pain Centre, University of Nottingham, UK; Medical Imaging Unit, School of Medicine, University of Nottingham, UK; Neuroradiology, Nottingham University Hospitals Trust, Nottingham NG7 2UH, UK
| | - V Chapman
- Arthritis Research UK Pain Centre, University of Nottingham, UK; School of Life Sciences, University of Nottingham, UK.
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15
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Ssali T, Anazodo UC, Bureau Y, MacIntosh BJ, Günther M, St. Lawrence K. Mapping Long-Term Functional Changes in Cerebral Blood Flow by Arterial Spin Labeling. PLoS One 2016; 11:e0164112. [PMID: 27706218 PMCID: PMC5051683 DOI: 10.1371/journal.pone.0164112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/20/2016] [Indexed: 12/02/2022] Open
Abstract
Although arterial spin labeling (ASL) is appealing for mapping long-term changes in functional activity, inter-sessional variations in basal blood flow, arterial transit times (ATTs), and alignment errors, can result in significant false activation when comparing images from separate sessions. By taking steps to reduce these sources of noise, this study assessed the ability of ASL to detect functional CBF changes between sessions. ASL data were collected in three sessions to image ATT, resting CBF and CBF changes associated with motor activation (7 participants). Activation maps were generated using rest and task images acquired in the same session and from sessions separated by up to a month. Good agreement was found when comparing between-session activation maps to within-session activation maps with only a 16% decrease in precision (within-session: 90 ± 7%) and a 13% decrease in the Dice similarity (within-session: 0.75 ± 0.07) coefficient after a month. In addition, voxel-wise reproducibility (within-session: 4.7 ± 4.5%) and reliability (within-session: 0.89 ± 0.20) of resting grey-matter CBF decreased by less than 18% for the between-session analysis relative to within-session values. ATT variability between sessions (5.0 ± 2.7%) was roughly half the between-subject variability, indicating that its effects on longitudinal CBF were minimal. These results demonstrate that conducting voxel-wise analysis on CBF images acquired on different days is feasible with only modest loss in precision, highlighting the potential of ASL for longitudinal studies.
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Affiliation(s)
- Tracy Ssali
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- * E-mail:
| | - Udunna C. Anazodo
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Yves Bureau
- Lawson Health Research Institute, London, ON, Canada
| | | | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
- Mediri GmbH, Heidelberg, Germany
| | - Keith St. Lawrence
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
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16
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Cottam WJ, Condon L, Alshuft H, Reckziegel D, Auer DP. Associations of limbic-affective brain activity and severity of ongoing chronic arthritis pain are explained by trait anxiety. Neuroimage Clin 2016; 12:269-76. [PMID: 27504262 PMCID: PMC4969259 DOI: 10.1016/j.nicl.2016.06.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/25/2022]
Abstract
Functional magnetic resonance imaging studies (fMRI) have transformed our understanding of central processing of evoked pain but the typically used block and event-related designs are not best suited to the study of ongoing pain. Here we used arterial spin labelling (ASL) for cerebral blood flow mapping to characterise the neural correlates of perceived intensity of osteoarthritis (OA) pain and its interrelation with negative affect. Twenty-six patients with painful knee OA and twenty-seven healthy controls underwent pain phenotyping and ASL MRI at 3T. Intensity of OA pain correlated positively with blood flow in the anterior mid-cingulate cortex (aMCC), subgenual cingulate cortex (sgACC), bilateral hippocampi, bilateral amygdala, left central operculum, mid-insula, putamen and the brainstem. Additional control for trait anxiety scores reduced the pain-CBF association to the aMCC, whilst pain catastrophizing scores only explained some of the limbic correlations. In conclusion, we found that neural correlates of reported intensity of ongoing chronic pain intensity mapped to limbic-affective circuits, and that the association pattern apart from aMCC was explained by trait anxiety thus highlighting the importance of aversiveness in the experience of clinical pain.
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Affiliation(s)
- William J. Cottam
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Laura Condon
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Hamza Alshuft
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Diane Reckziegel
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dorothee P. Auer
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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17
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Tanasescu R, Cottam WJ, Condon L, Tench CR, Auer DP. Functional reorganisation in chronic pain and neural correlates of pain sensitisation: A coordinate based meta-analysis of 266 cutaneous pain fMRI studies. Neurosci Biobehav Rev 2016; 68:120-133. [PMID: 27168346 PMCID: PMC5554296 DOI: 10.1016/j.neubiorev.2016.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 12/19/2022]
Abstract
Maladaptive mechanisms of pain processing in chronic pain conditions (CP) are poorly understood. We used coordinate based meta-analysis of 266 fMRI pain studies to study functional brain reorganisation in CP and experimental models of hyperalgesia. The pattern of nociceptive brain activation was similar in CP, hyperalgesia and normalgesia in controls. However, elevated likelihood of activation was detected in the left putamen, left frontal gyrus and right insula in CP comparing stimuli of the most painful vs. other site. Meta-analysis of contrast maps showed no difference between CP, controls, mood conditions. In contrast, experimental hyperalgesia induced stronger activation in the bilateral insula, left cingulate and right frontal gyrus. Activation likelihood maps support a shared neural pain signature of cutaneous nociception in CP and controls. We also present a double dissociation between neural correlates of transient and persistent pain sensitisation with general increased activation intensity but unchanged pattern in experimental hyperalgesia and, by contrast, focally increased activation likelihood, but unchanged intensity, in CP when stimulated at the most painful body part.
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Affiliation(s)
- Radu Tanasescu
- Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - William J Cottam
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Laura Condon
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Christopher R Tench
- Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.
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Abstract
Nonopioid agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are the most commonly used class of analgesics. Increasing evidence suggests that cyclooxygenase (COX) inhibition at both peripheral and central sites can contribute to the antihyperalgesic effects of NSAIDs, with the predominant clinical effect being mediated centrally. In this study, we examined the cerebral response to ibuprofen in presurgical and postsurgical states and looked at the analgesic interaction between surgical state and treatment. We used an established clinical pain model involving third molar extraction, and quantitative arterial spin labelling (ASL) imaging to measure changes in tonic/ongoing neural activity. Concurrent to the ASL scans, we presented visual analogue scales inside the scanner to evaluate the subjective experience of pain. This novel methodology was incorporated into a randomized double-blind placebo-controlled design, with an open method of drug administration. We found that independent of its antinociceptive action, ibuprofen has no effect on regional cerebral blood flow under pain-free conditions (presurgery). However, in the postsurgical state, we observed increased activation of top-down modulatory circuits, which was accompanied by decreases in the areas engaged because of ongoing pain. Our findings demonstrate that ibuprofen has a measurable analgesic response in the human brain, with the subjective effects of pain relief reflected in two distinct brain networks. The observed activation of descending modulatory circuits warrants further investigation, as this may provide new insights into the inhibitory mechanisms of analgesia that might be exploited to improve safety and efficacy in pain management.
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Segerdahl AR, Mezue M, Okell TW, Farrar JT, Tracey I. The dorsal posterior insula is not an island in pain but subserves a fundamental role - Response to: "Evidence against pain specificity in the dorsal posterior insula" by Davis et al. F1000Res 2015; 4:1207. [PMID: 26834997 PMCID: PMC4706052 DOI: 10.12688/f1000research.7287.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/24/2022] Open
Abstract
An interesting and valuable discussion has arisen from our recent article (Segerdahl, Mezue
et al., 2015) and we are pleased here to have the opportunity to expand on the various points we made. Equally important, we wish to correct several important misunderstandings that were made by Davis and colleagues that possibly contributed to their concerns about power when assessing our paper (e.g. actual subject numbers used in control experiment and the reality of the signal-to-noise and sampling of the multi-TI technique we employed). Here, we clarify the methods and analysis plus discuss how we interpret the data in the Brief Communication noting that the extrapolation and inferences made by Davis and colleagues are not consistent with our report or necessarily, in our opinion, what the data supports. We trust this reassures the
F1000Research readership regarding the robustness of our results and what we actually concluded in the paper regarding their possible meaning. We are pleased, though, that Davis and colleagues have used our article to raise an important discussion around pain perception, and here offer some further insights towards that broader discussion.
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Affiliation(s)
- Andrew R Segerdahl
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - Melvin Mezue
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - Thomas W Okell
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-6291, USA
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
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20
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Davis KD, Bushnell MC, Iannetti GD, St Lawrence K, Coghill R. Evidence against pain specificity in the dorsal posterior insula. F1000Res 2015; 4:362. [PMID: 26401267 PMCID: PMC4566284 DOI: 10.12688/f1000research.6833.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 11/23/2022] Open
Abstract
The search for a “pain centre” in the brain has long eluded neuroscientists. Although many regions of the brain have been shown to respond to painful stimuli, all of these regions also respond to other types of salient stimuli. In a recent paper, Segerdahl
et al. (Nature Neuroscience, 2015) claims that the dorsal posterior insula (dpIns) is a pain-specific region based on the observation that the magnitude of regional cerebral blood flow (rCBF) fluctuations in the dpIns correlated with the magnitude of evoked pain. However, such a conclusion is, simply, not justified by the experimental evidence provided. Here we discuss three major factors that seriously question this claim.
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Affiliation(s)
- Karen D Davis
- Institute of Medical Science and Department of Surgery, University of Toronto, Toronto, ON, M5T 2S8, Canada ; Division of Brain Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, Toronto, ON, M5T 2S8, Canada ; Joint Department of Medical Imaging, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - M Catherine Bushnell
- Pain and Integrative Neuroscience Branch, Division of Intramural Research, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, 20892-1302, USA
| | - Gian Domenico Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Keith St Lawrence
- Lawson Health Research Institute, London, ON, N6A 4V2, Canada ; Department of Medical Biophysics, The University of Western Ontario, London, ON, N6A 4V2, Canada
| | - Robert Coghill
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, 45229-3026, USA
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21
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Abstract
This series of papers aims to provide the dental and medical teams with an update in pain, both acute and chronic orofacial conditions, relevant to dentistry and medicine. Pain is the most common symptom for patients presenting to their dentist, and is increasingly commonly presenting to doctors as well, in general practice and A & E departments. Most of the dental team take for granted their knowledge and ability to manage acute dental pain. However, the education and preparation in managing patients with chronic pain conditions remains poor in many medical and dental schools. Conversely, medics are better educated and exposed to chronic pain during their undergraduate education, however, with regards to orofacial pain education, exposure is diminishing due to decreased exposure to dentistry, ENT, otolaryngology, OMFS and oral surgery. Thus many clinical teams remain disadvantaged when diagnosing and managing orofacial pain. Clinical Relevance: Significant advances that have been made in understanding the pain mechanisms are not to be overlooked and have a huge impact on how we manage patients in pain.
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Mikita N, Mehta MA, Zelaya FO, Stringaris A. Using arterial spin labeling to examine mood states in youth. Brain Behav 2015; 5:e00339. [PMID: 26085964 PMCID: PMC4467773 DOI: 10.1002/brb3.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Little is known about the neural correlates of mood states and the specific physiological changes associated with their valence and duration, especially in young people. Arterial spin labeling (ASL) imaging is particularly well-suited to study sustained cerebral states in young people, due to its robustness to low-frequency drift, excellent interscan reliability, and noninvasiveness. Yet, it has so far been underutilized for understanding the neural mechanisms underlying mood states in youth. METHODS In this exploratory study, 21 healthy adolescents aged 16 to 18 took part in a mood induction experiment. Neutral, sad, and happy mood states were induced using film clips and explicit instructions. An ASL scan was obtained following presentation of each film clip. RESULTS Mood induction led to robust changes in self-reported mood ratings. Compared to neutral, sad mood was associated with increased regional cerebral blood flow (rCBF) in the left middle frontal gyrus and anterior prefrontal cortex, and decreased rCBF in the right middle frontal gyrus and the inferior parietal lobule. A decrease in self-reported mood from neutral to sad condition was associated with increased rCBF in the precuneus. Happy mood was associated with increased rCBF in medial frontal and cingulate gyri, the subgenual anterior cingulate cortex, and ventral striatum, and decreased rCBF in the inferior parietal lobule. The level of current self-reported depressive symptoms was negatively associated with rCBF change in the cerebellum and lingual gyrus following both sad and happy mood inductions. CONCLUSIONS Arterial spin labeling is sensitive to experimentally induced mood changes in healthy young people. The effects of happy mood on rCBF patterns were generally stronger than the effects of sad mood.
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Affiliation(s)
- Nina Mikita
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & NeuroscienceLondon, UK
| | - Mitul A Mehta
- Centre for Neuroimaging Sciences, King's College London, Institute of Psychiatry, Psychology & NeuroscienceLondon, UK
| | - Fernando O Zelaya
- Centre for Neuroimaging Sciences, King's College London, Institute of Psychiatry, Psychology & NeuroscienceLondon, UK
| | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & NeuroscienceLondon, UK
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23
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Hargreaves RJ, Hoppin J, Sevigny J, Patel S, Chiao P, Klimas M, Verma A. Optimizing Central Nervous System Drug Development Using Molecular Imaging. Clin Pharmacol Ther 2015; 98:47-60. [PMID: 25869938 DOI: 10.1002/cpt.132] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/07/2015] [Indexed: 12/12/2022]
Abstract
Advances in multimodality fusion imaging technologies promise to accelerate the understanding of the systems biology of disease and help in the development of new therapeutics. The use of molecular imaging biomarkers has been proven to shorten cycle times for central nervous system (CNS) drug development and thereby increase the efficiency and return on investment from research. Imaging biomarkers can be used to help select the molecules, doses, and patients most likely to test therapeutic hypotheses by stopping those that have little chance of success and accelerating those with potential to achieve beneficial clinical outcomes. CNS imaging biomarkers have the potential to drive new medical care practices for patients in the latent phases of progressive neurodegenerative disorders by enabling the detection, preventative treatment, and tracking of disease in a paradigm shift from today's approaches that have to see the overt symptoms of disease before treating it.
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Affiliation(s)
| | - J Hoppin
- inviCRO, LLC, Boston, Massachusetts, USA
| | - J Sevigny
- Biogen, Cambridge, Massachusetts, USA
| | - S Patel
- Biogen, Cambridge, Massachusetts, USA
| | - P Chiao
- Biogen, Cambridge, Massachusetts, USA
| | - M Klimas
- Merck Research Laboratories, West Point, Pennsylvania, USA
| | - A Verma
- Biogen, Cambridge, Massachusetts, USA
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24
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Avants BB, Duda JT, Kilroy E, Krasileva K, Jann K, Kandel BT, Tustison NJ, Yan L, Jog M, Smith R, Wang Y, Dapretto M, Wang DJJ. The pediatric template of brain perfusion. Sci Data 2015; 2:150003. [PMID: 25977810 PMCID: PMC4413243 DOI: 10.1038/sdata.2015.3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) captures the dynamics of brain development with multiple modalities that quantify both structure and function. These measurements may yield valuable insights into the neural patterns that mark healthy maturation or that identify early risk for psychiatric disorder. The Pediatric Template of Brain Perfusion (PTBP) is a free and public neuroimaging resource that will help accelerate the understanding of childhood brain development as seen through the lens of multiple modality neuroimaging and in relation to cognitive and environmental factors. The PTBP uses cross-sectional and longitudinal MRI to quantify cortex, white matter, resting state functional connectivity and brain perfusion, as measured by Arterial Spin Labeling (ASL), in 120 children 7-18 years of age. We describe the PTBP and show, as a demonstration of validity, that global summary measurements capture the trajectories that demarcate critical turning points in brain maturation. This novel resource will allow a more detailed understanding of the network-level, structural and functional landmarks that are obtained during normal adolescent brain development.
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Affiliation(s)
- Brian B Avants
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jeffrey T Duda
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Emily Kilroy
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Kate Krasileva
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Kay Jann
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Benjamin T Kandel
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Nicholas J Tustison
- Department of Radiology, University of Virginia, Charlottesville, Virginia 22904, USA
| | - Lirong Yan
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Mayank Jog
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Robert Smith
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Yi Wang
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Mirella Dapretto
- Department of Neurology, University of California, Los Angeles, California 90095, USA
| | - Danny J J Wang
- Department of Neurology, University of California, Los Angeles, California 90095, USA
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25
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O'Muircheartaigh J, Marquand A, Hodkinson DJ, Krause K, Khawaja N, Renton TF, Huggins JP, Vennart W, Williams SCR, Howard MA. Multivariate decoding of cerebral blood flow measures in a clinical model of on-going postsurgical pain. Hum Brain Mapp 2014; 36:633-42. [PMID: 25307488 PMCID: PMC4322468 DOI: 10.1002/hbm.22652] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/09/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Recent reports of multivariate machine learning (ML) techniques have highlighted their potential use to detect prognostic and diagnostic markers of pain. However, applications to date have focussed on acute experimental nociceptive stimuli rather than clinically relevant pain states. These reports have coincided with others describing the application of arterial spin labeling (ASL) to detect changes in regional cerebral blood flow (rCBF) in patients with on-going clinical pain. We combined these acquisition and analysis methodologies in a well-characterized postsurgical pain model. The principal aims were (1) to assess the classification accuracy of rCBF indices acquired prior to and following surgical intervention and (2) to optimise the amount of data required to maintain accurate classification. Twenty male volunteers, requiring bilateral, lower jaw third molar extraction (TME), underwent ASL examination prior to and following individual left and right TME, representing presurgical and postsurgical states, respectively. Six ASL time points were acquired at each exam. Each ASL image was preceded by visual analogue scale assessments of alertness and subjective pain experiences. Using all data from all sessions, an independent Gaussian Process binary classifier successfully discriminated postsurgical from presurgical states with 94.73% accuracy; over 80% accuracy could be achieved using half of the data (equivalent to 15 min scan time). This work demonstrates the concept and feasibility of time-efficient, probabilistic prediction of clinically relevant pain at the individual level. We discuss the potential of ML techniques to impact on the search for novel approaches to diagnosis, management, and treatment to complement conventional patient self-reporting.
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Affiliation(s)
- Jonathan O'Muircheartaigh
- Department of Neuroimaging, Institute of Psychiatry, Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
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26
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Zou JX, Wang MJ, Lei XJ, Chen XG. 3.0 T MRI arterial spin labeling and magnetic resonance spectroscopy technology in the application of Alzheimer's disease. Exp Gerontol 2014; 60:31-6. [PMID: 25220149 DOI: 10.1016/j.exger.2014.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/11/2014] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the changes in the cerebral blood flow (CBF) and spectrum variables in the posterior cingulate region of patients with AD under the detection of arterial spin labeling (ASL) and magnetic resonance spectroscopy (MRS). A total of 20 AD patients (8 males and 12 females; mean age, 64.84±8.82 years) and 20 healthy controls (9 males and 11 females; mean age, 64.94±7.93 years) were included in this study for analysis. All images were obtained using a 3.0-T MR imager and an 8-channel head array receiving coil. MRS measurements were conducted exploring variables of metabolite ratios. Statistical analyses were conducted with the SPSS 11.0 statistical software package. Findings in the present study revealed a significant difference in the mean MMSE scores between the AD group and the healthy control group (16.21±4.01 vs. 27.35±1.01, P<0.01). Compared with the healthy control group, CBF in the bilateral frontal region showed a significant decrease in the AD group (right frontal: 83.5±7.2 vs. 110±11.5, P<0.05; left frontal: 85.6±8.1 vs. 108.7±12.2, P<0.05, respectively), and a similar association was also observed in the TL, TPJ, parietal, and hippocampal regions (all P<0.05). MRS imaging in the posterior cingulate region showed a significant reduction in the NAA/Cr ratio in the AD group (1.43±0.1 vs. 1.49±0.0, P<0.05). Additionally, we found that the MI/Cr and Cho/Cr ratios were higher than normal controls in patients with AD (all P<0.05). Our results suggested that 3D ASL detection combined with MRS in studying AD could show the regional hypo-perfusion with the decrease of CBF and the abnormal metabolic changes of the posterior cingulate cortex.
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Affiliation(s)
- Jian-Xun Zou
- Department of Radiology, Lishui People's Hospital, Lishui 323000, PR China.
| | - Ming-Jie Wang
- Department of Radiology, Lishui People's Hospital, Lishui 323000, PR China
| | - Xin-Jun Lei
- Department of Radiology, Lishui People's Hospital, Lishui 323000, PR China
| | - Xu-Gao Chen
- Department of Radiology, Lishui People's Hospital, Lishui 323000, PR China
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27
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Werner MU, Bischoff JM. Persistent postsurgical pain: evidence from breast cancer surgery, groin hernia repair, and lung cancer surgery. Curr Top Behav Neurosci 2014; 20:3-29. [PMID: 24523139 DOI: 10.1007/7854_2014_285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalences of severe persistent postsurgical pain (PPP) following breast cancer surgery (BCS), groin hernia repair (GHR), and lung cancer surgery (LCS) are 13, 2, and 4-12 %, respectively. Estimates indicate that 80,000 patients each year in the U.S.A. are affected by severe pain and debilitating impairment in the aftermath of BCS, GHR, and LCS. Data across the three surgical procedures indicate a 35-65 % decrease in prevalence of PPP at 4-6 years follow-up. However, this is outweighed by late-onset PPP, which appears following a pain-free interval. The consequences of PPP include severe impairments of physical, psychological, and socioeconomic aspects of life. The pathophysiology underlying PPP consists of a continuing inflammatory response, a neuropathic component, and/or a late reinstatement of postsurgical inflammatory pain. While the sensory profiles of PPP-patients and pain-free controls are comparable with hypofunction on the surgical side, this seems to be accentuated in PPP-patients. In BCS-patients and GHR-patients, the sensory profiles indicate inflammatory and neuropathic components with contribution of central sensitization. A number of surgical factors including increased duration of surgery, repeat surgery, more invasive surgical techniques, and intraoperative nerve lesion have been associated with PPP. One of the most consistent predictive factors for PPP is high intensity acute postsurgical pain, but also psychological factors including anxiety, catastrophizing trait, depression, and psychological vulnerability have been identified as significant predictors of PPP. The quest to identify improved surgical and anesthesiological techniques to prevent severe pain and functional impairment in patients after surgery continues.
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Affiliation(s)
- Mads Utke Werner
- Multidisciplinary Pain Center 7612, Neuroscience Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark,
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Wise RG, Harris AD, Stone AJ, Murphy K. Measurement of OEF and absolute CMRO2: MRI-based methods using interleaved and combined hypercapnia and hyperoxia. Neuroimage 2013; 83:135-47. [PMID: 23769703 PMCID: PMC4151288 DOI: 10.1016/j.neuroimage.2013.06.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/30/2013] [Accepted: 06/05/2013] [Indexed: 02/02/2023] Open
Abstract
Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) is most commonly used in a semi-quantitative manner to infer changes in brain activity. Despite the basis of the image contrast lying in the cerebral venous blood oxygenation level, quantification of absolute cerebral metabolic rate of oxygen consumption (CMRO2) has only recently been demonstrated. Here we examine two approaches to the calibration of fMRI signal to measure absolute CMRO2 using hypercapnic and hyperoxic respiratory challenges. The first approach is to apply hypercapnia and hyperoxia separately but interleaved in time and the second is a combined approach in which we apply hyperoxic challenges simultaneously with different levels of hypercapnia. Eleven healthy volunteers were studied at 3T using a dual gradient-echo spiral readout pulsed arterial spin labelling (ASL) imaging sequence. Respiratory challenges were conducted using an automated system of dynamic end-tidal forcing. A generalised BOLD signal model was applied, within a Bayesian estimation framework, that aims to explain the effects of modulation of CBF and arterial oxygen content to estimate venous deoxyhaemoglobin concentration ([dHb]0). Using CBF measurements combined with the estimated oxygen extraction fraction (OEF), absolute CMRO2 was calculated. The interleaved approach to hypercapnia and hyperoxia, as well as yielding estimates of CMRO2 and OEF demonstrated a significant increase in regional CBF, venous oxygen saturation (SvO2) (a decrease in OEF) and absolute CMRO2 in visual cortex in response to a continuous (20 min) visual task, demonstrating the potential for the method in measuring long term changes in CMRO2. The combined approach to oxygen and carbon dioxide modulation, as well as taking less time to acquire data, yielded whole brain grey matter estimates of CMRO2 and OEF of 184±45 μmol/100 g/min and 0.42±0.12 respectively, along with additional estimates of the vascular parameters α=0.33±0.06, the exponent relating relative increases in CBF to CBV, and β=1.35±0.13, the exponent relating deoxyhaemoglobin concentration to the relaxation rate R2*. Maps of cerebrovascular and cerebral metabolic parameters were also calculated. We show that combined modulation of oxygen and carbon dioxide can offer an experimentally more efficient approach to estimating OEF and absolute CMRO2 along with the additional vascular parameters that form an important part of the commonly used calibrated fMRI signal model.
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Affiliation(s)
- Richard G Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Park Place, Cardiff CF10 3AT, UK.
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29
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Abstract
Chronic pain is a state of physical suffering strongly associated with feelings of anxiety, depression and despair. Disease pathophysiology, psychological state, and social milieu can influence chronic pain, but can be difficult to diagnose based solely on clinical presentation. Here, we review brain neuroimaging research that is shaping our understanding of pain mechanisms, and consider how such knowledge might lead to useful diagnostic tools for the management of persistent pain in individual patients.
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Affiliation(s)
- M C Lee
- Nuffield Division of Anaesthetics and Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK.
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30
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Hooker B, Tobon G, Baker S, Zhu C, Hesterman J, Schmidt K, Rajagovindan R, Chandran P, Joshi S, Bannon A, Hoppin J, Beaver J, Fox G, Day M, Upadhyay J. Gabapentin-induced pharmacodynamic effects in the spinal nerve ligation model of neuropathic pain. Eur J Pain 2013; 18:223-37. [DOI: 10.1002/j.1532-2149.2013.00364.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2013] [Indexed: 12/15/2022]
Affiliation(s)
- B.A. Hooker
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | | | - S.J. Baker
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - C. Zhu
- Neuroscience Discovery; Abbvie Inc.; North Chicago USA
| | | | | | - R. Rajagovindan
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - P. Chandran
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - S.K. Joshi
- Neuroscience Discovery; Abbvie Inc.; North Chicago USA
| | - A.W. Bannon
- Neuroscience Discovery; Abbvie Inc.; North Chicago USA
| | | | - J. Beaver
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - G.B. Fox
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - M. Day
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
| | - J. Upadhyay
- Integrated Science and Technology; Abbvie Inc.; North Chicago USA
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31
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Maleki N, Brawn J, Barmettler G, Borsook D, Becerra L. Pain response measured with arterial spin labeling. NMR IN BIOMEDICINE 2013; 26:664-673. [PMID: 23319440 PMCID: PMC3634868 DOI: 10.1002/nbm.2911] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 06/01/2023]
Abstract
The majority of functional MRI studies of pain processing in the brain use the blood oxygenation level-dependent (BOLD) imaging approach. However, the BOLD signal is complex as it depends on simultaneous changes in blood flow, vascular volume and oxygen metabolism. Arterial spin labeling (ASL) perfusion imaging is another imaging approach in which the magnetically labeled arterial water is used as an endogenous tracer that allows for direct measurement of cerebral blood flow. In this study, we assessed the pain response in the brain using a pulsed-continuous arterial spin labeling (pCASL) approach and a thermal stimulation paradigm. Using pCASL, response to noxious stimulation was detected in somatosensory cortex, anterior cingulate cortex, anterior insula, hippocampus, amygdala, thalamus and precuneus, consistent with the pain response activation patterns detected using the BOLD imaging approach. We suggest that pCASL is a reliable alternative for functional MRI pain studies in conditions in which blood flow, volume or oxygen extraction are altered or compromised.
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Affiliation(s)
- Nasim Maleki
- P.A.I.N. Group, Department of Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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32
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Harvey AK, Taylor AM, Wise RG. Imaging pain in arthritis: advances in structural and functional neuroimaging. Curr Pain Headache Rep 2013; 16:492-501. [PMID: 23011761 DOI: 10.1007/s11916-012-0297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Arthritis is a heterogeneous disease characterized by joint stiffness, swelling, and pain. Although primarily considered a peripheral joint disease, the severity of pain reported by arthritis patients does not always reflect the extent of joint pathology detectable by conventional means. Using structural and functional brain imaging techniques, a growing number of evolving neuroimaging methods are providing insight into these observed discrepancies at different time-scales. Of these methods, functional magnetic resonance imaging is exploited for short-term evoked pain examination and treatment evaluation; 'resting-state' approaches provide insight into fluctuations in pain; perfusion imaging captures elements of on-going clinical pain; and morphological brain assessment provides evidence for long-term structural changes in the brain associated with chronic pain. Further insight into arthritic pain processing at the brain-systems level could in the future be provided by combined neuroimaging approaches, specifically investigating the interactions between functional and structural alterations.
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Affiliation(s)
- Ann K Harvey
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, CF10 3AX, UK.
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33
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Hodkinson DJ, Krause K, Khawaja N, Renton TF, Huggins JP, Vennart W, Thacker MA, Mehta MA, Zelaya FO, Williams SCR, Howard MA. Quantifying the test-retest reliability of cerebral blood flow measurements in a clinical model of on-going post-surgical pain: A study using pseudo-continuous arterial spin labelling. NEUROIMAGE-CLINICAL 2013; 3:301-310. [PMID: 24143296 PMCID: PMC3797555 DOI: 10.1016/j.nicl.2013.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Arterial spin labelling (ASL) is increasingly being applied to study the cerebral response to pain in both experimental human models and patients with persistent pain. Despite its advantages, scanning time and reliability remain important issues in the clinical applicability of ASL. Here we present the test–retest analysis of concurrent pseudo-continuous ASL (pCASL) and visual analogue scale (VAS), in a clinical model of on-going pain following third molar extraction (TME). Using ICC performance measures, we were able to quantify the reliability of the post-surgical pain state and ΔCBF (change in CBF), both at the group and individual case level. Within-subject, the inter- and intra-session reliability of the post-surgical pain state was ranked good-to-excellent (ICC > 0.6) across both pCASL and VAS modalities. The parameter ΔCBF (change in CBF between pre- and post-surgical states) performed reliably (ICC > 0.4), provided that a single baseline condition (or the mean of more than one baseline) was used for subtraction. Between-subjects, the pCASL measurements in the post-surgical pain state and ΔCBF were both characterised as reliable (ICC > 0.4). However, the subjective VAS pain ratings demonstrated a significant contribution of pain state variability, which suggests diminished utility for interindividual comparisons. These analyses indicate that the pCASL imaging technique has considerable potential for the comparison of within- and between-subjects differences associated with pain-induced state changes and baseline differences in regional CBF. They also suggest that differences in baseline perfusion and functional lateralisation characteristics may play an important role in the overall reliability of the estimated changes in CBF. Repeated measures designs have the important advantage that they provide good reliability for comparing condition effects because all sources of variability between subjects are excluded from the experimental error. The ability to elicit reliable neural correlates of on-going pain using quantitative perfusion imaging may help support the conclusions derived from subjective self-report. Test-retest reliability of pCASL is considered in a post-surgical pain model. Pain-state and ∆CBF measurements were reliable at the group and individual level. Single or average baseline measurements improve reliability of ∆CBF. pCASL is a reliable technique for detecting cerebral responses to on-going pain.
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Affiliation(s)
- Duncan J Hodkinson
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Kings College London, London, UK
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34
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Newton JT. Interpreting pain as 'catastrophic' makes it worse: the neurological basis. J Dent Res 2012; 92:107-8. [PMID: 23232146 DOI: 10.1177/0022034512470138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- J T Newton
- Unit of Social and Behavioral Sciences, King's College London Dental Institute, Bessemer Road, London, UK
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35
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Alterations in resting-state regional cerebral blood flow demonstrate ongoing pain in osteoarthritis: An arterial spin-labeled magnetic resonance imaging study. ACTA ACUST UNITED AC 2012; 64:3936-46. [DOI: 10.1002/art.37685] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/23/2012] [Indexed: 11/07/2022]
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36
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Loggia ML, Kim J, Gollub RL, Vangel MG, Kirsch I, Kong J, Wasan AD, Napadow V. Default mode network connectivity encodes clinical pain: an arterial spin labeling study. Pain 2012; 154:24-33. [PMID: 23111164 DOI: 10.1016/j.pain.2012.07.029] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/19/2012] [Accepted: 07/26/2012] [Indexed: 11/29/2022]
Abstract
Neuroimaging studies have suggested the presence of alterations in the anatomo-functional properties of the brain of patients with chronic pain. However, investigation of the brain circuitry supporting the perception of clinical pain presents significant challenges, particularly when using traditional neuroimaging approaches. While potential neuroimaging markers for clinical pain have included resting brain connectivity, these cross-sectional studies have not examined sensitivity to within-subject exacerbation of pain. We used the dual regression probabilistic Independent Component Analysis approach to investigate resting-state connectivity on arterial spin labeling data. Brain connectivity was compared between patients with chronic low back pain (cLBP) and healthy controls, before and after the performance of maneuvers aimed at exacerbating clinical pain levels in the patients. Our analyses identified multiple resting state networks, including the default mode network (DMN). At baseline, patients demonstrated stronger DMN connectivity to the pregenual anterior cingulate cortex (pgACC), left inferior parietal lobule, and right insula (rINS). Patients' baseline clinical pain correlated positively with connectivity strength between the DMN and right insula (DMN-rINS). The performance of calibrated physical maneuvers induced changes in pain, which were paralleled by changes in DMN-rINS connectivity. Maneuvers also disrupted the DMN-pgACC connectivity, which at baseline was anticorrelated with pain. Finally, baseline DMN connectivity predicted maneuver-induced changes in both pain and DMN-rINS connectivity. Our results support the use of arterial spin labeling to evaluate clinical pain, and the use of resting DMN connectivity as a potential neuroimaging biomarker for chronic pain perception.
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Affiliation(s)
- Marco L Loggia
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School (HMS), Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, HMS, Boston, MA, USA MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Program in Placebo Studies & the Therapeutic Encounter, Beth Israel Deaconess Medical Center, HMS, Boston, MA, USA Department of Psychiatry, Brigham and Women's Hospital, HMS, Boston, MA, USA
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37
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Central Mechanisms of Pain Revealed Through Functional and Structural MRI. J Neuroimmune Pharmacol 2012; 8:518-34. [DOI: 10.1007/s11481-012-9386-8] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/02/2012] [Indexed: 12/31/2022]
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38
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Hughes JP, Chessell I, Malamut R, Perkins M, Bačkonja M, Baron R, Farrar JT, Field MJ, Gereau RW, Gilron I, McMahon SB, Porreca F, Rappaport BA, Rice F, Richman LK, Segerdahl M, Seminowicz DA, Watkins LR, Waxman SG, Wiech K, Woolf C. Understanding chronic inflammatory and neuropathic pain. Ann N Y Acad Sci 2012; 1255:30-44. [PMID: 22564068 DOI: 10.1111/j.1749-6632.2012.06561.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This meeting report highlights the main topics presented at the conference "Chronic Inflammatory and Neuropathic Pain," convened jointly by the New York Academy of Sciences, MedImmune, and Grünenthal GmbH, on June 2-3, 2011, with the goal of providing a conducive environment for lively, informed, and synergistic conversation among participants from academia, industry, clinical practice, and government to explore new frontiers in our understanding and treatment of chronic and neuropathic pain. The program included leading and emerging investigators studying the pathophysiological mechanisms underlying neuropathic and chronic pain, and experts in the clinical development of pain therapies. Discussion included novel issues, current challenges, and future directions of basic research in pain and preclinical and clinical development of new therapies for chronic pain.
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39
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Farrell MJ. Age-Related Changes in the Structure and Function of Brain Regions Involved in Pain Processing. PAIN MEDICINE 2012; 13 Suppl 2:S37-43. [DOI: 10.1111/j.1526-4637.2011.01287.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Handley R, Zelaya FO, Reinders AATS, Marques TR, Mehta MA, O'Gorman R, Alsop DC, Taylor H, Johnston A, Williams S, McGuire P, Pariante CM, Kapur S, Dazzan P. Acute effects of single-dose aripiprazole and haloperidol on resting cerebral blood flow (rCBF) in the human brain. Hum Brain Mapp 2012; 34:272-82. [PMID: 22451196 DOI: 10.1002/hbm.21436] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 06/22/2011] [Accepted: 07/25/2011] [Indexed: 11/07/2022] Open
Abstract
Antipsychotic drugs act on the dopaminergic system (first-generation antipsychotics, FGA), but some also directly affect serotonergic function (second-generation antipsychotics, SGA) in the brain. Short and long-term effects of these drugs on brain physiology remain poorly understood. Moreover, it remains unclear whether any physiological effect in the brain may be different for FGAs and SGAs. Immediate (+3.30 h) and different effects of single-dose FGA (haloperidol, 3 mg) and a SGA (aripiprazole, 10 mg) on resting cerebral blood flow (rCBF) were explored in the same 20 healthy volunteers using a pulsed continuous arterial spin labeling (pCASL) sequence (1.5T) in a placebo-controlled, repeated measures design. Both antipsychotics increased striatal rCBF but the effect was greater after haloperidol. Both decreased frontal rCBF, and opposite effects of the drugs were observed in the temporal cortex (haloperidol decreased, aripiprazole increased rCBF) and in the posterior cingulate (haloperidol increased, aripiprazole decreased rCBF). Further increases were evident in the insula, hippocampus, and anterior cingulate after both antipsychotics, in the motor cortex following haloperidol and in the occipital lobe the claustrum and the cerebellum after aripiprazole. Further decreases were observed in the parietal and occipital cortices after aripiprazole. This study suggests that early and different rCBF changes are evident following a single-dose of FGA and SGA. The effects occur in healthy volunteers, thus may be independent from any underlying pathology, and in the same regions identified as structurally and functionally altered in schizophrenia, suggesting a possible relationship between antipsychotic-induced rCBF changes and brain alterations in schizophrenia.
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Affiliation(s)
- Rowena Handley
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, United Kingdom.
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Imaging the neural correlates of neuropathic pain and pleasurable relief associated with inherited erythromelalgia in a single subject with quantitative arterial spin labelling. Pain 2012; 153:1122-1127. [PMID: 22365309 PMCID: PMC3438450 DOI: 10.1016/j.pain.2011.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/05/2011] [Accepted: 12/12/2011] [Indexed: 11/23/2022]
Abstract
We identified a patient with severe inherited erythromelalgia secondary to an L858F mutation in the voltage-gated sodium channel Nav1.7. The patient reported severe ongoing foot pain, which was exquisitely sensitive to limb cooling. We confirmed this heat hypersensitivity using quantitative sensory testing. Additionally, we employed a novel perfusion imaging technique in a simple block design to assess her baseline erythromelalgia pain vs cooling relief. Robust activations of key pain, pain-affect, and reward-related centres were observed. This combined approach allowed us to confirm the presence of a temperature-sensitive channelopathy of peripheral neurons and to investigate the neural correlates of tonic neuropathic pain and relief in a single subject.
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43
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Detre JA, Rao H, Wang DJJ, Chen YF, Wang Z. Applications of arterial spin labeled MRI in the brain. J Magn Reson Imaging 2012; 35:1026-37. [PMID: 22246782 DOI: 10.1002/jmri.23581] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 12/15/2011] [Indexed: 01/18/2023] Open
Abstract
Perfusion provides oxygen and nutrients to tissues and is closely tied to tissue function while disorders of perfusion are major sources of medical morbidity and mortality. It has been almost two decades since the use of arterial spin labeling (ASL) for noninvasive perfusion imaging was first reported. While initial ASL magnetic resonance imaging (MRI) studies focused primarily on technological development and validation, a number of robust ASL implementations have emerged, and ASL MRI is now also available commercially on several platforms. As a result, basic science and clinical applications of ASL MRI have begun to proliferate. Although ASL MRI can be carried out in any organ, most studies to date have focused on the brain. This review covers selected research and clinical applications of ASL MRI in the brain to illustrate its potential in both neuroscience research and clinical care.
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Affiliation(s)
- John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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44
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Rossaneis AC, Reis GM, Prado WA. Stimulation of the occipital or retrosplenial cortex reduces incision pain in rats. Pharmacol Biochem Behav 2011; 100:220-7. [DOI: 10.1016/j.pbb.2011.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/26/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022]
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