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Ma S, Zhang J, Hua X, Wu J, Zheng M, Xu J. Tuina therapy promotes behavioral improvement and brain plasticity in rats with peripheral nerve injury and repair. Brain Behav 2023; 13:e3174. [PMID: 37522806 PMCID: PMC10498059 DOI: 10.1002/brb3.3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Tuina is currently one of the popular complementary and alternative methods of rehabilitation therapy. Tuina can improve patients' pain and mobility function. However, the underlying physiological mechanism remains largely unknown, which might limit its further popularization in clinical practice. The aim of this study is to explore the short-term and long-term changes in brain functional activity following Tuina intervention for peripheral nerve injury repair. METHODS A total of 16 rats were equally divided into the intervention group and the control group. Rats in the intervention group received Tuina therapy applying on the gastrocnemius muscle of the right side for 4 months following sciatic nerve transection and immediate repair, while the control group received nerve transection and repair only. The block-design functional magnetic resonance imaging scan was applied in both groups at 1 and 4 months after the surgery. During the scan, both the injured and intact hindpaw was electrically stimulated according to a "boxcar" paradigm. RESULTS When stimulating the intact hindpaw, the intervention group exhibited significantly lower activation in the somatosensory area, limbic/paralimbic areas, pain-regulation areas, and basal ganglia compared to the control group, with only the prefrontal area showing higher activation. After 4 months of sciatic nerve injury, the control group exhibited decreased motor cortex activity compared to the activity observed at 1 month, and the intervention group demonstrated stronger bilateral motor cortex activity compared to the control group. CONCLUSION Tuina therapy on the gastrocnemius muscle of rats with sciatic nerve injury can effectively alleviate pain and maintain the motor function of the affected limb. In addition, Tuina therapy reduced the activation level of pain-related brain regions and inhibited the decreased activity of the motor cortex caused by nerve injury, reflecting the impact of peripheral stimulation on brain plasticity.
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Affiliation(s)
- Shu‐Jie Ma
- Department of Traditional Chinese Rehabilitation MedicineThe Second Rehabilitation Hospital of ShanghaiShanghaiChina
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
| | - Jun‐Peng Zhang
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xu‐Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- Department of Traumatology and Orthopedics, Yueyang HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jia‐Jia Wu
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- Department of Rehabilitation Medicine, Yueyang HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Mou‐Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- Department of Traumatology and Orthopedics, Yueyang HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jian‐Guang Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
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Caston RM, Davis TS, Smith EH, Rahimpour S, Rolston JD. A novel thermoelectric device integrated with a psychophysical paradigm to study pain processing in human subjects. J Neurosci Methods 2023; 386:109780. [PMID: 36586439 PMCID: PMC9892356 DOI: 10.1016/j.jneumeth.2022.109780] [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: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cerebral projections of nociceptive stimuli are of great interest as targets for neuromodulation in chronic pain. To study cerebral networks involved in processing noxious stimuli, researchers often rely on thermo-nociception to induce pain. However, various limitations exist in many pain-inducing techniques, such as not accounting for individual variations in pain and trial structure predictability. METHODS We propose an improved and reliable psychometric experimental method to evaluate human nociceptive processing to overcome some of these limitations. The developed testing paradigm leverages a custom-built, open-source, thermoelectric device (TED). The device construction and hardware are described. A maximum-likelihood adaptive algorithm is integrated into the TED software, facilitating individual psychometric functions representative of both hot and cold pain perception. In addition to testing only hot or cold thresholds, the TED may also be used to induce the thermal grill illusion (TGI), where the bars are set to alternating warm and cool temperatures. RESULTS Here, we validated the TED's capability to adjust between different temperatures and showed that the device quickly and automatically changes temperature without any experimenter input. We also validated the device and integrated psychometric pain task in 21 healthy human subjects. Hot and cold pain thresholds (HPT, CPT) were determined in human subjects with <1 °C of variation. Thresholds were anticorrelated, meaning a volunteer with a low CPT likely had a high HPT. We also showed how the TED can be used to induce the TGI. CONCLUSION The TED can induce thermo-nociception and provide probabilistic measures of hot and cold pain thresholds. Based on the findings presented, we discuss how the TED could be used to study thermo-nociceptive cerebral projections if paired with intracranial electrode monitoring.
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Affiliation(s)
- Rose M Caston
- University of Utah, Department of Biomedical Engineering, USA; University of Utah, Department of Neurosurgery, USA.
| | | | | | - Shervin Rahimpour
- University of Utah, Department of Biomedical Engineering, USA; University of Utah, Department of Neurosurgery, USA
| | - John D Rolston
- University of Utah, Department of Biomedical Engineering, USA; Brigham & Women's Hospital and Harvard Medical School, Department of Neurosurgery, USA
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The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies. J Clin Med 2020; 9:jcm9061945. [PMID: 32580436 PMCID: PMC7355617 DOI: 10.3390/jcm9061945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain.
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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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Liu CC, Chien JH, Chang YW, Kim JH, Anderson WS, Lenz FA. Functional role of induced gamma oscillatory responses in processing noxious and innocuous sensory events in humans. Neuroscience 2015; 310:389-400. [PMID: 26408986 DOI: 10.1016/j.neuroscience.2015.09.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022]
Abstract
Gamma time-frequency responses (TFRs) induced by painful laser in the contralateral primary somatosensory (SI) cortex have been shown to correlate with perceived pain-intensity in human. Given the functional roles of gamma TFRs in the cortical spaces, it remains unclear whether such a relationship is sustained for other brain regions where the laser-evoked potentials (LEPs) are presented. In this study, we delivered the painful laser pluses at random pain-intensity levels (i.e. strong, medium and weak) in a single train to the dorsal hand of six patients with uncontrolled epilepsy. The laser stimulus produced a painful pinprick sensation by activating nociceptors located in the superficial layers of the skin. For each patient, arrays of >64 subdural electrodes were implanted directly covering the contralateral SI, parasylvian (PS) and medial frontal (MF) cortices to study the stimulus related gamma (TFRs) in the neocortex. In addition, using the same stimulation paradigm, the modality specificity of gamma TFRs was further examined by applying innocuous vibrotactile stimuli to the same regions of the dorsal hand in a separated group of five patients. Our results showed that gamma TFRs are not modality specific, but the largest gamma TFRs were consistently found within the SI region and noxious laser elicited significantly stronger gamma TFRs than innocuous nonpainful vibratory stimuli. Furthermore, stronger pain induced stronger gamma TFRs in the cortices of SI (r=0.4, p<0.001) and PS (r=0.29, p=0.005). Given that potentially harmful noxious stimulus would automatically capture greater attention than the innocuous ones, our results support the hypothesis that the degree of SI and PS gamma TFRs is associated with an attentional drive provoked by painful stimuli.
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Affiliation(s)
- C C Liu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
| | - J H Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Y W Chang
- Boehringer Ingelheim, Ridgefield, CT, USA
| | - J H Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - W S Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - F A Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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Liu CC, Chien JH, Kim JH, Chuang YF, Cheng DT, Anderson WS, Lenz FA. Cross-frequency coupling in deep brain structures upon processing the painful sensory inputs. Neuroscience 2015; 303:412-21. [PMID: 26168707 DOI: 10.1016/j.neuroscience.2015.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/19/2015] [Accepted: 07/02/2015] [Indexed: 11/30/2022]
Abstract
Cross-frequency coupling has been shown to be functionally significant in cortical information processing, potentially serving as a mechanism for integrating functionally relevant regions in the brain. In this study, we evaluate the hypothesis that pain-related gamma oscillatory responses are coupled with low-frequency oscillations in the frontal lobe, amygdala and hippocampus, areas known to have roles in pain processing. We delivered painful laser pulses to random locations on the dorsal hand of five patients with uncontrolled epilepsy requiring depth electrode implantation for seizure monitoring. Two blocks of 40 laser stimulations were delivered to each subject and the pain-intensity was controlled at five in a 0-10 scale by adjusting the energy level of the laser pulses. Local-field-potentials (LFPs) were recorded through bilaterally implanted depth electrode contacts to study the oscillatory responses upon processing the painful laser stimulations. Our results show that painful laser stimulations enhanced low-gamma (LH, 40-70 Hz) and high-gamma (HG, 70-110 Hz) oscillatory responses in the amygdala and hippocampal regions on the right hemisphere and these gamma responses were significantly coupled with the phases of theta (4-7 Hz) and alpha (8-1 2 Hz) rhythms during pain processing. Given the roles of these deep brain structures in emotion, these findings suggest that the oscillatory responses in these regions may play a role in integrating the affective component of pain, which may contribute to our understanding of the mechanisms underlying the affective information processing in humans.
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Affiliation(s)
- C C Liu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
| | - J H Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J H Kim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA; Department of Neurosurgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Y F Chuang
- Institute of Public Health, National Yang-Ming University, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan
| | - D T Cheng
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - W S Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - F A Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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LeBlanc BW, Lii TR, Silverman AE, Alleyne RT, Saab CY. Cortical theta is increased while thalamocortical coherence is decreased in rat models of acute and chronic pain. Pain 2014; 155:773-782. [PMID: 24457192 DOI: 10.1016/j.pain.2014.01.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/08/2014] [Accepted: 01/14/2014] [Indexed: 01/28/2023]
Abstract
Thalamocortical oscillations are critical for sensory perception. Although pain is known to disrupt synchrony in thalamocortical oscillations, evidence in the literature is controversial. Thalamocortical coherence has been reported to be increased in patients with neurogenic pain but decreased in a rat model of central pain. Moreover, theta (4 to 8 Hz) oscillations in primary somatosensory (S1) cortex are speculated to predict pain in humans. To date, the link between pain and network oscillations in animal models has been understudied. Thus, we tested the hypothesis that pain disrupts thalamocortical coherence and S1 theta power in two rat models of pain. We recorded electrocorticography (ECoG) waveforms over S1 and local field potentials (LFP) within ventral posterolateral thalamus in freely behaving rats under spontaneous (stimulus-independent) pain conditions. Rats received intradermal capsaicin injection (Cap) in the hindpaw, followed hours later by chronic constriction injury (CCI) of the sciatic nerve lasting several days. Our results show that pain decreases coherence between LFP and ECoG waveforms in the 2- to 30-Hz range, and increases ECoG power in the theta range. These changes are short-lasting after Cap and longer-lasting after CCI. These data might be particularly relevant to preclinical correlates of spontaneous pain-like behavior, with potential implications to clinical biomarkers of ongoing pain.
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Affiliation(s)
- Brian W LeBlanc
- Department of Neurosurgery, Rhode Island Hospital, and Department of Neuroscience, Brown University, Providence, RI, USA
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Saab CY. Pain-related changes in the brain: diagnostic and therapeutic potentials. Trends Neurosci 2012; 35:629-37. [DOI: 10.1016/j.tins.2012.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 05/25/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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