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Sedighimehr N, Razeghi M, Rezaei I. Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial. Heliyon 2024; 10:e31699. [PMID: 38841514 PMCID: PMC11152953 DOI: 10.1016/j.heliyon.2024.e31699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the "static needling", the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception. Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).
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Affiliation(s)
- Najmeh Sedighimehr
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Rezaei
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Kleeva D, Soghoyan G, Biktimirov A, Piliugin N, Matvienko Y, Sintsov M, Lebedev M. Modulations in high-density EEG during the suppression of phantom-limb pain with neurostimulation in upper limb amputees. Cereb Cortex 2024; 34:bhad504. [PMID: 38220575 DOI: 10.1093/cercor/bhad504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Phantom limb pain (PLP) is a distressing and persistent sensation that occurs after the amputation of a limb. While medication-based treatments have limitations and adverse effects, neurostimulation is a promising alternative approach whose mechanism of action needs research, including electroencephalographic (EEG) recordings for the assessment of cortical manifestation of PLP relieving effects. Here we collected and analyzed high-density EEG data in 3 patients (P01, P02, and P03). Peripheral nerve stimulation suppressed PLP in P01 but was ineffective in P02. In contrast, transcutaneous electrical nerve stimulation was effective in P02. In P03, spinal cord stimulation was used to suppress PLP. Changes in EEG oscillatory components were analyzed using spectral analysis and Petrosian fractal dimension. With these methods, changes in EEG spatio-spectral components were found in the theta, alpha, and beta bands in all patients, with these effects being specific to each individual. The changes in the EEG patterns were found for both the periods when PLP level was stationary and the periods when PLP was gradually changing after neurostimulation was turned on or off. Overall, our findings align with the proposed roles of brain rhythms in thalamocortical dysrhythmia or disruption of cortical excitation and inhibition which has been linked to neuropathic pain. The individual differences in the observed effects could be related to the specifics of each patient's treatment and the unique spectral characteristics in each of them. These findings pave the way to the closed-loop systems for PLP management where neurostimulation parameters are adjusted based on EEG-derived markers.
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Affiliation(s)
- Daria Kleeva
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University
| | - Gurgen Soghoyan
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
| | - Artur Biktimirov
- Laboratory of Experimental and Translational Medicine, School of Biomedicine, Far Eastern Federal University
| | - Nikita Piliugin
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
| | | | | | - Mikhail Lebedev
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences
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3
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Mathew J, Perez TM, Adhia DB, De Ridder D, Mani R. Is There a Difference in EEG Characteristics in Acute, Chronic, and Experimentally Induced Musculoskeletal Pain States? a Systematic Review. Clin EEG Neurosci 2024; 55:101-120. [PMID: 36377346 DOI: 10.1177/15500594221138292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Electroencephalographic (EEG) alterations have been demonstrated in acute, chronic, and experimentally induced musculoskeletal (MSK) pain conditions. However, there is no cumulative evidence on the associated EEG characteristics differentiating acute, chronic, and experimentally induced musculoskeletal pain states, especially compared to healthy controls. The present systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA) to review and summarize available evidence for cortical brain activity and connectivity alterations in acute, chronic, and experimentally induced MSK pain states. Five electronic databases were systematically searched from their inception to 2022. A total of 3471 articles were screened, and 26 full articles (five studies on chronic pain and 21 studies on experimentally induced pain) were included for the final synthesis. Using the Downs and Black risk of assessment tool, 92% of the studies were assessed as low to moderate quality. The review identified a 'very low' level of evidence for the changes in EEG and subjective outcome measures for both chronic and experimentally induced MSK pain based on the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Overall, the findings of this review indicate a trend toward decreased alpha and beta EEG power in evoked chronic clinical pain conditions and increased theta and alpha power in resting-state EEG recorded from chronic MSK pain conditions. EEG characteristics are unclear under experimentally induced pain conditions.
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Affiliation(s)
- Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Tyson Michael Perez
- Department of Surgical Sciences, Section of Neurosurgery, Otago Medical School-Dunedin campus, University of Otago, Dunedin, New Zealand
| | - Divya Bharatkumar Adhia
- Department of Surgical Sciences, Section of Neurosurgery, Otago Medical School-Dunedin campus, University of Otago, Dunedin, New Zealand
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Otago Medical School-Dunedin campus, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Lopes TS, Santana JE, Silva WS, Fraga FJ, Montoya P, Sá KN, Lopes LC, Lucena R, Zana Y, Baptista AF. Increased Delta and Theta Power Density in Sickle Cell Disease Individuals with Chronic Pain Secondary to Hip Osteonecrosis: A Resting-State Eeg Study. Brain Topogr 2023:10.1007/s10548-023-01027-x. [PMID: 38060074 DOI: 10.1007/s10548-023-01027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Identify the presence of a dysfunctional electroencephalographic (EEG) pattern in individuals with sickle cell disease (SCD) and hip osteonecrosis, and assess its potential associations with depression, anxiety, pain severity, and serum levels of brain-derived neurotrophic factor (BDNF). METHODS In this cross-sectional investigation, 24 SCD patients with hip osteonecrosis and chronic pain were matched by age and sex with 19 healthy controls. Resting-state EEG data were recorded using 32 electrodes for both groups. Power spectral density (PSD) and peak alpha frequency (PAF) were computed for each electrode across Delta, Theta, Alpha, and Beta frequency bands. Current Source Density (CSD) measures were performed utilizing the built-in Statistical nonparametric Mapping Method of the LORETA-KEY software. RESULTS Our findings demonstrated that SCD individuals exhibited higher PSD in delta and theta frequency bands when compared to healthy controls. Moreover, SCD individuals displayed increased CSD in delta and theta frequencies, coupled with decreased CSD in the alpha frequency within brain regions linked to pain processing, motor function, emotion, and attention. In comparison to the control group, depression symptoms, and pain intensity during hip abduction were positively correlated with PSD and CSD in the delta frequency within the parietal region. Depression symptoms also exhibited a positive association with PSD and CSD in the theta frequency within the same region, while serum BDNF levels showed a negative correlation with CSD in the alpha frequency within the left insula. CONCLUSION This study indicates that individuals with SCD experiencing hip osteonecrosis and chronic pain manifest a dysfunctional EEG pattern characterized by the persistence of low-frequency PSD during a resting state. This dysfunctional EEG pattern may be linked to clinical and biochemical outcomes, including depression symptoms, pain severity during movement, and serum BDNF levels.
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Affiliation(s)
- Tiago S Lopes
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, Santo Andre, Brazil.
- NAPEN network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, Brazil.
- Bahia Adventist College, Cachoeira, Brazil.
| | - Jamille E Santana
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, Santo Andre, Brazil
- NAPEN network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, Brazil
| | | | - Francisco J Fraga
- Engineering, Modelling, and Applied Social Sciences Center, Federal University of ABC, Santo André, SP, Brazil
| | - Pedro Montoya
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, Santo Andre, Brazil
- Research Institute of Health Sciences, University of Balearic Islands, Palma de Mallorca, Spain
| | - Katia N Sá
- NAPEN network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, Brazil
- Postgraduate and Research, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Larissa C Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Rita Lucena
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Yossi Zana
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, Santo Andre, Brazil
| | - Abrahão F Baptista
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, Santo Andre, Brazil
- NAPEN network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, Brazil
- Laboratory of Medical Investigations 54, Clinics Hospital, São Paulo State University, São Paulo, Brazil
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Bemani S, Sarrafzadeh J, Dehkordi SN, Talebian S, Salehi R, Zarei J. Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial. Adv Rheumatol 2023; 63:57. [PMID: 38049905 DOI: 10.1186/s42358-023-00329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. METHODS 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. RESULTS There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. CONCLUSIONS In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
- Department of Rehabilitation Management, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Bemani S, Sarrafzadeh J, Noorizadeh Dehkordi S, Talebian S, Salehi R, Zarei J. The Analysis of Spontaneous Electroencephalogram (EEG) in Chronic Low Back Pain Patients Compared with Healthy Subjects. Med J Islam Repub Iran 2023; 37:128. [PMID: 38318405 PMCID: PMC10843364 DOI: 10.47176/mjiri.37.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 02/07/2024] Open
Abstract
Background Quantitative electroencephalography (EEG) power spectra analysis was applied to assess brain activation during chronic pain. Although many studies have shown that there are some common characteristics among individuals suffering from various pain syndromes, the data remains inconclusive. The present study aimed to assess chronic low back pain (CLBP) based on functional brain changes with EEG in CLBP patients compared with healthy controls. Methods Multichannel electroencephalogram data were recorded from 30 subjects with CLBP and 30 healthy controls under eye-open resting state conditions and active lumbar forward flexion, and their cortical oscillations were compared using electrode-level analysis. Data were analyzed using a pair t-test. Results A total of 30 patients (19 men and 11 women in the case group (mean [SD] age, 35.23 [5.93] years) with 30 age and sex-match healthy controls participated in the study. A paired t-test was applied to identify whether there was any difference in the absolute and relative power of frequency spectra between CLBP patients and healthy controls. The results showed a significant increase in alpha relative power in CLBP patients compared with healthy controls in an open-eye resting state ( P < 0.050) and active lumbar forward flexion ( P < 0.050). Conclusion The enhanced alpha relative power in CLBP patients could be relevant to attenuating sensory information gating and excessive integration of pain-related information. Increased power at the EEG seems to be one of the clinical characteristics of individuals with CLBP. EEG can be a simple and objective tool for studying the mechanisms involved in chronic pain and identifying specific characteristics of CLBP patients.
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Affiliation(s)
- Sanaz Bemani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Gervasio S, Zarei AA, Mrachacz-Kersting N. EEG signatures of low back and knee joint pain during movement execution: a short report. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1216069. [PMID: 37662545 PMCID: PMC10468999 DOI: 10.3389/fresc.2023.1216069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023]
Abstract
Chronic musculoskeletal pain has a high prevalence between European citizens, affecting their quality of life and their ability to work. The plastic changes associated with the occurrence of chronic musculoskeletal pain are still not fully understood. The current short report investigated the possible changes in brain activity caused by pain during movement in two of the most common musculoskeletal pain disorders in Denmark, knee pain and low back pain. Electroencephalography (EEG) was recorded from 20 participants (5 participants with knee pain, 5 with low back pain and 10 healthy controls). Participants with pain performed a movement that evoked pain in the area of interest, and the healthy controls performed the same movement. Electromyographic (EMG) signals were also collected to identify movement initiation. No differences were observed in brain activity of participants with pain and healthy controls during rest. During movement execution, though, participants with pain showed significantly higher event related synchronization in the alpha and beta bands compared to healthy controls. These changes could be related to higher cognitive processing, possibly due to the attempt of suppressing the pain. These results highlight the importance of assessing cortical activity during movement to reveal plastic changes due to musculoskeletal pain. This adds to our knowledge regarding plastic changes in cortical activity related to musculoskeletal pain in different locations. Such knowledge could help us identify neurophysiological markers for clinical changes and contribute to the development of new treatment approaches based on neuromodulation such as neurofeedback.
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Affiliation(s)
- Sabata Gervasio
- Neural Engineering and Neurophysiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ali Asghar Zarei
- Neural Engineering and Neurophysiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- REDO—Neurosystems, Aalborg, Denmark
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Rockholt MM, Kenefati G, Doan LV, Chen ZS, Wang J. In search of a composite biomarker for chronic pain by way of EEG and machine learning: where do we currently stand? Front Neurosci 2023; 17:1186418. [PMID: 37389362 PMCID: PMC10301750 DOI: 10.3389/fnins.2023.1186418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Machine learning is becoming an increasingly common component of routine data analyses in clinical research. The past decade in pain research has witnessed great advances in human neuroimaging and machine learning. With each finding, the pain research community takes one step closer to uncovering fundamental mechanisms underlying chronic pain and at the same time proposing neurophysiological biomarkers. However, it remains challenging to fully understand chronic pain due to its multidimensional representations within the brain. By utilizing cost-effective and non-invasive imaging techniques such as electroencephalography (EEG) and analyzing the resulting data with advanced analytic methods, we have the opportunity to better understand and identify specific neural mechanisms associated with the processing and perception of chronic pain. This narrative literature review summarizes studies from the last decade describing the utility of EEG as a potential biomarker for chronic pain by synergizing clinical and computational perspectives.
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Affiliation(s)
- Mika M. Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain 2023; 164:1200-1221. [PMID: 36409624 PMCID: PMC10184564 DOI: 10.1097/j.pain.0000000000002825] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACT Reliable and objective biomarkers promise to improve the assessment and treatment of chronic pain. Resting-state electroencephalography (EEG) is broadly available, easy to use, and cost efficient and, therefore, appealing as a potential biomarker of chronic pain. However, results of EEG studies are heterogeneous. Therefore, we conducted a systematic review (PROSPERO CRD42021272622) of quantitative resting-state EEG and magnetoencephalography (MEG) studies in adult patients with different types of chronic pain. We excluded populations with severe psychiatric or neurologic comorbidity. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Semiquantitative data synthesis was conducted using modified albatross plots. We included 76 studies after searching MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and EMBASE. For cross-sectional studies that can serve to develop diagnostic biomarkers, we found higher theta and beta power in patients with chronic pain than in healthy participants. For longitudinal studies, which can yield monitoring and/or predictive biomarkers, we found no clear associations of pain relief with M/EEG measures. Similarly, descriptive studies that can yield diagnostic or monitoring biomarkers showed no clear correlations of pain intensity with M/EEG measures. Risk of bias was high in many studies and domains. Together, this systematic review synthesizes evidence on how resting-state M/EEG might serve as a diagnostic biomarker of chronic pain. Beyond, this review might help to guide future M/EEG studies on the development of pain biomarkers.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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10
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Larie MS, Esfandiarpour F, Riahi F, Parnianpour M. Brain Wave Patterns in Patients With Chronic Low Back Pain: A Case-control Study. Basic Clin Neurosci 2023; 14:225-235. [PMID: 38107529 PMCID: PMC10719979 DOI: 10.32598/bcn.2021.2398.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 09/25/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2023] Open
Abstract
Introduction Research evidence indicates that maladaptive reorganization of the brain plays a critical role in amplifying pain experiences and pain chronification; however, no clear evidence of change exists in brain wave activity among patients with chronic low back pain (CLBP). The objective of this study was to assess brain wave activity in patients with CLBP, compared to healthy controls. Methods Twenty-five patients with CLBP and twenty-four healthy controls participated in the study. A quantitative electroencephalography device was used to assess brain wave activity in eyes-open and eyes-closed (EO and EC) conditions. The regional absolute and relative power of brain waves were compared between the groups. Results Our results showed a significant increase in the absolute power of theta (F=5.905, P=0.019), alpha (F=5.404, P=0.024) waves in patients with CLBP compared to healthy subjects in both EC and EO conditions. Patients with CLBP showed a reduced delta absolute power in the frontal region (F=5.852, P=0.019) and augmented delta absolute power in the central region (F=5.597, P=0.022) in the EO condition. An increased delta absolute power was observed in the frontal (F=7.563 P=0.008), central (F=10.430, P=0.002), and parietal (F=4.596, P=0.037) regions in patients with CLBP compared to the healthy subjects in the EC condition. In the EC condition, significant increases in theta relative power (F=4.680, P=0.036) in the parietal region were also found in patients with CLBP. Conclusion The increased absolute power of brain waves in people with CLBP may indicate cortical overactivity and changes in the pain processing mechanisms in these patients. Highlights Chronic low back pain (CLBP) increases the alpha, theta, and delta power in the brain.CLBP is associated with increased brain wave activity in the frontal, central, and parietal regions.Our findings suggest altered central pain processing in CLBP. Plain Language Summary Traditional diagnosis and treatment of CLBP are mainly focused on peripheral pathology. But, the modern neuroscience approach to pain highlights the role of cortical plasticity in chronic musculoskeletal pain. In this regard, several studies found structural and functional changes in the brain in patients with chronic pain. Detailed knowledge about cortical changes in CLBP can improve our understanding of mechanisms involved in CLBP, opening a new window to better treatment of LBP (Low back pain). This study investigated brain wave activity in patients with CLBP compared to healthy individuals. Our findings suggest increased brain activity in various parts of the brain in patients with chronic LBP. This finding indicates that CLBP treatment should focus on both peripheral and cortical factors rather than local tissue damage.
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Affiliation(s)
- Maryam Sadat Larie
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fateme Esfandiarpour
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Forough Riahi
- Department of Psychiatry, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Faculty of Biomechanics, Sharif University of Technology, Tehran, Iran
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11
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Takeuchi N. Pain control based on oscillatory brain activity using transcranial alternating current stimulation: An integrative review. Front Hum Neurosci 2023; 17:941979. [PMID: 36742359 PMCID: PMC9892942 DOI: 10.3389/fnhum.2023.941979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Developing effective tools and strategies to relieve chronic pain is a high-priority scientific and clinical goal. In particular, the brain regions related to pain processing have been investigated as potential targets to relieve pain by non-invasive brain stimulation (NIBS). In addition to elucidating the relationship between pain and oscillatory brain activity, transcranial alternating current stimulation (tACS), which can non-invasively entrain oscillatory brain activity and modulate oscillatory brain communication, has attracted scientific attention as a possible technique to control pain. This review focuses on the use of tACS to relieve pain through the manipulation of oscillatory brain activity and its potential clinical applications. Several studies have reported that tACS on a single brain reduces pain by normalizing abnormal oscillatory brain activity in patients with chronic pain. Interpersonal tACS approaches based on inter-brain synchrony to manipulate inter-brain communication may result in pain relief via prosocial effects. Pain is encoded by the spatiotemporal neural communication that represents the integration of cognitive, emotional-affective, and sensorimotor aspects of pain. Therefore, future studies should seek to identify the pathological oscillatory brain communication in chronic pain as a therapeutic target for tACS. In conclusion, tACS could be effective for re-establishing oscillatory brain activity and assisting social interaction, and it might help develop novel approaches for pain control.
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12
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Electroencephalographic characteristics of children and adolescents with chronic musculoskeletal pain. Pain Rep 2022; 7:e1054. [PMID: 36601627 PMCID: PMC9788982 DOI: 10.1097/pr9.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The pathophysiology of pediatric musculoskeletal (MSK) pain is unclear, contributing to persistent challenges to its management. Objectives This study hypothesizes that children and adolescents with chronic MSK pain (CPs) will show differences in electroencephalography (EEG) features at rest and during thermal pain modalities when compared with age-matched controls. Methods One hundred forty-two CP patients and 45 age-matched healthy controls (HCs) underwent a standardized thermal tonic heat and cold stimulations, while a 21-electrode headset collected EEG data. Cohorts were compared with respect to their EEG features of spectral power, peak frequency, permutation entropy, weight phase-lag index, directed phase-lag index, and node degree at 4 frequency bands, namely, delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz), at rest and during the thermal conditions. Results At rest, CPs showed increased global delta (P = 0.0493) and beta (P = 0.0002) power in comparison with HCs. These findings provide further impetus for the investigation and prevention of long-lasting developmental sequalae of early life chronic pain processes. Although no cohort differences in pain intensity scores were found during the thermal pain modalities, CPs and HCs showed significant difference in changes in EEG spectral power, peak frequency, permutation entropy, and network functional connectivity at specific frequency bands (P < 0.05) during the tonic heat and cold stimulations. Conclusion This suggests that EEG can characterize subtle differences in heat and cold pain sensitivity in CPs. The complementation of EEG and evoked pain in the clinical assessment of pediatric chronic MSK pain can better detect underlying pain mechanisms and changes in pain sensitivity.
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Transkranielle Wechselstromstimulation zur Modulation von Oszillationen bei Schmerzerkrankungen. Schmerz 2022:10.1007/s00482-022-00684-4. [PMID: 36508031 DOI: 10.1007/s00482-022-00684-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic pain is a common health problem, for which the treatment is complex and challenging. Non-invasive brain stimulation techniques, specifically transcranial alternating current stimulation (tACS), show promise as a well-tolerated new therapeutic modality with few side effects. This is supported by growing evidence of an association between altered neuronal oscillations and chronic pain. However, to date, only a handful of studies with variable methodology have evaluated tACS for potential applicability to patients with chronic pain. OBJECTIVES Presentation and discussion of the evidence thus far, evaluation of a potential therapeutic benefit for chronic pain patients. MATERIALS AND METHODS Literature search in MEDLINE, Embase, Cochrane Library, and Google Scholar databases. RESULTS To date, tACS for chronic pain therapy has been investigated in only three studies with very different methodological approaches and quality. DISCUSSION These data currently do not provide sufficient evidence for the therapeutic use of tACS for chronic pain therapy. Future studies may address the question of a therapeutic benefit of tACS for this indication utilizing improved stimulation techniques and considering existing recommendations for the design and conduct of tACS studies.
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14
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Relief of chronic pain associated with increase in midline frontal theta power. Pain Rep 2022; 7:e1040. [PMID: 36247110 PMCID: PMC9555895 DOI: 10.1097/pr9.0000000000001040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Unique electroencephalogram signatures of relief from chronic pain demonstrate theta power increase in the midline frontal cortex. Introduction: Objectives: Methods: Results: Conclusion:
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15
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Mazaheri A, Seminowicz DA, Furman AJ. Peak alpha frequency as a candidate biomarker of pain sensitivity: the importance of distinguishing slow from slowing. Neuroimage 2022; 262:119560. [PMID: 35973563 DOI: 10.1016/j.neuroimage.2022.119560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
The study by Valentini et al. (2022) observed that the peak alpha frequency (PAF) of participants became slower after they were exposed to painful, as well as non-painful but unpleasant stimuli. The authors interpreted this as a challenge to our previous studies which propose that the speed of resting PAF, independently of pain-induced changes to PAF, can be a reliable biomarker marker for gaging individual pain sensitivity. While investigations into the role that PAF plays in pain perception are timely, we have some concerns about the assumptions and methodology employed by Valentini et al. Moreover, we believe the authors here have also misrepresented some of our previous work. In the current commentary, we detail the critical differences between our respective studies, with the ultimate aim of guiding future investigations.
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Affiliation(s)
- Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, UK; Centre for Human Brain Health (CHBH), University of Birmingham, Birmingham, UK.
| | - David A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrew J Furman
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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16
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Mussigmann T, Bardel B, Lefaucheur JP. Resting-state electroencephalography (EEG) biomarkers of chronic neuropathic pain. A systematic review. Neuroimage 2022; 258:119351. [PMID: 35659993 DOI: 10.1016/j.neuroimage.2022.119351] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022] Open
Abstract
Diagnosis and management of chronic neuropathic pain are challenging, leading to current efforts to characterize 'objective' biomarkers of pain using imaging or neurophysiological techniques, such as electroencephalography (EEG). A systematic literature review was conducted in PubMed-Medline and Web-of-Science until October 2021 to identify EEG biomarkers of chronic neuropathic pain in humans. The risk of bias was assessed by the Newcastle-Ottawa-Scale. Experimental, provoked, or chronic non-neuropathic pain studies were excluded. We identified 14 studies, in which resting-state EEG spectral analysis was compared between patients with pain related to a neurological disease and patients with the same disease but without pain or healthy controls. From these heterogeneous exploratory studies, some conclusions can be drawn, even if they must be weighted by the fact that confounding factors, such as medication and association with anxio-depressive disorders, are generally not taken into account. Overall, EEG signal power was increased in the θ band (4-7Hz) and possibly in the high-β band (20-30Hz), but decreased in the high-α-low-β band (10-20Hz) in the presence of ongoing neuropathic pain, while increased γ band oscillations were not evidenced, unlike in experimental pain. Consequently, the dominant peak frequency was decreased in the θ-α band and increased in the whole-β band in neuropathic pain patients. Disappointingly, pain intensity correlated with various EEG changes across studies, with no consistent trend. This review also discusses the location of regional pain-related EEG changes in the pain connectome, as the perspectives offered by advanced techniques of EEG signal analysis (source location, connectivity, or classification methods based on artificial intelligence). The biomarkers provided by resting-state EEG are of particular interest for optimizing the treatment of chronic neuropathic pain by neuromodulation techniques, such as transcranial alternating current stimulation or neurofeedback procedures.
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Affiliation(s)
- Thibaut Mussigmann
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Benjamin Bardel
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France.
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17
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Zolezzi DM, Alonso-Valerdi LM, Ibarra-Zarate DI. Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization. Neurosci Biobehav Rev 2022; 136:104599. [PMID: 35271915 DOI: 10.1016/j.neubiorev.2022.104599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
The management of chronic neuropathic pain remains a challenge, because pain is subjective, and measuring it objectively is usually out of question. However, neuropathic pain is also a signal provided by maladaptive neuronal activity. Thus, the integral management of chronic neuropathic pain should not only rely on the subjective perception of the patient, but also on objective data that measures the evolution of neuronal activity. We will discuss different objective and subjective methods for the characterization of neuropathic pain. Additionally, the gaps and proposals for an integral management of chronic neuropathic pain will also be discussed. The current management that relies mostly on subjective measures has not been sufficient, therefore, this has hindered advances in pain management and clinical trials. If an integral characterization is achieved, clinical management and stratification for clinical trials could be based on both questionnaires and neuronal activity. Appropriate characterization may lead to an increased effectiveness for new therapies, and a better quality of life for neuropathic pain sufferers.
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Affiliation(s)
- Daniela M Zolezzi
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Monterrey 64849, Nuevo León, México; Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg 9220, Denmark.
| | | | - David I Ibarra-Zarate
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Puebla 72453, Puebla, México
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18
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Mao CP, Wilson G, Cao J, Meshberg N, Huang Y, Kong J. Abnormal Anatomical and Functional Connectivity of the Thalamo-sensorimotor Circuit in Chronic Low Back Pain: Resting-state Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Study. Neuroscience 2022; 487:143-154. [PMID: 35134490 PMCID: PMC8930700 DOI: 10.1016/j.neuroscience.2022.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
Thalamocortical dysfunction is thought to underlie the pathophysiology of chronic pain revealed by electroencephalographic studies. The thalamus serves as a primary relay center to transmit sensory information and motor impulses via dense connections with the somatosensory and motor cortex. In this study, diffusion tensor imaging (DTI) (probabilistic tractography) and resting-state functional magnetic resonance imaging (functional connectivity) were used to characterize the anatomical and functional integrity of the thalamo-sensorimotor pathway in chronic low back pain (cLBP). Fifty-four patients with cLBP and 54 healthy controls were included. The results suggested significantly increased anatomical connectivity of the left thalamo-motor pathway characterized by probabilistic tractography in patients with cLBP. Moreover, there was significantly altered resting-state functional connectivity (rsFC) of bilateral thalamo-motor/somatosensory pathways in patients with cLBP as compared to healthy controls. We also detected a significant correlation between pain intensity during the MRI scan and rsFC of the right thalamo-somatosensory pathway in cLBP. Our findings highlight the involvement of the thalamo-sensorimotor circuit in the pathophysiology of cLBP.
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Affiliation(s)
- Cui Ping Mao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Nathaniel Meshberg
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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19
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Millard SK, Bokelmann K, Schalbroeck R, van der Wee NJA, van Loey NEE, van Laarhoven AIM. No indications for altered EEG oscillatory activity in patients with chronic post-burn itch compared to healthy controls. Sci Rep 2022; 12:5184. [PMID: 35338171 PMCID: PMC8956573 DOI: 10.1038/s41598-022-08742-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
A large proportion of patients with burn injuries develop chronic itch, which impacts quality of life. The underlying pathophysiological mechanisms are poorly understood. This cross-sectional pilot study investigates whether altered cortical oscillatory processes are involved in chronic post-burn itch. Continuous electroencephalography (EEG) data were recorded during rest and stimulation of non-injured skin, inducing itch (histamine and electrical) and cold-pressor task pain for 15 adults with chronic post-burn itch and 15 matched healthy controls. Quantitative metrics comprised oscillatory power and peak frequencies in theta, alpha, and beta bands. No statistical differences between patients and healthy controls were found in oscillatory activity during rest or stimulation, with Bayesian analysis suggesting equivocal evidence. However, post-traumatic stress symptoms and duration of chronic itch may be associated with changes in oscillatory activity. A lack of differences in cortical oscillatory processing and itch levels at non-injured sites, suggests that itch symptoms have a localised character in this sample of patients with post-burn itch. For future studies, a biopsychological approach with integration of peripheral and central nervous system techniques, linear and non-linear EEG analysis, injured and non-injured stimulation sites, and incorporation of individual characteristics is recommended. Insight into pathophysiological mechanisms underlying chronic post-burn itch could improve diagnostics and treatments.
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Affiliation(s)
- Samantha K Millard
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.,Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, Sydney, NSW, 2031, Australia.,School of Medical Science, Faculty of Medicine, University of New South Wales, 18 High St, Kensington, Sydney, NSW, 2052, Australia
| | - Klara Bokelmann
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Rik Schalbroeck
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nancy E E van Loey
- Association of Dutch Burn Centers, Maasstad Hospital, Burn Center, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.,Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. .,Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition (LIBC), Leiden University, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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20
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Simis M, Imamura M, Pacheco-Barrios K, Marduy A, de Melo PS, Mendes AJ, Teixeira PEP, Battistella L, Fregni F. EEG theta and beta bands as brain oscillations for different knee osteoarthritis phenotypes according to disease severity. Sci Rep 2022; 12:1480. [PMID: 35087082 PMCID: PMC8795380 DOI: 10.1038/s41598-022-04957-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
This study aims to investigate the multivariate relationship between different sociodemographic, clinical, and neurophysiological variables with resting-state, high-definition, EEG spectral power in subjects with chronic knee osteoarthritis (OA) pain. This was a cross-sectional study. Sociodemographic and clinical data were collected from 66 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models by frequency bands (delta, theta, alpha, beta, low-beta, and high-beta) and by pre-defined regions (frontal, central, and parietal). From adjusted multivariate models, we found that: (1) increased frontocentral high-beta power and reduced central theta activity are positively correlated with pain intensity (β = 0.012, 95% CI 0.004-0.020; and β = - 0.008; 95% CI 0.014 to - 0.003; respectively); (2) delta and alpha oscillations have a direct relationship with higher cortical inhibition; (3) diffuse increased power at low frequencies (delta and theta) are associated with poor cognition, aging, and depressive symptoms; and (4) higher alpha and beta power over sensorimotor areas seem to be a maladaptive compensatory mechanism to poor motor function and severe joint degeneration. Subjects with higher pain intensity and higher OA severity (likely subjects with maladaptive compensatory mechanisms to severe OA) have higher frontocentral beta power and lower theta activity. On the other hand, subjects with less OA severity and less pain have higher theta oscillations power. These associations showed the potential role of brain oscillations as a marker of pain intensity and clinical phenotypes in chronic knee OA patients. Besides, they suggest a potential compensatory mechanism of these two brain oscillators according to OA severity.
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Affiliation(s)
- Marcel Simis
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marta Imamura
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA
| | - Paulo S de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA
| | - Augusto J Mendes
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Paulo E P Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA
| | - Linamara Battistella
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA, USA.
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21
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Hu XS, Nascimento TD, DaSilva AF. Shedding light on pain for the clinic: a comprehensive review of using functional near-infrared spectroscopy to monitor its process in the brain. Pain 2021; 162:2805-2820. [PMID: 33990114 PMCID: PMC8490487 DOI: 10.1097/j.pain.0000000000002293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Pain is a complex experience that involves sensation, emotion, and cognition. The subjectivity of the traditional pain measurement tools has expedited the interest in developing neuroimaging techniques to monitor pain objectively. Among noninvasive neuroimaging techniques, functional near-infrared spectroscopy (fNIRS) has balanced spatial and temporal resolution; yet, it is portable, quiet, and cost-effective. These features enable fNIRS to image the cortical mechanisms of pain in a clinical environment. In this article, we evaluated pain neuroimaging studies that used the fNIRS technique in the past decade. Starting from the experimental design, we reviewed the regions of interest, probe localization, data processing, and primary findings of these existing fNIRS studies. We also discussed the fNIRS imaging's potential as a brain surveillance technique for pain, in combination with artificial intelligence and extended reality techniques. We concluded that fNIRS is a brain imaging technique with great potential for objective pain assessment in the clinical environment.
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Affiliation(s)
- Xiao-Su Hu
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Thiago D. Nascimento
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
| | - Alexandre F. DaSilva
- University of Michigan, School of Dentistry, Biologic & Materials Sciences Department, Hedache & Orofacial Pain Effort Lab
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22
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Bessa DR, Dunkel MADA, Bessa LR, Cruz LAB, Avena KDM, Lessa BF. Association between headache and tinnitus among medical students. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:982-988. [PMID: 34816995 DOI: 10.1590/0004-282x-anp-2021-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Headache is a very common complaint and it is increasingly prevalent among university students. Tinnitus consists of subjectively perceived sounds that occur in the absence of an external auditory signal. Presence of headache and tinnitus in association has implications for therapy and prognosis, because this describes the temporality of the symptoms. Recognition of the epidemiological profile of symptomatic students might contribute to interventions. OBJECTIVE To investigate the prevalence of the association between headache and tinnitus, and to describe the epidemiological profile of the study population and the chronological order of appearance of these symptoms. METHODS Cross-sectional, observational and analytical study on a sample representative of an academic center. Data referring to the epidemiological and clinical profile of headache and tinnitus among medical students were collected through an online questionnaire built using the Google Forms tool. RESULTS Out of the 234 participants, 26.1% reported having tinnitus and headache (p < 0.001). The participants with headache were more likely to be women (p = 0.045), white (p = 0.009) and 21-25 years old (p = 0.356). Among right-sided, left-sided and non-unilateral headaches, tinnitus was present predominantly in the non-unilateral type, but without statistical significance. Regarding timing, 18.0% of the students said that tinnitus started before headache, 57.4% said that headache started before tinnitus and 24.6% said that they started simultaneously. CONCLUSIONS An important association between headache and tinnitus regarding lateralization and temporality was demonstrated. Thus, these data match the presumption that headache and tinnitus have a physiopathological connection.
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23
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Bemani S, Dehkordi SN, Sarrafzadeh J, Talebian S, Salehi R, Zarei J. Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial. Trials 2021; 22:679. [PMID: 34620205 PMCID: PMC8499517 DOI: 10.1186/s13063-021-05580-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain. METHODS This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up. DISCUSSION Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran.
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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24
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Vanneste S, De Ridder D. Chronic pain as a brain imbalance between pain input and pain suppression. Brain Commun 2021; 3:fcab014. [PMID: 33758824 PMCID: PMC7966784 DOI: 10.1093/braincomms/fcab014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is pain that persists beyond the expected period of healing. The subjective experience of chronic pain results from pathological brain network interactions, rather than from persisting physiological sensory input of nociceptors. We hypothesize that pain is an imbalance between pain evoking dorsal anterior cingulate cortex and somatosensory cortex and pain suppression (i.e. pregenual anterior cingulate cortex). This imbalance can be measured objectively by current density ratios between pain input and pain inhibition. A balance between areas involved in pain input and pain suppression requires communication, which can be objectively identified by connectivity measures, both functional and effective connectivity. In patients with chronic neuropathic pain, electroencephalography is performed with source localization demonstrating that pain is reflected by an abnormal ratio between the dorsal anterior cingulate cortex, somatosensory cortex and pregenual anterior cingulate cortex. Functional connectivity demonstrates decreased communication between these areas, and effective connectivity puts the culprit at the dorsal anterior cingulate cortex, suggesting that the problem is related to abnormal behavioral relevance attached to the pain. In conclusion, chronic pain can be considered as an imbalance between pain input and pain suppression.
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Affiliation(s)
- Sven Vanneste
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, 9016 Dunedin, New Zealand
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25
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Wang WE, Ho RLM, Gatto B, van der Veen SM, Underation MK, Thomas JS, Antony AB, Coombes SA. Cortical dynamics of movement-evoked pain in chronic low back pain. J Physiol 2020; 599:289-305. [PMID: 33067807 DOI: 10.1113/jp280735] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 01/22/2023] Open
Abstract
KEY POINTS Cortical activity underlying movement-evoked pain is not well understood, despite being a key symptom of chronic musculoskeletal pain. We combined high-density electroencephalography with a full-body reaching protocol in a virtual reality environment to assess cortical activity during movement-evoked pain in chronic low back pain. Movement-evoked pain in individuals with chronic low back pain was associated with longer reaction times, delayed peak velocity and greater movement variability. Movement-evoked pain was associated with attenuated disinhibition in prefrontal motor areas, as evidenced by an attenuated reduction in beta power in the premotor cortex and supplementary motor area. ABSTRACT Although experimental pain alters neural activity in the cortex, evidence of changes in neural activity in individuals with chronic low back pain (cLBP) remains scarce and results are inconsistent. One of the challenges in studying cLBP is that the clinical pain fluctuates over time and often changes during movement. The goal of the present study was to address this challenge by recording high-density electroencephalography (HD-EEG) data during a full-body reaching task to understand neural activity during movement-evoked pain. HD-EEG data were analysed using independent component analyses, source localization and measure projection analyses to compare neural oscillations between individuals with cLBP who experienced movement-evoked pain and pain-free controls. We report two novel findings. First, movement-evoked pain in individuals with cLBP was associated with longer reaction times, delayed peak velocity and greater movement variability. Second, movement-evoked pain was associated with an attenuated reduction in beta power in the premotor cortex and supplementary motor area. Our observations move the field forward by revealing attenuated disinhibition in prefrontal motor areas during movement-evoked pain in cLBP.
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Affiliation(s)
- Wei-En Wang
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - Rachel L M Ho
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - Bryan Gatto
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Susanne M van der Veen
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, VA, USA
| | - Matthew K Underation
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, VA, USA
| | - James S Thomas
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, VA, USA
| | | | - Stephen A Coombes
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
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26
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Ta Dinh S, Nickel MM, Tiemann L, May ES, Heitmann H, Hohn VD, Edenharter G, Utpadel-Fischler D, Tölle TR, Sauseng P, Gross J, Ploner M. Brain dysfunction in chronic pain patients assessed by resting-state electroencephalography. Pain 2020; 160:2751-2765. [PMID: 31356455 PMCID: PMC7195856 DOI: 10.1097/j.pain.0000000000001666] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is a common and severely disabling disease whose treatment is often unsatisfactory. Insights into the brain mechanisms of chronic pain promise to advance the understanding of the underlying pathophysiology and might help to develop disease markers and novel treatments. Here, we systematically exploited the potential of electroencephalography to determine abnormalities of brain function during the resting state in chronic pain. To this end, we performed state-of-the-art analyses of oscillatory brain activity, brain connectivity, and brain networks in 101 patients of either sex suffering from chronic pain. The results show that global and local measures of brain activity did not differ between chronic pain patients and a healthy control group. However, we observed significantly increased connectivity at theta (4-8 Hz) and gamma (>60 Hz) frequencies in frontal brain areas as well as global network reorganization at gamma frequencies in chronic pain patients. Furthermore, a machine learning algorithm could differentiate between patients and healthy controls with an above-chance accuracy of 57%, mostly based on frontal connectivity. These results suggest that increased theta and gamma synchrony in frontal brain areas are involved in the pathophysiology of chronic pain. Although substantial challenges concerning the reproducibility of the findings and the accuracy, specificity, and validity of potential electroencephalography-based disease markers remain to be overcome, our study indicates that abnormal frontal synchrony at theta and gamma frequencies might be promising targets for noninvasive brain stimulation and/or neurofeedback approaches.
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Affiliation(s)
- Son Ta Dinh
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Moritz M Nickel
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Laura Tiemann
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Elisabeth S May
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Henrik Heitmann
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Vanessa D Hohn
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Günther Edenharter
- Department of Anesthesiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Utpadel-Fischler
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas R Tölle
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Paul Sauseng
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany.,Centre for Cognitive Neuroimaging, University of Glasgow, Glasgow, United Kingdom
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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27
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Abnormal alpha band power in the dynamic pain connectome is a marker of chronic pain with a neuropathic component. NEUROIMAGE-CLINICAL 2020; 26:102241. [PMID: 32203904 PMCID: PMC7090370 DOI: 10.1016/j.nicl.2020.102241] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 01/08/2023]
Abstract
High theta and low gamma activity in the dynamic pain connectome is linked to chronic pain. High alpha-band activity is present when neuropathic pain is likely. Spectral frequency band strength distinguish neuropathic from non-neuropathic pain.
We previously identified alpha frequency slowing and beta attenuation in the dynamic pain connectome related to pain severity and interference in patients with multiple sclerosis-related neuropathic pain (NP). Here, we determined whether these abnormalities, are markers of aberrant temporal dynamics in non-neuropathic inflammatory pain (non-NP) or when NP is also suspected. We measured resting-state magnetoencephalography (MEG) spectral density in 45 people (17 females, 28 males) with chronic back pain due to ankylosing spondylitis (AS) and 38 age/sex matched healthy controls. We used painDETECT scores to divide the chronic pain group into those with only non-NP (NNP) and those who likely also had a component of NP in addition to their inflammatory pain. We also assessed pain severity, pain interference, and disease activity with the Brief Pain Inventory and Bath AS Disease Activity Index (BASDAI). We examined spectral power in the dynamic pain connectome, including nodes of the ascending nociceptive pathway (ANP), default mode (DMN), and salience networks (SN). Compared to the healthy controls, the AS patients exhibited increased theta power in the DMN and decreased low-gamma power in the DMN and ANP, but did not exhibit beta-band attenuation or peak-alpha slowing. The NNP patients were not different from HCs. Compared to both healthy controls and NNP, NP patients had increased alpha power in the ANP. Increased alpha power within the ANP was associated with reduced BASDAI in the NNP group, and increased pain in the mixed-NP group within the DMN, SN, and ANP. Thus, high theta and low gamma activity may be markers of chronic pain but high alpha-band activity may relate to particular features of neuropathic chronic pain.
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28
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Moon D, Plečkaitytė G, Choi T, Seol M, Kim B, Lee D, Han J, Meyyappan M. On-Demand Printing of Wearable Thermotherapy Pad. Adv Healthc Mater 2020; 9:e1901575. [PMID: 31945277 DOI: 10.1002/adhm.201901575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/16/2019] [Indexed: 11/07/2022]
Abstract
Thermotherapy is an effective method for pain relief, recovery from injury, and general healthcare. The ordinary heat pad used for thermotherapy at home is not usually tailored to the individual but supplied in a few different pre-fixed sizes and shapes for mass marketing. A customized wearable heat pad often requires expert support. Herein, an instant, custom-fit, and on-demand heat pad for thermotherapy is demonstrated. The heater is directly printed using silver nanoparticle ink on an off-the-shelf medical grade tape by inkjet technology. By coating the tape with silica nanoparticles as ink-absorbing layer and chloride ions as chemical sintering agent, stable heater patterns are printed without the need for subsequent high temperature sintering process. A 3D scanner is used to acquire body information, and a customized heater is produced using the information. The printed heat pad is attached to the shoulder and the effect of thermotherapy is verified objectively through electroencephalography and subjectively through survey. This printed heat pad produced by simple and low-cost fabrication provides wearable medical devices for personal thermotherapy.
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Affiliation(s)
- Dong‐Il Moon
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Universities Space Research AssociationNASA Ames Research Center Mountain View CA 94035 USA
| | - Gintarė Plečkaitytė
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Institute of Chemistry and GeosciencesVilnius University Vilnius LT‐03225 Lithuania
| | - Taejun Choi
- Looxid Labs 636 Montage Circle East Palo Alto CA 94303 USA
| | - Myeong‐Lok Seol
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Universities Space Research AssociationNASA Ames Research Center Mountain View CA 94035 USA
| | - Beomseok Kim
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Universities Space Research AssociationNASA Ames Research Center Mountain View CA 94035 USA
| | - Dongil Lee
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Universities Space Research AssociationNASA Ames Research Center Mountain View CA 94035 USA
| | - Jin‐Woo Han
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
- Universities Space Research AssociationNASA Ames Research Center Mountain View CA 94035 USA
| | - M. Meyyappan
- Center for NanotechnologyNASA Ames Research Center Mountain View CA 94035 USA
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29
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Krupina NA, Churyukanov MV, Kukushkin ML, Yakhno NN. Central Neuropathic Pain and Profiles of Quantitative Electroencephalography in Multiple Sclerosis Patients. Front Neurol 2020; 10:1380. [PMID: 32038459 PMCID: PMC6990108 DOI: 10.3389/fneur.2019.01380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Pain has a significant impact on the quality of life of patients with multiple sclerosis (MS). However, the neurophysiological mechanisms of central neuropathic pain in a MS course are not known. We hypothesized that changes in power spectral density (PSD) that take place in the electroencephalography (EEG) of MS patients with and without the central neuropathic pain (CNP) would differ. The study aimed to assess the features of quantitative EEG using the PSD indicator along with peak frequencies in the standard frequency bands in MS patients with and without CNP. We have analyzed the quantitative spectral content of the EEG at a resting state in 12 MS patients with CNP, 12 MS patients without CNP, and 12 gender- and age-matched healthy controls using fast Fourier transformation. Based on the ANOVA, at the group level, the theta band absolute and relative PSD showed an increase, whereas alpha band relative PSD showed a decrease in MS patients both with and without CNP. However, only in MS with CNP group, the absolute and relative PSD in the beta1 and beta2 bands increased and exceeded that in patients without pain. Only MS patients with CNP demonstrated the significantly increased absolute PSD for the theta, beta1, and beta2 frequency bands in most regions of interest. In the theta band, MS patients with CNP displayed the increase in absolute spectral power for the mid-temporal derivation of the right hemisphere and the increase in relative spectral power for the prefrontal derivation of this hemisphere. In the beta1 band, the increase in absolute spectral power was observed for the three temporal derivations of the right hemisphere, whereas in the beta2 band, for the occipital, parietal, and temporal lobes of both hemispheres. In the alpha band, only a relative spectral power decrease was revealed for the occipital lobes of both hemispheres and parietal lobe of the right hemisphere. In MS patients with CNP, the frequencies of the dominant spectral power (peak frequencies) in the high-frequency beta band were higher than in the healthy control in posterior areas of the left hemisphere. Data could represent central nervous system alterations related to central neuropathic pain in MS patients that lead to the disturbances in cortical communication.
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Affiliation(s)
- Nataliya A Krupina
- Laboratory of General Pathology of the Nervous System, The Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Maxim V Churyukanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Clinic of Pain Study and Treatment, B.V. Petrovsky Russian Scientific Surgery Center, Moscow, Russia
| | - Mikhail L Kukushkin
- Laboratory of Fundamental and Applied Problems of Pain, The Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Nikolay N Yakhno
- Scientific and Research Department of Neurology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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30
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From correlation towards causality: modulating brain rhythms of pain using transcranial alternating current stimulation. Pain Rep 2019; 4:e723. [PMID: 31579843 PMCID: PMC6727992 DOI: 10.1097/pr9.0000000000000723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Accumulating evidence suggests that neural oscillations at different frequencies and their synchrony between brain regions play a crucial role in the processing of nociceptive input and the emergence of pain. Most findings are limited by their correlative nature, however, which impedes causal inferences. Objective To move from correlative towards causal evidence, methods that allow to experimentally manipulate oscillatory brain activity are needed. Results Transcranial alternating current stimulation (tACS) is a noninvasive brain stimulation technique designed to modulate neural oscillations in a frequency specific manner and as such a suitable method to investigate the contribution of oscillatory brain activity to pain. Despite its appeal, tACS has been barely applied in the field of pain research. In the present review, we address this issue and discuss how tACS can be used to gather mechanistic evidence for the relationship between pain and neural oscillations in humans. Conclusions Transcranial alternating current stimulation holds great potential for the investigation of the neural mechanisms underlying pain and the development of new treatment approaches for chronic pain if necessary methodological precautions are taken.
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31
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Hyperexcitability of Cortical Oscillations in Patients with Somatoform Pain Disorder: A Resting-State EEG Study. Neural Plast 2019; 2019:2687150. [PMID: 31360161 PMCID: PMC6652032 DOI: 10.1155/2019/2687150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 01/21/2023] Open
Abstract
Patients with somatoform pain disorder (SPD) suffer from somatic pain that cannot be fully explained by specific somatic pathology. While the pain experience requires the integration of sensory and contextual processes, the cortical oscillations have been suggested to play a crucial role in pain processing and integration. The present study is aimed at identifying the abnormalities of spontaneous cortical oscillations among patients with SPD, thus for a better understanding of the ongoing brain states in these patients. Spontaneous electroencephalography data during a resting state with eyes open were recorded from SPD patients and healthy controls, and their cortical oscillations as well as functional connectivity were compared using both electrode-level and source-level analysis. Compared with healthy controls, SPD patients exhibited greater resting-state alpha oscillations (8.5-12.5 Hz) at the parietal region, as reflected by both electrode-level spectral power density and exact low-resolution brain electromagnetic tomography (eLORETA) cortical current density. A significant correlation between parietal alpha oscillation and somatization severity was observed in SPD patients, after accounting for the influence of anxiety and depression. Functional connectivity analysis further revealed a greater frontoparietal connectivity of the resting-state alpha oscillations in SPD patients, which was indexed by the coherence between pairs of electrodes and the linear connectivity between pairs of eLORETA cortical sources. The enhanced resting-state alpha oscillation in SPD patients could be relevant with attenuated sensory information gating and excessive integration of pain-related information, while the enhanced frontoparietal connectivity could be reflecting their sustained attention to bodily sensations and hypervigilance to somatic sensations.
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32
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Ahn S, Prim JH, Alexander ML, McCulloch KL, Fröhlich F. Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study. THE JOURNAL OF PAIN 2019; 20:277.e1-277.e11. [PMID: 30268803 PMCID: PMC6382517 DOI: 10.1016/j.jpain.2018.09.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/23/2018] [Accepted: 09/23/2018] [Indexed: 01/29/2023]
Abstract
Chronic pain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns, such as neuronal network oscillations in the thalamocortical system, plays a key role in the pathophysiology of chronic pain. Yet, little is known about whether and how such network pathologies can be targeted with noninvasive brain stimulation as a nonpharmacological treatment option. We hypothesized that alpha oscillations, a prominent thalamocortical activity pattern in the human brain, are impaired in chronic pain and can be modulated with transcranial alternating current stimulation (tACS). We performed a randomized, crossover, double-blind, sham-controlled study in patients with chronic low back pain (CLBP) to investigate how alpha oscillations relate to pain symptoms for target identification and whether tACS can engage this target and thereby induce pain relief. We used high-density electroencephalography to measure alpha oscillations and found that the oscillation strength in the somatosensory region at baseline before stimulation was negatively correlated with pain symptoms. Stimulation with alpha-tACS compared to sham (placebo) stimulation significantly enhanced alpha oscillations in the somatosensory region. The stimulation-induced increase of alpha oscillations in the somatosensory region was correlated with pain relief. Given these findings of successful target identification and engagement, we propose that modulating alpha oscillations with tACS may represent a target-specific, nonpharmacological treatment approach for CLBP. This trial has been registered in ClinicalTrials.gov (NCT03243084). PERSPECTIVE: This study suggests that a rational design of transcranial alternating current stimulation, which is target identification, engagement, and validation, could be a nonpharmacological treatment approach for patients with CLBP.
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Affiliation(s)
- Sangtae Ahn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Julianna H Prim
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Morgan L Alexander
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Karen L McCulloch
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Flavio Fröhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599..
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33
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Electroencephalography and magnetoencephalography in pain research-current state and future perspectives. Pain 2019; 159:206-211. [PMID: 29944612 DOI: 10.1097/j.pain.0000000000001087] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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34
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Zhou R, Wang J, Qi W, Liu FY, Yi M, Guo H, Wan Y. Elevated Resting State Gamma Oscillatory Activities in Electroencephalogram of Patients With Post-herpetic Neuralgia. Front Neurosci 2018; 12:750. [PMID: 30405337 PMCID: PMC6205978 DOI: 10.3389/fnins.2018.00750] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022] Open
Abstract
In acute and ongoing pain, the spontaneous oscillatory activity of electroencephalogram (EEG) has been characterized by suppression of alpha band oscillations and enhancement of gamma band oscillations. In pathological chronic pain which is more severe and common in clinic practice, it is of great interest to investigate the oscillatory activity especially at the broad gamma frequency bands. Our present study explored the resting state oscillatory activities of EEG in patients with post-herpetic neuralgia (PHN) over 3 months which is a typical neuropathic pain model in clinical researches. It was found that the PHN patients showed anxiety and depression revealed by Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) examinations. Power spectrum analysis revealed that the power at gamma frequency band (from 40 to 70 Hz) of EEG was significantly higher in the PHN patients, and positively correlated with pain intensity, anxiety, and depression indexes. Further, increased gamma activity derived from the prefrontal cortex and the cerebellum were revealed by cluster-based sensor level and the beamforming source level analyses. These results suggest the enhanced gamma oscillatory activity in the prefrontal cortex and cerebellum is a characteristic marker in chronic neuropathic pain patients.
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Affiliation(s)
- Rui Zhou
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Jing Wang
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Institute For Brain Disorders, Capital Medical University, Beijing, China
| | - Wenjing Qi
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Feng-Yu Liu
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Ming Yi
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Huailian Guo
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - You Wan
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
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35
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Assessment of pain quality reveals distinct differences between nociceptive innervation of low back fascia and muscle in humans. Pain Rep 2018; 3:e662. [PMID: 29922749 PMCID: PMC5999409 DOI: 10.1097/pr9.0000000000000662] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/28/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction/Objectives Verbal descriptors are an important pain assessment parameter. The purpose of this study was to explore the ability to discriminate deep muscle pain and overlying fascia pain according to verbal descriptors and compare the pattern with skin stimulation (from previously published data). Methods In 16 healthy human subjects, electrical stimulation was chosen to excite a broad spectrum of nociceptive primary afferents innervating the respective tissues. The 24-item Pain Perception Scale (Schmerzempfindungsskala [SES]) was used to determine the induced pain quality. Results Overall, affective (P = 0.69) and sensory scores (P = 0.07) were not significantly different between muscle and fascia. Factor analysis of the sensory descriptors revealed a stable 3-factor solution distinguishing superficial thermal ("heat pain" identified by the items "burning," "scalding," and "hot") from superficial mechanical ("sharp pain" identified by the items "cutting," "tearing," and "stinging") and "deep pain" (identified by the items "beating," "throbbing," and "pounding"). The "deep pain" factor was more pronounced for muscle than fascia (P < 0.01), whereas the other 2 factors were more pronounced for fascia (both P < 0.01). The patterns of skin and fascia matched precisely in sensory factors and on single-item level. Conclusion The differences in sensory descriptor patterns between muscle and fascia may potentially guide treatment towards muscle or fascia in low back pain physiotherapeutic regimes. The similarity of descriptor patterns between fascia and skin, both including the terms "burning" and "stinging," opens the possibility that neuropathic back pain (when the dorsal ramus of the spinal nerve is affected) may be confused with low back pain of fascia origin.
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36
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Shirvalkar P, Veuthey TL, Dawes HE, Chang EF. Closed-Loop Deep Brain Stimulation for Refractory Chronic Pain. Front Comput Neurosci 2018; 12:18. [PMID: 29632482 PMCID: PMC5879131 DOI: 10.3389/fncom.2018.00018] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/07/2018] [Indexed: 01/09/2023] Open
Abstract
Pain is a subjective experience that alerts an individual to actual or potential tissue damage. Through mechanisms that are still unclear, normal physiological pain can lose its adaptive value and evolve into pathological chronic neuropathic pain. Chronic pain is a multifaceted experience that can be understood in terms of somatosensory, affective, and cognitive dimensions, each with associated symptoms and neural signals. While there have been many attempts to treat chronic pain, in this article we will argue that feedback-controlled ‘closed-loop’ deep brain stimulation (DBS) offers an urgent and promising route for treatment. Contemporary DBS trials for chronic pain use “open-loop” approaches in which tonic stimulation is delivered with fixed parameters to a single brain region. The impact of key variables such as the target brain region and the stimulation waveform is unclear, and long-term efficacy has mixed results. We hypothesize that chronic pain is due to abnormal synchronization between brain networks encoding the somatosensory, affective and cognitive dimensions of pain, and that multisite, closed-loop DBS provides an intuitive mechanism for disrupting that synchrony. By (1) identifying biomarkers of the subjective pain experience and (2) integrating these signals into a state-space representation of pain, we can create a predictive model of each patient's pain experience. Then, by establishing how stimulation in different brain regions influences individual neural signals, we can design real-time, closed-loop therapies tailored to each patient. While chronic pain is a complex disorder that has eluded modern therapies, rich historical data and state-of-the-art technology can now be used to develop a promising treatment.
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Affiliation(s)
- Prasad Shirvalkar
- Pain Management Division, Departments of Neurology and Anesthesiology, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Tess L Veuthey
- Neuroscience Graduate Program, University of California, San Francisco, San Francisco, CA, United States
| | - Heather E Dawes
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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Case M, Shirinpour S, Zhang H, Datta YH, Nelson SC, Sadak KT, Gupta K, He B. Increased theta band EEG power in sickle cell disease patients. J Pain Res 2017; 11:67-76. [PMID: 29343982 PMCID: PMC5749555 DOI: 10.2147/jpr.s145581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Pain is a major issue in the care of patients with sickle cell disease (SCD). The mechanisms behind pain and the best way to treat it are not well understood. We studied how electroencephalography (EEG) is altered in SCD patients. Methods We recruited 20 SCD patients and compared their resting state EEG to that of 14 healthy controls. EEG power was found across frequency bands using Welch's method. Electrophysiological source imaging was assessed for each frequency band using the eLORETA algorithm. Results SCD patients had increased theta power and decreased beta2 power compared to controls. Source localization revealed that areas of greater theta band activity were in areas related to pain processing. Imaging parameters were significantly correlated to emergency department visits, which indicate disease severity and chronic pain intensity. Conclusion The present results support the pain mechanism referred to as thalamocortical dysrhythmia. This mechanism causes increased theta power in patients. Significance Our findings show that EEG can be used to quantitatively evaluate differences between controls and SCD patients. Our results show the potential of EEG to differentiate between different levels of pain in an unbiased setting, where specific frequency bands could be used as biomarkers for chronic pain.
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Affiliation(s)
| | | | | | | | - Stephen C Nelson
- Pediatric Hematology-Oncology, Children's Hospitals and Clinics of Minnesota
| | - Karim T Sadak
- Pediatric Hematology-Oncology, University of Minnesota Masonic Children's Hospital
| | | | - Bin He
- Department of Biomedical Engineering.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
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Uglem M, Omland PM, Stjern M, Gravdahl GB, Sand T. Habituation of laser-evoked potentials by migraine phase: a blinded longitudinal study. J Headache Pain 2017; 18:100. [PMID: 28971336 PMCID: PMC5624861 DOI: 10.1186/s10194-017-0810-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022] Open
Abstract
Background Migraineurs seem to have cyclic variations in cortical excitability in several neurophysiological modalities. Laser-evoked potentials (LEP) are of particular interest in migraine because LEP specifically targets pain pathways, and studies have reported different LEP-changes both between and during headaches. Our primary aim was to explore potential cyclic variations in LEP amplitude and habituation in more detail with a blinded longitudinal study design. Methods We compared N1 and N2P2 amplitudes and habituation between two blocks of laser stimulations to the dorsal hand, obtained from 49 migraineurs with four sessions each. We used migraine diaries to categorize sessions as interictal (> one day from previous and to next attack), preictal (< one day before the attack), ictal or postictal (< one day after the attack). Also, we compared 29 interictal recordings from the first session to 30 controls. Results N1 and N2P2 amplitudes and habituation did not differ between preictal, interictal and postictal phase sessions, except for a post hoc contrast that showed deficient ictal habituation of N1. Habituation is present and similar in migraineurs in the interictal phase and controls. Conclusions Hand-evoked LEP amplitudes and habituation were mainly invariable between migraine phases, but this matter needs further study. Because hand-evoked LEP-habituation was similar in migraineurs and controls, the present findings contradict several previous LEP studies. Pain-evoked cerebral responses are normal and show normal habituation in migraine. Electronic supplementary material The online version of this article (10.1186/s10194-017-0810-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Uglem
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. .,NTNU, Faculty of Medicine and Health Sciences, P.B. 8905, N-7491, Trondheim, Norway.
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Marit Stjern
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | | | - Trond Sand
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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Fischer IW, Gram M, Hansen TM, Brokjaer A, Graversen C, Malver LP, Mørch CD, Christrup LL, Drewes AM, Olesen AE. Cortical and spinal assessment - a comparative study using encephalography and the nociceptive withdrawal reflex. J Pharmacol Toxicol Methods 2017; 84:37-43. [DOI: 10.1016/j.vascn.2016.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/20/2016] [Accepted: 10/27/2016] [Indexed: 01/03/2023]
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Abstract
Pain is an integrative phenomenon that results from dynamic interactions between sensory and contextual (i.e., cognitive, emotional, and motivational) processes. In the brain the experience of pain is associated with neuronal oscillations and synchrony at different frequencies. However, an overarching framework for the significance of oscillations for pain remains lacking. Recent concepts relate oscillations at different frequencies to the routing of information flow in the brain and the signaling of predictions and prediction errors. The application of these concepts to pain promises insights into how flexible routing of information flow coordinates diverse processes that merge into the experience of pain. Such insights might have implications for the understanding and treatment of chronic pain.
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Affiliation(s)
- Markus Ploner
- Department of Neurology and TUMNeuroimaging Center, Technische Universität München, Munich, Germany.
| | - Christian Sorg
- Departments of Neuroradiology and Psychiatry and TUMNeuroimaging Center, Technische Universität München, Munich, Germany
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
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Meneses FM, Queirós FC, Montoya P, Miranda JGV, Dubois-Mendes SM, Sá KN, Luz-Santos C, Baptista AF. Patients with Rheumatoid Arthritis and Chronic Pain Display Enhanced Alpha Power Density at Rest. Front Hum Neurosci 2016; 10:395. [PMID: 27540360 PMCID: PMC4972828 DOI: 10.3389/fnhum.2016.00395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 07/22/2016] [Indexed: 12/29/2022] Open
Abstract
Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over 5 min with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = 0.002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls [F(1.39) = 6.39, p = 0.016], as well as increased average relative alpha power density [F(1.39) = 5.82, p = 0.021] in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls [F(1, 39) = 4.51, p = 0.040], controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.
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Affiliation(s)
- Francisco M Meneses
- Graduate Program in Medicine and Health, School of Medicine, Federal University of BahiaSalvador, Brazil; Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of BahiaSalvador, Brazil
| | - Fernanda C Queirós
- Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of Bahia Salvador, Brazil
| | - Pedro Montoya
- Department of Psychology, Research Institute of Health Sciences, University of Balearic Islands Palma de Mallorca, Spain
| | - José G V Miranda
- Nucleus of Innovation and Technology in Rehabilitation, Institute of Physics, Federal University of Bahia Salvador, Brazil
| | - Selena M Dubois-Mendes
- Graduate Program in Medicine and Health, School of Medicine, Federal University of BahiaSalvador, Brazil; Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of BahiaSalvador, Brazil; Physiotherapy Program, Bahia School of Medicine and Public HealthSalvador, Brazil
| | - Katia N Sá
- Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of BahiaSalvador, Brazil; Physiotherapy Program, Bahia School of Medicine and Public HealthSalvador, Brazil
| | - Cleber Luz-Santos
- Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of Bahia Salvador, Brazil
| | - Abrahão F Baptista
- Graduate Program in Medicine and Health, School of Medicine, Federal University of BahiaSalvador, Brazil; Functional Electrostimulation Laboratory, Biomorphology Department, Health Sciences Institute, Federal University of BahiaSalvador, Brazil; Physiotherapy Program, Bahia School of Medicine and Public HealthSalvador, Brazil
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Fu Y, Yu G, McNichol E, Marczewski K, José Closs S. The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study. Int J Nurs Stud 2016; 59:197-207. [DOI: 10.1016/j.ijnurstu.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
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Electroencephalographic Patterns in Chronic Pain: A Systematic Review of the Literature. PLoS One 2016; 11:e0149085. [PMID: 26914356 PMCID: PMC4767709 DOI: 10.1371/journal.pone.0149085] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/27/2016] [Indexed: 01/08/2023] Open
Abstract
The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.
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Tinnitus and Headache. BIOMED RESEARCH INTERNATIONAL 2015; 2015:797416. [PMID: 26583133 PMCID: PMC4637068 DOI: 10.1155/2015/797416] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tinnitus and headache are frequent disorders. Here, we aimed to investigate whether the occurrence of headache among tinnitus patients is purely coincidental or whether tinnitus and headache are pathophysiologically linked. We investigated a large sample of patients with tinnitus and headache to estimate prevalence rates of different headache forms, to determine the relationship between tinnitus laterality and headache laterality, and to explore the relationship between tinnitus and headache over time. METHOD Patients who presented at a tertiary referral center because of tinnitus and reported comorbid headache were asked to complete validated questionnaires to determine the prevalence of migraine and tension-type headache and to assess tinnitus severity. In addition, several questions about the relationship between headache and tinnitus were asked. RESULTS Datasets of 193 patients with tinnitus and headache were analysed. 44.6% suffered from migraine, 13% from tension-type headache, and 5.7% from both. Headache laterality was significantly related to tinnitus laterality and in the majority of patients fluctuations in symptom severity of tinnitus and headache were interrelated. CONCLUSION These findings suggest a significant relationship between tinnitus and headache laterality and symptom interaction over time and argue against a purely coincidental cooccurrence of tinnitus and headache. Both disorders may be linked by common pathophysiological mechanisms.
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Liao F, Zhang C, Bian Z, Xie D, Kang M, Li X, Wan Y, Chen R, Yi M. Characterizing heat-sensitization responses in suspended moxibustion with high-density EEG. PAIN MEDICINE 2015; 15:1272-81. [PMID: 25132308 DOI: 10.1111/pme.12512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We have reported "heat-sensitization" responses during suspended moxibustion, whose occurrence is associated with significantly better therapeutic effects. The present study aimed to characterize the electrophysiological features of this interesting phenomenon with high-density electroencephalography (EEG). METHODS We performed EEG recording in a group of patients with chronic low back pain before, during, and after moxibustion treatment at DU3. RESULTS 12 out of 25 subjects experienced strong heat-sensitization during moxibustion, which was accompanied by increased power spectral densities (PSDs) at the theta, alpha, and beta frequency bands. The scalp topographies of averaged power indicated that the theta and beta PSD changes were most obvious in fronto-central regions, whereas those of the alpha band were more global. In addition, nonsensitized and sensitized groups showed distinct activity patterns, with heat-sensitization inducing increased phase coherence at the theta and beta ranges. CONCLUSIONS These data were the first objective evidence of heat-sensitization responses during suspended moxibustion, which were characterized by widespread oscillatory changes in scalp EEG.
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Affiliation(s)
- Feifei Liao
- Neuroscience Research Institute, Peking University, Beijing, China
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Abstract
BACKGROUND The search for effective treatments for fibromyalgia (FM) has continued for years. The present study premises that thalamocortical dysrhythmia is implicated in fibromyalgia and that low-frequency sound stimulation (LFSS) can play a regulatory function by driving neural rhythmic oscillatory activity. OBJECTIVE To assess the effect of LFSS on FM. METHOD The present open-label study with no control group used a repeated-measures design with no noncompleters. Nineteen female volunteers (median age 51 years; median duration of FM 5.76 years) were administered 10 treatments (twice per week for five weeks). Treatments involved 23 min of LFSS at 40 Hz, delivered using transducers in a supine position. Measures (repeated before and after treatment) included the Fibromyalgia Impact Questionnaire, Jenkins Sleep Scale, Pain Disability Index, sitting and standing without pain (in minutes), cervical muscle range of motion and muscle tone. Mean percentages were calculated on end of treatment self-reports of improvement on pain, mood, insomnia and activities of daily living. RESULTS Significant improvements were observed with median scores: Fibromyalgia Impact Questionnaire, 81% (P<0.0001); Jenkins Sleep Scale, 90% (P<0.0001); and Pain Disability Index, 49.1% (P<0.0001). Medication dose was reduced in 73.68% of patients and completely discontinued in 26.32%. Time sitting and standing without pain increased significantly (P<0.0001). Cervical muscle range of motion increased from 25% to 75% (P=0.001), while muscle tone changed from hypertonic to normal (P=0.0002). CONCLUSION In the present study, the LFSS treatment showed no adverse effects and patients receiving the LFSS treatment showed statistically and clinically relevant improvement. Further phase 2 and 3 trials are warranted.
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de Vries M, Wilder-Smith OHG, Jongsma MLA, van den Broeke EN, Arns M, van Goor H, van Rijn CM. Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain. J Pain Res 2013; 6:815-24. [PMID: 24379694 PMCID: PMC3843642 DOI: 10.2147/jpr.s50919] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in the brain's resting state. We aimed to investigate novel potential markers of chronic pain in the resting state EEG of patients with chronic pancreatitis. PARTICIPANTS Resting state EEG data from 16 patients with persistent abdominal pain due to chronic pancreatitis (CP) were compared to data from healthy controls matched for age, sex and education. METHODS The peak alpha frequency (PAF) and power amplitude in the alpha band (7.5-13 Hz) were compared between groups in four regions of interest (frontal, central, parietal, and occipital) and were correlated with pain duration. RESULTS The average PAF was lowered in CP patients compared with that in healthy controls, observed as a statistically significant between-group effect (mean 9.9 versus 9.5 Hz; P=0.049). Exploratory post hoc analysis of average PAF per region of interest revealed a significant difference, particularly in the parietal and occipital regions. In addition, we observed a significant correlation between pain duration and PAF and showed increased shifts in PAF with longer pain durations. No significant group differences were found in peak power amplitudes. CONCLUSION CP pain is associated with alterations in spontaneous brain activity, observed as a shift toward lower PAF. This shift correlates with the duration of pain, which demonstrates that PAF has the potential to be a clinically feasible biomarker for chronic pain. These findings could be helpful for assisting diagnosis, establishing optimal treatment, and studying efficacy of new therapeutic agents in chronic pain patients.
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Affiliation(s)
- Marjan de Vries
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Oliver HG Wilder-Smith
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marijtje LA Jongsma
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Martijn Arns
- Research Institute Brainclinics Nijmegen, Nijmegen, The Netherlands
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Clementina M van Rijn
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
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van den Broeke EN, Wilder-Smith OHG, van Goor H, Vissers KCP, van Rijn CM. Patients with persistent pain after breast cancer treatment show enhanced alpha activity in spontaneous EEG. PAIN MEDICINE 2013; 14:1893-9. [PMID: 24034712 DOI: 10.1111/pme.12216] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate whether patients with persistent pain after breast cancer treatment show an enhanced and slowed dominant alpha activity in their electroencephalogram (EEG) recorded during rest in comparison with patients that also had undergone breast cancer treatment but do not have pain. METHODS The spontaneous EEG was recorded during rest and before painful stimulation of the calf and analyzed with spectral analysis (Fast Fourier Transformation). Outcome measures, i.e., alpha indices (center of gravity and overall amplitude), were statistically tested between patients with and without persistent pain. RESULTS In comparison with patients without pain, patients with persistent pain after breast cancer treatment show more alpha activity in their spontaneous EEG observed from parietal-occipital brain regions. CONCLUSION Persistent pain after breast cancer treatment affects spontaneous brain activity, which might influence cognitive functioning.
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Affiliation(s)
- Emanuel N van den Broeke
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
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