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Dong TS, Gee GC, Beltran-Sanchez H, Wang M, Osadchiy V, Kilpatrick LA, Chen Z, Subramanyam V, Zhang Y, Guo Y, Labus JS, Naliboff B, Cole S, Zhang X, Mayer EA, Gupta A. How Discrimination Gets Under the Skin: Biological Determinants of Discrimination Associated With Dysregulation of the Brain-Gut Microbiome System and Psychological Symptoms. Biol Psychiatry 2023; 94:203-214. [PMID: 36754687 PMCID: PMC10684253 DOI: 10.1016/j.biopsych.2022.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Discrimination is associated with negative health outcomes as mediated in part by chronic stress, but a full understanding of the biological pathways is lacking. Here we investigate the effects of discrimination involved in dysregulating the brain-gut microbiome (BGM) system. METHODS A total of 154 participants underwent brain magnetic resonance imaging to measure functional connectivity. Fecal samples were obtained for 16S ribosomal RNA profiling and fecal metabolites and serum for inflammatory markers, along with questionnaires. The Everyday Discrimination Scale was administered to measure chronic and routine experiences of unfair treatment. A sparse partial least squares-discriminant analysis was conducted to predict BGM alterations as a function of discrimination, controlling for sex, age, body mass index, and diet. Associations between discrimination-related BGM alterations and psychological variables were assessed using a tripartite analysis. RESULTS Discrimination was associated with anxiety, depression, and visceral sensitivity. Discrimination was associated with alterations of brain networks related to emotion, cognition and self-perception, and structural and functional changes in the gut microbiome. BGM discrimination-related associations varied by race/ethnicity. Among Black and Hispanic individuals, discrimination led to brain network changes consistent with psychological coping and increased systemic inflammation. For White individuals, discrimination was related to anxiety but not inflammation, while for Asian individuals, the patterns suggest possible somatization and behavioral (e.g., dietary) responses to discrimination. CONCLUSIONS Discrimination is attributed to changes in the BGM system more skewed toward inflammation, threat response, emotional arousal, and psychological symptoms. By integrating diverse lines of research, our results demonstrate evidence that may explain how discrimination contributes to health inequalities.
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Affiliation(s)
- Tien S Dong
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California; Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Gilbert C Gee
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California; California Center for Population Research, University of California, Los Angeles, Los Angeles, California
| | - Hiram Beltran-Sanchez
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California; California Center for Population Research, University of California, Los Angeles, Los Angeles, California
| | - May Wang
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California
| | - Vadim Osadchiy
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lisa A Kilpatrick
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Zixi Chen
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Vishvak Subramanyam
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Yurui Zhang
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Yinming Guo
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Jennifer S Labus
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Bruce Naliboff
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Steve Cole
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry & Biobehavioral Sciences and Medicine, University of California, Los Angeles, Los Angeles, California
| | - Xiaobei Zhang
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Arpana Gupta
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California.
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2
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Clauw DJ, Choy EHS, Napadow V, Soni A, Boehnke KF, Naliboff B, Hassett AL, Arewasikporn A, Schrepf A, Kaplan CM, Williams D, Basu N, Bergmans RS, Harris RE, Harte SE, Chadwick A, Macfarlane GJ. Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia. Nat Rev Rheumatol 2023; 19:321. [PMID: 36964334 PMCID: PMC10878028 DOI: 10.1038/s41584-023-00951-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Ernest H S Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Vitaly Napadow
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Anushka Soni
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Naliboff
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Anne Arewasikporn
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea M Kaplan
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Chadwick
- Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary J Macfarlane
- Department of Public Health, School of Medicine, University of Aberdeen, Aberdeen, UK
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3
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Kilpatrick L, Zhang K, Dong T, Gee G, Beltran-Sanchez H, Wang M, Labus J, Naliboff B, Mayer E, Gupta A. Mediating role of obesity on the association between disadvantaged neighborhoods and intracortical myelination. Res Sq 2023:rs.3.rs-2592087. [PMID: 36993600 PMCID: PMC10055549 DOI: 10.21203/rs.3.rs-2592087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
We investigated the relationship between neighborhood disadvantage (area deprivation index [ADI]) and intracortical myelination (T1-weighted/T2-weighted ratio at deep to superficial cortical levels), and the potential mediating role of the body mass index (BMI) and perceived stress in 92 adults. Worse ADI was correlated with increased BMI and perceived stress (p's<.05). Non-rotated partial least squares analysis revealed associations between worse ADI and decreased myelination in middle/deep cortex in supramarginal, temporal, and primary motor regions and increased myelination in superficial cortex in medial prefrontal and cingulate regions (p<.001); thus, neighborhood disadvantage may influence the flexibility of information processing involved in reward, emotion regulation, and cognition. Structural equation modelling revealed increased BMI as partially mediating the relationship between worse ADI and observed myelination increases (p=.02). Further, trans-fatty acid intake was correlated with observed myelination increases (p=.03), suggesting the importance of dietary quality. These data further suggest ramifications of neighborhood disadvantage on brain health.
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Affiliation(s)
| | | | - Tien Dong
- University of California Los Angeles
| | | | | | - May Wang
- University of California Los Angeles
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4
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Sauk JS, Ryu HJ, Labus JS, Khandadash A, Ahdoot AI, Lagishetty V, Katzka W, Wang H, Naliboff B, Jacobs JP, Mayer EA. High Perceived Stress is Associated With Increased Risk of Ulcerative Colitis Clinical Flares. Clin Gastroenterol Hepatol 2023; 21:741-749.e3. [PMID: 35952942 DOI: 10.1016/j.cgh.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although perceived stress (PS) has been associated with symptomatic flares in inflammatory bowel disease, clinical and physiological measures associated with perceived stress and flare are not known. The aim of this study was to identify physiological factors associated with perceived stress in ulcerative colitis (UC) subjects, and their relationship with flare. METHODS Patients with UC in clinical remission (Simple Colitis Clinical Activity Index [SCCAI] score <5) underwent clinical and behavioral assessments, morning salivary cortisol measurements, autonomic nervous system activity testing (heart rate variability, electrodermal activity) at baseline with patient-reported SCCAI every 2 weeks over 1 to 2 years and fecal calprotectin at time of flare. Clinical flares (SCCAI ≥5) and biochemical flares (SCCAI ≥5 with fecal calprotectin ≥250 μg/g) were evaluated. RESULTS One hundred ten patients with UC were enrolled, with mean follow-up of 65.6 weeks. Patients with UC with higher and lower PS were determined. Although the high PS group had 3.6 times higher odds of a clinical flare than the low PS group, no significant differences in biochemical flares were observed between the low and high PS groups. The high vs low PS group differed in tonic sympathetic arousal as indexed by significantly greater baseline electrodermal activity (4.3 vs 3.4 microsiemens; P = .026) in the high PS group, but not in terms of heart rate variability and morning cortisol levels. Increased fecal calprotectin was associated with cardioautonomic measures, suggesting lower parasympathetic activity. CONCLUSIONS Increased PS assessed at baseline is associated with tonic sympathetic arousal and greater odds of clinical flares in patients with UC.
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Affiliation(s)
- Jenny S Sauk
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Hyo Jin Ryu
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Ariela Khandadash
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Aaron I Ahdoot
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Venu Lagishetty
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - William Katzka
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Hao Wang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
| | - Jonathan P Jacobs
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California; Division of Gastroenterology, Hepatology and Parenteral Nutrition, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California.
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5
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Sarnoff RP, Bhatt RR, Osadchiy V, Dong T, Labus JS, Kilpatrick LA, Chen Z, Subramanyam V, Zhang Y, Ellingson BM, Naliboff B, Chang L, Mayer EA, Gupta A. A multi-omic brain gut microbiome signature differs between IBS subjects with different bowel habits. Neuropharmacology 2023; 225:109381. [PMID: 36539012 DOI: 10.1016/j.neuropharm.2022.109381] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Alterations of the brain-gut-microbiome system (BGM) have been implicated in the pathophysiology of irritable bowel syndrome (IBS), yet bowel habit-specific alterations have not been elucidated. In this cross-sectional study, we apply a systems biology approach to characterize BGM patterns related to predominant bowel habit. Fecal samples and resting state fMRI were obtained from 102 premenopausal women (36 constipation-predominant IBS (IBS-C), 27 diarrhea-predominant IBS (IBS-D), 39 healthy controls (HCs)). Data integration analysis using latent components (DIABLO) was used to integrate data from the phenome, microbiome, metabolome, and resting-state connectome to predict HCs vs IBS-C vs IBS-D. Bloating and visceral sensitivity, distinguishing IBS from HC, were negatively associated with beneficial microbes and connectivity involving the orbitofrontal cortex. This suggests that gut interactions may generate aberrant central autonomic and descending pain pathways in IBS. The connection between IBS symptom duration, key microbes, and caudate connectivity may provide mechanistic insight to the chronicity of pain in IBS. Compared to IBS-C and HCs, IBS-D had higher levels of many key metabolites including tryptophan and phenylalanine, and increased connectivity between the sensorimotor and default mode networks; thus, suggestingan influence on diarrhea, self-related thoughts, and pain perception in IBS-D ('bottom-up' mechanism). IBS-C's microbiome and metabolome resembled HCs, but IBS-C had increased connectivity in the default mode and salience networks compared to IBS-D, which may indicate importance of visceral signals, suggesting a more 'top-down' BGM pathophysiology. These BGM characteristics highlight possible mechanistic differences for variations in the IBS bowel habit phenome. This article is part of the Special Issue on 'Microbiome & the Brain: Mechanisms & Maladies'.
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Affiliation(s)
- Rachel P Sarnoff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Ravi R Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, USA
| | - Vadim Osadchiy
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Tien Dong
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA; UCLA Microbiome Center, USA; Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jennifer S Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA
| | - Lisa A Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA
| | - Zixi Chen
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA
| | | | - Yurui Zhang
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA
| | - Benjamin M Ellingson
- Departments of Radiological Sciences, Psychiatry, and Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Bruce Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA
| | - Lin Chang
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA; UCLA Microbiome Center, USA.
| | - Arpana Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, USA; David Geffen School of Medicine, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, USA; UCLA Microbiome Center, USA.
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6
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Farrar J, Locke K, Clemens J, Griffith J, Harte S, Kirkali Z, Kreder K, Krieger J, Lai HH, Moldwin R, Mullins C, Naliboff B, Pontari M, Rodríguez L, Schaeffer A, Stephens-Shields A, Sutcliffe S, Taple B, Williams D, Landis J. Widespread Pain Phenotypes Impact Treatment Efficacy Results in Randomized Clinical Trials for Interstitial Cystitis/Bladder Pain Syndrome: A MAPP Network Study. Res Sq 2023:rs.3.rs-2441086. [PMID: 36865104 PMCID: PMC9980200 DOI: 10.21203/rs.3.rs-2441086/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Clinical trials of pain are notoriously difficult and inefficient in demonstrating efficacy even for known efficacious treatments. Determining the appropriate pain phenotype to study can be problematic. Recent work has identified the extend of widespread pain as an important factor in the likelihood of response to therapy, but has not been tested in clinical trials. Using data from three previously published negative studies of the treatment of interstitial cystitis/ bladder pain with data on the extent of widespread pain, we examined the response of patients to different therapies base on the amount of pain beyond the pelvis. Participants with predominately local but not widespread pain responded to therapy targeting local symptoms. Participants with widespread and local pain responded to therapy targeting widespread pain. Differentiating patients with and without widespread pain phenotypes may be a key feature of designing future pain clinical trials to demonstrate treatments that are effective versus not.
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Affiliation(s)
- John Farrar
- University of Pennsylvania Perelman School of Medicine
| | - Kenneth Locke
- University of Pennsylvania, Perelman School of Medicine
| | - J Clemens
- University of Michigan Medical School
| | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | - Karl Kreder
- University of Iowa Carver College of Medicine
| | | | | | | | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | | | | | | | | | | | | | - Bayley Taple
- Northwestern University Feinberg School of Medicine
| | | | - J Landis
- University of Pennsylvania Perelman School of Medicine
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7
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Labus JS, Wang C, Mayer EA, Gupta A, Oughourlian T, Kilpatrick L, Tillisch K, Chang L, Naliboff B, Ellingson BM. Sex-specific brain microstructural reorganization in irritable bowel syndrome. Pain 2023; 164:292-304. [PMID: 35639426 PMCID: PMC9691795 DOI: 10.1097/j.pain.0000000000002699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Preliminary evidence suggests that there are sex differences in microstructural brain organization among individuals with irritable bowel syndrome (IBS). The aim of this study was to further investigate sex-dependent differences in brain microstructure and organization in a large sample of well-phenotyped participants with IBS compared with healthy controls. We hypothesized that female patients with IBS would show evidence for increased axonal strength and myelination within and between brain regions concerned with pain and sensory processing, when compared with males with IBS. We also hypothesized that female compared with male IBS subjects show greater levels of somatic awareness and sensory sensitivity consistent with multisystem sensory sensitivity. Diffusion tensor images and clinical assessments were obtained in 100 healthy controls (61 females) and 152 IBS (107 females) on a 3T Siemens Trio. Whole brain voxel-wise differences in fractional anisotropy, mean, radial and axial diffusivity, and track density as differences in somatic awareness and sensory sensitivity were assessed using the general linear model. Female compared with male IBS participants showed extensive microstructural alterations in sensorimotor, corticothalamic, and basal ganglia circuits involved in pain processing and integration of sensorimotor information. Together with the observed increases in symptom severity, somatic awareness, and sensory sensitivity, the findings support the hypotheses that the etiology and maintenance of symptoms in females with IBS may be driven by greater central sensitivity for multiple sensory stimuli.
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Affiliation(s)
- Jennifer S. Labus
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Emeran A Mayer
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Arpana Gupta
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Talia Oughourlian
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Lisa Kilpatrick
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kirsten Tillisch
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Lin Chang
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Bruce Naliboff
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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8
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Sutcliffe S, Newcomb C, Bradley CS, Clemens JQ, Erickson B, Gupta P, Lai HH, Naliboff B, Strachan E, Stephens-Shields A. Associations Between Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking Activity: Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study. J Urol 2023; 209:101097JU0000000000003155. [PMID: 36630590 PMCID: PMC10333444 DOI: 10.1097/ju.0000000000003155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Most studies on interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome use typical or average levels of pelvic pain or urological symptom intensity as their outcome, as both are associated with reduced quality of life. Symptom exacerbations or "flares" have also been found to be associated with reduced quality of life, but no studies, to our knowledge, have investigated whether these associations are independent of typical pelvic pain levels and thus might be useful additional outcome measures (or stated differently, whether reducing flare frequency even without reducing mean pain intensity may be important to patients). MATERIALS AND METHODS We used screening visit and weekly run-in period data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study to investigate associations between flare frequency and multiple measures of illness impact and health care seeking activity, independent of typical nonflare and overall pelvic pain levels. RESULTS Among the 613 eligible participants, greater flare frequency was associated with worse condition-specific illness impact (standardized β coefficients=0.11-0.68, P trends < .0001) and health care seeking activity (odds ratios=1.52-3.94, P trends .0039 to < .0001) in analyses adjusted for typical nonflare and overall pelvic pain levels. Experiencing ≥1/d was also independently associated with worse general illness impact (standardized β coefficients=0.11-0.25). CONCLUSIONS Our findings suggest that flare frequency and possibly other flare characteristics may be worth considering as additional outcome measures in urological chronic pelvic pain syndrome research to support the development of new preventive and therapeutic flare strategies.
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Affiliation(s)
- Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery; Alvin J. Siteman Cancer Cancer; and the Department of Obstetrics and Gynecology; Washington University School of Medicine, St. Louis, MO
| | - Craig Newcomb
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Catherine S. Bradley
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | - Bradley Erickson
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - H. Henry Lai
- Division of Urologic Surgery, Department of Surgery; and the Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Bruce Naliboff
- Department of Medicine, Geffen School of Medicine, University of California – Los Angeles, Los Angeles, CA
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Alisa Stephens-Shields
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Schrepf A, Gallop R, Naliboff B, Harte SE, Afari N, Lai HH, Pontari M, McKernan LC, Strachan E, Kreder KJ, As-Sanie SA, Rodriguez LV, Griffith JW, Williams DA. Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. J Pain 2022; 23:1594-1603. [PMID: 35472518 PMCID: PMC10547025 DOI: 10.1016/j.jpain.2022.03.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0-31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. PERSPECTIVE: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Robert Gallop
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Niloofar Afari
- Department of Psychiatry, UC San Diego & VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - H Henry Lai
- Department of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Michel Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Lindsey C McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Karl J Kreder
- Departments of Urology and Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa
| | - Sawsan A As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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10
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Trieschmann K, Chang L, Park S, Naliboff B, Joshi S, Labus JS, Sauk JS, Limketkai BN, Mayer EA. The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease. Neurogastroenterol Motil 2022; 34:e14384. [PMID: 35478469 PMCID: PMC9427691 DOI: 10.1111/nmo.14384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are chronic gastrointestinal (GI) disorders. GI symptom-specific anxiety (GSA) is the cognitive, affective, and behavioral response stemming from fear of GI symptoms. The Visceral Sensitivity Index (VSI) measures GSA and is validated in IBS and may be useful in IBD. METHODS We compared VSI scores in IBD participants to IBS participants and healthy controls (HCs). Using validated questionnaires, we assessed the VSI's correlation with anxiety, health-related quality of life (HRQOL), and IBD activity. KEY RESULTS We recruited 222 age- and sex-matched participants (74 IBD [23 Crohn's disease; 51 ulcerative colitis], 74 IBS, and 74 HCs). IBD and IBS participants had higher VSI scores compared with HCs (IBD = 26.62 ± 16.64, IBS = 38.83 ± 15.06; HCs = 3.42±5.06; all p's < 0.001). VSI scores were lower in IBD vs IBS (p < 0.001). In IBD, VSI modestly correlated with current anxiety (R = 0.35, p = 0.002) and the physical component of HRQOL (R = -0.45, p = 0.0001) but less with the mental component of HRQOL (R = -0.23, p = 0.05). CONCLUSIONS & INFERENCES Our findings suggest the VSI is a useful measure in IBD. The VSI in IBD is related to general anxiety but is measuring a different construct and is not affected by the presence of trait anxiety. IBD patients have GSA that is associated with decreased HRQOL, which can negatively affect treatment compliance and other long-term disease outcomes. Future studies are needed to further validate the VSI in IBD and to assess its correlation with disease activity.
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Affiliation(s)
- Kimberly Trieschmann
- UCLA Division of Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah Park
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Swapna Joshi
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S. Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jenny S. Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Berkeley N. Limketkai
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A. Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
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11
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Gupta A, Bhatt RR, Rivera-Cancel A, Makkar R, Kragel PA, Rodriguez T, Graner JL, Alaverdyan A, Hamadani K, Vora P, Naliboff B, Labus JS, LaBar KS, Mayer EA, Zucker N. Complex functional brain network properties in anorexia nervosa. J Eat Disord 2022; 10:13. [PMID: 35123579 PMCID: PMC8817538 DOI: 10.1186/s40337-022-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a disorder characterized by an incapacitating fear of weight gain and by a disturbance in the way the body is experienced, facets that motivate dangerous weight loss behaviors. Multimodal neuroimaging studies highlight atypical neural activity in brain networks involved in interoceptive awareness and reward processing. METHODS The current study used resting-state neuroimaging to model the architecture of large-scale functional brain networks and characterize network properties of individual brain regions to clinical measures. Resting-state neuroimaging was conducted in 62 adolescents, 22 (21 female) with a history of AN and 40 (39 female) healthy controls (HCs). Sensorimotor and basal ganglia regions, as part of a 165-region whole-brain network, were investigated. Subject-specific functional brain networks were computed to index centrality. A contrast analysis within the general linear model covarying for age was performed. Correlations between network properties and behavioral measures were conducted (significance q < .05). RESULTS Compared to HCs, AN had lower connectivity from sensorimotor regions, and greater connectivity from the left caudate nucleus to the right postcentral gyrus. AN demonstrated lower sensorimotor centrality, but higher basal ganglia centrality. Sensorimotor connectivity dyads and centrality exhibited negative correlations with body dissatisfaction and drive for thinness, two essential features of AN. CONCLUSIONS These findings suggest that AN is associated with greater communication from the basal ganglia, and lower information propagation in sensorimotor cortices. This is consistent with the clinical presentation of AN, where individuals exhibit patterns of rigid habitual behavior that is not responsive to bodily needs, and seem "disconnected" from their bodies.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA. .,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.
| | - Ravi R Bhatt
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine at USC, University of Southern California, Los Angeles, USA
| | | | - Rishi Makkar
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | | | - Thomas Rodriguez
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - John L Graner
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Anita Alaverdyan
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Kareem Hamadani
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Kevin S LaBar
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.,Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA, 90095, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.,Department of Psychology and Neuroscience, Duke University, Durham, USA
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12
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Coley EJ, Mayer EA, Osadchiy V, Chen Z, Subramanyam V, Zhang Y, Hsiao EY, Gao K, Bhatt R, Dong T, Vora P, Naliboff B, Jacobs JP, Gupta A. Early life adversity predicts brain-gut alterations associated with increased stress and mood. Neurobiol Stress 2021; 15:100348. [PMID: 34113697 PMCID: PMC8170500 DOI: 10.1016/j.ynstr.2021.100348] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 01/16/2023] Open
Abstract
Alterations in the brain-gut system have been implicated in various disease states, but little is known about how early-life adversity (ELA) impacts development and adult health as mediated by brain-gut interactions. We hypothesize that ELA disrupts components of the brain-gut system, thereby increasing susceptibility to disordered mood. In a sample of 128 healthy adult participants, a history of ELA and current stress, depression, and anxiety were assessed using validated questionnaires. Fecal metabolites were measured using liquid chromatography tandem mass spectrometry-based untargeted metabolomic profiling. Functional brain connectivity was evaluated by magnetic resonance imaging. Sparse partial least squares-discriminant analysis, controlling for sex, body mass index, age, and diet was used to predict brain-gut alterations as a function of ELA. ELA was correlated with four gut-regulated metabolites within the glutamate pathway (5-oxoproline, malate, urate, and glutamate gamma methyl ester) and alterations in functional brain connectivity within primarily sensorimotor, salience, and central executive networks. Integrated analyses revealed significant associations between these metabolites, functional brain connectivity, and scores for perceived stress, anxiety, and depression. This study reveals a novel association between a history of ELA, alterations in the brain-gut axis, and increased vulnerability to negative mood and stress. Results from the study raise the hypothesis that select gut-regulated metabolites may contribute to the adverse effects of critical period stress on neural development via pathways related to glutamatergic excitotoxicity and oxidative stress.
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Affiliation(s)
- Elena J.L. Coley
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emeran A. Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,David Geffen School of Medicine, University of California, Los Angeles, USA,Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA,UCLA Microbiome Center, Los Angeles, CA, USA
| | - Vadim Osadchiy
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,David Geffen School of Medicine, University of California, Los Angeles, USA,Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Zixi Chen
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA
| | - Vishvak Subramanyam
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA
| | - Yurui Zhang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA
| | - Elaine Y. Hsiao
- David Geffen School of Medicine, University of California, Los Angeles, USA,UCLA Microbiome Center, Los Angeles, CA, USA,Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kan Gao
- Laboratory of Gastrointestinal Microbiology, Nanjing Agricultural University, PR China
| | - Ravi Bhatt
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,Imaging Genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
| | - Tien Dong
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,David Geffen School of Medicine, University of California, Los Angeles, USA,Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA,UCLA Microbiome Center, Los Angeles, CA, USA,Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,David Geffen School of Medicine, University of California, Los Angeles, USA,Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA
| | - Jonathan P. Jacobs
- David Geffen School of Medicine, University of California, Los Angeles, USA,Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA,UCLA Microbiome Center, Los Angeles, CA, USA,Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, USA,David Geffen School of Medicine, University of California, Los Angeles, USA,Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA,UCLA Microbiome Center, Los Angeles, CA, USA,Corresponding author. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA CHS, 42-210 MC737818 10833 Le Conte Avenue, USA.
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13
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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14
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Ravichandran S, Bhatt RR, Pandit B, Osadchiy V, Alaverdyan A, Vora P, Stains J, Naliboff B, Mayer EA, Gupta A. Alterations in reward network functional connectivity are associated with increased food addiction in obese individuals. Sci Rep 2021; 11:3386. [PMID: 33564081 PMCID: PMC7873272 DOI: 10.1038/s41598-021-83116-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
Functional neuroimaging studies in obesity have identified alterations in the connectivity within the reward network leading to decreased homeostatic control of ingestive behavior. However, the neural mechanisms underlying sex differences in the prevalence of food addiction in obesity is unknown. The aim of the study was to identify functional connectivity alterations associated with: (1) Food addiction, (2) Sex- differences in food addiction, (3) Ingestive behaviors. 150 participants (females: N = 103, males: N = 47; food addiction: N = 40, no food addiction: N = 110) with high BMI ≥ 25 kg/m2 underwent functional resting state MRIs. Participants were administered the Yale Food Addiction Scale (YFAS), to determine diagnostic criteria for food addiction (YFAS Symptom Count ≥ 3 with clinically significant impairment or distress), and completed ingestive behavior questionnaires. Connectivity differences were analyzed using a general linear model in the CONN Toolbox and images were segmented using the Schaefer 400, Harvard-Oxford Subcortical, and Ascending Arousal Network atlases. Significant connectivities and clinical variables were correlated. Statistical significance was corrected for multiple comparisons at q < .05. (1) Individuals with food addiction had greater connectivity between brainstem regions and the orbital frontal gyrus compared to individuals with no food addiction. (2) Females with food addiction had greater connectivity in the salience and emotional regulation networks and lowered connectivity between the default mode network and central executive network compared to males with food addiction. (3) Increased connectivity between regions of the reward network was positively associated with scores on the General Food Cravings Questionnaire-Trait, indicative of greater food cravings in individuals with food addiction. Individuals with food addiction showed greater connectivity between regions of the reward network suggesting dysregulation of the dopaminergic pathway. Additionally, greater connectivity in the locus coeruleus could indicate that the maladaptive food behaviors displayed by individuals with food addiction serve as a coping mechanism in response to pathological anxiety and stress. Sex differences in functional connectivity suggest that females with food addiction engage more in emotional overeating and less cognitive control and homeostatic processing compared to males. These mechanistic pathways may have clinical implications for understanding the sex-dependent variability in response to diet interventions.
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Affiliation(s)
- Soumya Ravichandran
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
| | - Ravi R Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, USA
| | - Bilal Pandit
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
| | - Vadim Osadchiy
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
- David Geffen School of Medicine At UCLA, Los Angeles, USA
| | - Anita Alaverdyan
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
| | - Priten Vora
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
| | - Jean Stains
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
- David Geffen School of Medicine At UCLA, Los Angeles, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, USA
| | - Bruce Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
- David Geffen School of Medicine At UCLA, Los Angeles, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, USA
- UCLA Microbiome Center, Los Angeles, USA
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA
- David Geffen School of Medicine At UCLA, Los Angeles, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, USA
- UCLA Microbiome Center, Los Angeles, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Arpana Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, CHS 42-210 MC737818, 10833 Le Conte Avenue, Los Angeles, USA.
- David Geffen School of Medicine At UCLA, Los Angeles, USA.
- Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, USA.
- UCLA Microbiome Center, Los Angeles, USA.
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15
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Osadchiy V, Mayer EA, Gao K, Labus JS, Naliboff B, Tillisch K, Chang L, Jacobs JP, Hsiao EY, Gupta A. Analysis of brain networks and fecal metabolites reveals brain-gut alterations in premenopausal females with irritable bowel syndrome. Transl Psychiatry 2020; 10:367. [PMID: 33139708 PMCID: PMC7608552 DOI: 10.1038/s41398-020-01071-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023] Open
Abstract
Alterations in brain-gut-microbiome (BGM) interactions have been implicated in the pathogenesis of irritable bowel syndrome (IBS). Here, we apply a systems biology approach, leveraging neuroimaging and fecal metabolite data, to characterize BGM interactions that are driving IBS pathophysiology. Fecal samples and resting state fMRI images were obtained from 138 female subjects (99 IBS, 39 healthy controls (HCs)). Partial least-squares discriminant analysis (PLS-DA) was conducted to explore group differences, and partial correlation analysis explored significantly changed metabolites and neuroimaging data. All correlational tests were performed controlling for age, body mass index, and diet; results are reported after FDR correction, with q < 0.05 as significant. Compared to HCs, IBS showed increased connectivity of the putamen with regions of the default mode and somatosensory networks. Metabolite pathways involved in nucleic acid and amino acid metabolism differentiated the two groups. Only a subset of metabolites, primarily amino acids, were associated with IBS-specific brain changes, including tryptophan, glutamate, and histidine. Histidine was the only metabolite positively associated with both IBS-specific alterations in brain connectivity. Our findings suggest a role for several amino acid metabolites in modulating brain function in IBS. These metabolites may alter brain connectivity directly, by crossing the blood-brain-barrier, or indirectly through peripheral mechanisms. This is the first study to integrate both neuroimaging and fecal metabolite data supporting the BGM model of IBS, building the foundation for future mechanistic studies on the influence of gut microbial metabolites on brain function in IBS.
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Affiliation(s)
- Vadim Osadchiy
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Emeran A. Mayer
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381UCLA Microbiome Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Kan Gao
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA
| | - Jennifer S. Labus
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Bruce Naliboff
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Kirsten Tillisch
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381UCLA Microbiome Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Lin Chang
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Jonathan P. Jacobs
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381UCLA Microbiome Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA ,grid.417119.b0000 0001 0384 5381Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Elaine Y. Hsiao
- grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA USA
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, CA, USA. .,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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16
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Lenhart A, Naliboff B, Shih W, Gupta A, Tillisch K, Liu C, Mayer EA, Chang L. Postmenopausal women with irritable bowel syndrome (IBS) have more severe symptoms than premenopausal women with IBS. Neurogastroenterol Motil 2020; 32:e13913. [PMID: 32469130 PMCID: PMC7529855 DOI: 10.1111/nmo.13913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although irritable bowel syndrome (IBS) is more common in women, little is known about the role of hormonal changes and menopause in IBS. This study aimed to evaluate for differences in gastrointestinal (GI) and psychological symptoms between pre- and postmenopausal women with IBS compared to age-matched men with IBS. METHODS Patients with Rome-positive IBS were identified. Premenopausal women were <45 years of age with regular menses. Postmenopausal women were ≥45 years without menses for at least 1 year. Younger men were <45 years, and older men were ≥45 years. Questionnaires measured severity of IBS symptoms, somatic symptoms, health-related quality of life (HRQOL), and psychological symptoms. Multivariable linear or logistic regressions evaluating relationships between age and sex were performed. KEY RESULTS 190 premenopausal women (mean age 30.25 years), 52 postmenopausal women (mean age 54.38 years), 190 men <45 years (mean age 30.45 years), and 52 men ≥45 years (mean age 53.37 years) were included. Postmenopausal IBS women had greater severity of IBS symptoms (P = .003) and worse physical HRQOL (P = .048) compared to premenopausal women. No differences were observed between age-matched older and younger IBS men. Constipation increased with age for both sexes but was the principal IBS subtype in women only. CONCLUSIONS AND INFERENCES Postmenopausal women with IBS have more severe IBS symptoms than premenopausal women, while no comparable age-related changes were seen in IBS men. The modulatory effect of female sex hormones on brain-gut interactions which affect visceral perception and GI function likely contributes to these findings.
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Affiliation(s)
- Adrienne Lenhart
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
| | - Bruce Naliboff
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
| | - Wendy Shih
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, CA, USA
| | - Arpana Gupta
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
| | - Kirsten Tillisch
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
| | - Cathy Liu
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
| | - Emeran A. Mayer
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases,
David Geffen School of Medicine, University of California, Los Angeles, CA,
USA
- G Oppenheimer Center for Neurobiology of Stress and
Resilience, University of California, Los Angeles, CA, USA
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17
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Rahal H, Videlock EJ, Icenhour A, Shih W, Naliboff B, Gupta A, Mayer EA, Chang L. Importance of trauma-related fear in patients with irritable bowel syndrome and early adverse life events. Neurogastroenterol Motil 2020; 32:e13896. [PMID: 32558017 PMCID: PMC7483907 DOI: 10.1111/nmo.13896] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although early adverse life events (EALs) are prevalent among patients with irritable bowel syndrome (IBS), the impact of fear or dissociation experienced during the trauma has not been evaluated. We investigated the prevalence of fear at the time of trauma and its association with IBS status among individuals with early-life trauma before the age of 18. METHODS Among participants with ≥1 EAL, association of fear and dissociation with IBS status was determined with logistic regression, and improvement in prediction of IBS over ETI score alone was determined with the likelihood ratio test. Controlling for age, sex, and IBS status, we then examined the association of each EAL with reported fear. KEY RESULTS Compared to healthy controls (HCs), IBS subjects reported a higher prevalence of fear (60.4% vs 36.2%, P < .0005) and dissociation (23.5% vs 13.0%, P < .0005) at the time of EAL. Fear, but not dissociation, improved prediction of IBS over the total number of EALs (odds ratio = 2.00, P < .0001). CONCLUSIONS AND INFERENCES This study highlights the importance of EAL-related factors such as fear in addition to the presence or absence of EALs in IBS pathophysiology.
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Affiliation(s)
- Harman Rahal
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
| | - Elizabeth J. Videlock
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
| | - Adriane Icenhour
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Wendy Shih
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States,Center of Health Research, School of Public Health, Loma Linda University, Loma Linda, California
| | - Bruce Naliboff
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
| | - Arpana Gupta
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
| | - Emeran A. Mayer
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
| | - Lin Chang
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 42-210, Los Angeles, California 90095-7378, United States
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18
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Davydov DM, Shahabi L, Naliboff B. Cardiovascular phenotyping for personalized lifestyle treatments of chronic abdominal pain in Irritable Bowel Syndrome: A randomized pilot study. Neurogastroenterol Motil 2019; 31:e13710. [PMID: 31429514 PMCID: PMC6861616 DOI: 10.1111/nmo.13710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Different physical exercise interventions for pain and other related symptoms largely follow non-personalized guidelines and show a high degree of variability in outcome. These interventions are considered to have different pathways toward improvement in autonomic regulation of energy metabolism. The current pilot study was conducted to assess the predictive value of individual cardiovascular (CV) activity markers at rest to predict clinical outcomes for two popular exercise-based interventions (walking and yoga) in patients with Irritable Bowel Syndrome (IBS). METHODS Twenty-seven adult participants with IBS were randomly assigned to a 16-biweekly Iyengar yoga or walking program. They completed pre- and post-treatment assessments on IBS symptom severity, affective and somatic complaints, and various measures of resting autonomic function including blood pressure (BP), heart rate and its variability, baroreceptor sensitivity (BRS) to activations and inhibitions with gains of brady- and tachycardiac baro-responses, and BP start points for these spontaneous baroreflexes. RESULTS Pretreatment BRS was differentially related to clinical response for the treatment groups. Specifically, a significant decrease in pain severity was found in response to yoga for those participants who had lower resting BRS to activations, but decreased pain severity was associated with higher resting BRS for those in the walking group. The effect was not related to affective symptom relief. Other CV measures showed similar associations with clinical outcomes for both groups. CONCLUSIONS The data suggest therefore that CV based phenotypes may be useful in personalizing clinical interventions for IBS. They may also point to autonomic mechanisms that are targets for such interventions.
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Affiliation(s)
- Dmitry M. Davydov
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, 8 Baltiyskaia ul., Moscow, 125315, Russia,Correspondence to Dmitry M. Davydov, Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, 8 Baltiyskaia ul., Moscow, 125315, Russia; Phone: 7 (495) 496 5234; Fax: 7 (495) 601 2366;
| | - Leila Shahabi
- Departments of Medicine, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095
| | - Bruce Naliboff
- Departments of Medicine, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095
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19
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Schrepf A, Naliboff B, Williams DA, Stephens-Shields AJ, Landis JR, Gupta A, Mayer E, Rodriguez LV, Lai H, Luo Y, Bradley C, Kreder K, Lutgendorf SK. Adverse Childhood Experiences and Symptoms of Urologic Chronic Pelvic Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study. Ann Behav Med 2019; 52:865-877. [PMID: 30212850 DOI: 10.1093/abm/kax060] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Adverse Childhood Experiences (ACEs) such as sexual and physical violence, serious illness, and bereavement have been linked to number of chronic pain conditions in adulthood, and specifically to urologic chronic pelvic pain syndrome (UCPPS). Purpose We sought to characterize the prevalence of ACEs in UCPPS using a large well-characterized cohort in comparison with a group of healthy controls. We also sought to determine the association of ACE severity with psychological factors known to impact pain and to determine whether ACEs are associated with patterns of improvement or worsening of symptom over a year of naturalistic observation. Methods For longitudinal analyses we used functional clusters identifying broad classes of (a) improved, (b) worsened, and (c) stable groups for genitourinary pain and urinary symptoms. We employed a mediation/path analysis framework to determine whether ACEs influenced 1 year outcomes directly, or indirectly through worse perceptions of physical well-being. Results ACE severity was elevated in UCPPS (n = 421) participants compared with healthy controls (n = 414; p < .001), and was most strongly associated with factors associated with complex chronic pain, including more diffuse pain, comorbid functional symptoms/syndromes, and worse perceived physical well-being (all p < .001). Finally, worse physical well-being mediated the relationship between ACE severity and less likelihood of painful symptom improvement (OR = .871, p = .007)) and a greater likelihood of painful symptom worsening (OR = 1.249, p = .003) at 1 year. Conclusions These results confirm the association between ACEs and UCPPS symptoms, and suggest potential targets for therapeutic interventions in UCPPS. Clinical Trial registration NCT01098279.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Naliboff
- Department of Medicine, University of California, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Alisa J Stephens-Shields
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Emeran Mayer
- Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yi Luo
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Catherine Bradley
- Department of Urology, University of Iowa, Iowa City, IA, USA.,Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences and Urology, University of Iowa, Iowa City, IA, USA
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20
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Osadchiy V, Mayer EA, Bhatt R, Labus JS, Gao L, Kilpatrick LA, Liu C, Tillisch K, Naliboff B, Chang L, Gupta A. History of early life adversity is associated with increased food addiction and sex-specific alterations in reward network connectivity in obesity. Obes Sci Pract 2019; 5:416-436. [PMID: 31687167 PMCID: PMC6819979 DOI: 10.1002/osp4.362] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neuroimaging studies have identified obesity-related differences in the brain's resting state activity. An imbalance between homeostatic and reward aspects of ingestive behaviour may contribute to obesity and food addiction. The interactions between early life adversity (ELA), the reward network and food addiction were investigated to identify obesity and sex-related differences, which may drive obesity and food addiction. METHODS Functional resting state magnetic resonance imaging was acquired in 186 participants (high body mass index [BMI]: ≥25: 53 women and 54 men; normal BMI: 18.50-24.99: 49 women and 30 men). Participants completed questionnaires to assess ELA (Early Traumatic Inventory) and food addiction (Yale Food Addiction Scale). A tripartite network analysis based on graph theory was used to investigate the interaction between ELA, brain connectivity and food addiction. Interactions were determined by computing Spearman rank correlations, thresholded at q < 0.05 corrected for multiple comparisons. RESULTS Participants with high BMI demonstrate an association between ELA and food addiction, with reward regions playing a role in this interaction. Among women with high BMI, increased ELA was associated with increased centrality of reward and emotion regulation regions. Men with high BMI showed associations between ELA and food addiction with somatosensory regions playing a role in this interaction. CONCLUSIONS The findings suggest that ELA may alter brain networks, leading to increased vulnerability for food addiction and obesity later in life. These alterations are sex specific and involve brain regions influenced by dopaminergic or serotonergic signalling.
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Affiliation(s)
- V. Osadchiy
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - E. A. Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Ahmanson‐Lovelace Brain Mapping CenterUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - R. Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - J. S. Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Gao
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. A. Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - C. Liu
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - K. Tillisch
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - B. Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Chang
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - A. Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
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21
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Rodríguez LV, Stephens AJ, Clemens JQ, Buchwald D, Yang C, Lai HH, Krieger JN, Newcomb C, Bradley CS, Naliboff B. Symptom Duration in Patients With Urologic Chronic Pelvic Pain Syndrome is not Associated With Pain Severity, Nonurologic Syndromes and Mental Health Symptoms: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Study. Urology 2018; 124:14-22. [PMID: 30452963 DOI: 10.1016/j.urology.2018.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate if patients with urologic chronic pelvic pain syndromes (UCPPS) with longer duration of symptoms experience more severe pain and urologic symptoms, higher rates of chronic overlapping pain conditions (COPC) and psychosocial comorbidities than those with a more recent onset of the condition. We evaluated cross-sectional associations between UCPPS symptom duration and (1) symptom severity, (2) presence of COPC, and (3) mental health comorbidities. METHODS We analyzed baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain. Symptom severity, COPC, and mental health comorbidities were compared between patients with symptom duration of < 2 vs ≥ 2 years. Symptom severity was assessed by the Genitourinary Pain Index, the Interstitial Cystitis Symptom and Problem Index, and Likert scales for pelvic pain, urgency, and frequency. Depression and anxiety were evaluated with the Hospital Anxiety and Depression Scale and stress with the Perceived Stress Scale. RESULTS Males (but not females) with UCPPS symptom duration ≥2 years had more severe symptoms than those with <2 years. Participants with short (<2 years) and longer (≥2 years) symptom duration were as likely to experience COPC. CONCLUSION Longer UCPPS symptom duration was associated with more severe symptoms only in limited patient subpopulations. Symptom duration was not associated with risk for COPC or mental health comorbidities. Females with longer UCPPS duration had decreased distress, but the association was largely attributable to age.
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Affiliation(s)
- Larissa V Rodríguez
- Departments of Urology and Obstetrics and Gynecology, Institute of Urology, University of Southern California, Los Angeles, CA.
| | - Alisa J Stephens
- Data Coordinating Core, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J Quentin Clemens
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI
| | - Dedra Buchwald
- Department of Urology, University of Washington, Seattle, WA
| | - Claire Yang
- Department of Urology, University of Washington, Seattle, WA
| | - Henry H Lai
- Departments of Surgery (Division of Urologic Surgery) and Anesthesiology, Washington University, St. Louis, MO
| | - John N Krieger
- Department of Urology, University of Washington, Seattle, WA
| | - Craig Newcomb
- Data Coordinating Core, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cate S Bradley
- Department of Obstetrics and Gynecology, and Urology, College of Medicine and Department of Public Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry, The Geffen School of Medicine at UCLA, Los Angeles, CA
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22
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Schrepf A, Williams DA, Gallop R, Naliboff B, Basu N, Kaplan C, Harper DE, Landis R, Clemens JQ, Strachan E, Griffith JW, Afari N, Hassett A, Pontari MA, Clauw DJ, Harte SE. Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: a MAPP Research Network study. Pain 2018; 159:2002-2011. [PMID: 29863527 PMCID: PMC6705610 DOI: 10.1097/j.pain.0000000000001299] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic overlapping pain conditions (COPCs) are characterized by aberrant central nervous system processing of pain. This "centralized pain" phenotype has been described using a large and diverse set of symptom domains, including the spatial distribution of pain, pain intensity, fatigue, mood imbalances, cognitive dysfunction, altered somatic sensations, and hypersensitivity to external stimuli. Here, we used 3 cohorts, including patients with urologic chronic pelvic pain syndrome, a mixed pain cohort with other COPCs, and healthy individuals (total n = 1039) from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network to explore the factor structure of symptoms of centralized pain. Using exploratory and confirmatory factor analysis, we identified 2 general factors in all 3 cohorts, one characterized by a broad increased sensitivity to internal somatic sensations,environmental stimuli, and diffuse pain, termed Generalized Sensory Sensitivity, and one characterized by constitutional symptoms-Sleep, Pain, Affect, Cognition, Energy (SPACE). Longitudinal analyses in the urologic chronic pelvic pain syndrome cohort found the same 2-factor structure at month 6 and 1 year, suggesting that the 2-factor structure is reproducible over time. In secondary analyses, we found that Generalized Sensory Sensitivity particularly is associated with the presence of comorbid COPCs, whereas SPACE shows modest associations with measures of disability and urinary symptoms. These factors may represent an important and distinct continuum of symptoms that are indicative of the centralized pain phenotype at high levels. Future research of COPCs should accommodate the measurement of each factor.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles CA, USA
| | - Neil Basu
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Chelsea Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E. Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Niloofar Afari
- VA San Diego Healthcare System and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Afton Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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23
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Lai HH, Naliboff B, Liu AB, Amundsen CL, Shimony JS, Magnotta VA, Shaffer JJ, Gilliam RL, Wiseman JB, Helmuth ME, Andreev VP, Kirkali Z, Harte SE. The LURN Research Network Neuroimaging and Sensory Testing (NIST) Study: Design, protocols, and operations. Contemp Clin Trials 2018; 74:76-87. [PMID: 30248454 DOI: 10.1016/j.cct.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
The Neuroimaging and Sensory Testing (NIST) Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a cross-sectional, case-control study designed to investigate whether disrupted brain connectivity and sensory processing are associated with abnormal lower urinary tract symptoms (LUTS) in patients with overactive bladder syndrome (OAB). The NIST Study tests the hypotheses that patients with urinary urgency will demonstrate: (1) abnormal functional and structural connectivity of brain regions involved in urinary sensation on magnetic resonance imaging (MRI), and (2) hypersensitivity to painful (pressure) and non-painful (auditory) sensory stimuli on quantitative sensory testing (QST), compared to controls. Male and female adults (18 years or older) who present at one of the six participating LURN clinical centers for clinical care of their LUTS, with symptoms of urinary urgency with or without urgency urinary incontinence, are eligible to participate. The NIST Study is the largest MRI and QST study of its kind, yielding a neuroimaging and sensory testing dataset unprecedented in OAB research. Advanced multi-modal techniques are used to understand brain functional and structural connectivity, including gray matter volume, and sensory function. Unlike previous MRI studies which involved invasive catheterization and repeated cycles of non-physiologic bladder filling and emptying via a catheter, we use a water ingestion protocol to mimic more physiological bladder filling through natural diuresis. Furthermore, these data will be used in concert with other phenotyping data to improve our understanding of clinically meaningful subtypes of patients with LUTS in order to improve patient care and management outcomes.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Alice B Liu
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, United States
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Joseph J Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Robin L Gilliam
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | | | | | - Victor P Andreev
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, MI, United States
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24
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Davydov DM, Naliboff B, Shahabi L, Shapiro D. Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: Focusing on irritable bowel syndrome. Neurogastroenterol Motil 2018; 30. [PMID: 28834014 DOI: 10.1111/nmo.13186] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Objective measures of pain severity remain ill defined, although its accurate measurement is critical. Reciprocal baroreflex mechanisms of blood pressure (BP) control were found to impact differently on pain regulation, and thus their asymmetry was hypothesized to also connect to chronic pain duration and severity. METHODS Seventy-eight female patients with irritable bowel syndrome (IBS) and 27 healthy women were assessed for IBS severity and chronicity, negative affect, and various measures of resting autonomic function including BP, heart rate and its variability (HRV), baroreceptor-sensitivity to activations and inhibitions, gains of brady- and tachy-cardiac baro-responses, gains of BP falls/rises, and BP start points for these spontaneous baroreflexes. KEY RESULTS IBS directly and indirectly (through increased negative affect) was associated with asymmetry between baroreceptor activations/inhibitions compared to symmetrical baroreflex reciprocity in the healthy women. In the IBS group, independently of specific IBS symptoms, pain chronicity was associated with (i) decreased BP falls coupled with either (a) decreased tachycardia associated with lower disease severity (earlier "pain resilience" mechanism), or (b) decreased bradycardia associated with higher disease severity (later "pain decompensation" mechanism), or (ii) increased BP start point for baroreceptor activations coupled with either (a) BP increase (delayed "pain adaptation" mechanism) or (b) affect-related HRV decrease (delayed "pain aggravation" mechanism). CONCLUSION AND INFERENCES We anticipate the findings to be a starting point for validating these autonomic metrics of pain suffering and pain coping mechanisms in other chronic pain syndromes to suggest them as biomarkers of its severity and duration for profiling and correct management of chronic pain patients.
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Affiliation(s)
- D M Davydov
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, Moscow, Russia.,Department of Medical Development, GLMED Longevity & Beauty Residence, Moscow, Russia
| | - B Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - D Shapiro
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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25
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Gupta A, Mayer EA, Labus JS, Bhatt RR, Ju T, Love A, Bal A, Tillisch K, Naliboff B, Sanmiguel CP, Kilpatrick LA. Sex Commonalities and Differences in Obesity-Related Alterations in Intrinsic Brain Activity and Connectivity. Obesity (Silver Spring) 2018; 26:340-350. [PMID: 29280306 PMCID: PMC5783781 DOI: 10.1002/oby.22060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to characterize obesity-related sex differences in the intrinsic activity and connectivity of the brain's reward networks. METHODS Eighty-six women (n = 43) and men (n = 43) completed a 10-minute resting functional magnetic resonance imaging scan. Sex differences and commonalities in BMI-related frequency power distribution and reward seed-based connectivity were investigated by using partial least squares analysis. RESULTS For whole-brain activity in both men and women, increased BMI was associated with increased slow-5 activity in the left globus pallidus (GP) and substantia nigra. In women only, increased BMI was associated with increased slow-4 activity in the right GP and bilateral putamen. For seed-based connectivity in women, increased BMI was associated with reduced slow-5 connectivity between the left GP and putamen and the emotion and cortical regulation regions, but in men, increased BMI was associated with increased connectivity with the medial frontal cortex. In both men and women, increased BMI was associated with increased slow-4 connectivity between the right GP and bilateral putamen and the emotion regulation and sensorimotor-related regions. CONCLUSIONS The stronger relationship between increased BMI and decreased connectivity of core reward network components with cortical and emotion regulation regions in women may be related to the greater prevalence of emotional eating. The present findings suggest the importance of personalized treatments for obesity that consider the sex of the affected individual.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
| | - Emeran A. Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
- Ahmanson-Lovelace Brain Mapping Center at University of California Los Angeles (UCLA)
| | - Jennifer S. Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
| | - Ravi R. Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- Pediatric Pain and Palliative Care Program at UCLA
| | - Tiffany Ju
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
| | - Aubrey Love
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
| | - Amanat Bal
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
| | - Kirsten Tillisch
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
- Pediatric Pain and Palliative Care Program at UCLA
| | - Bruce Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
| | - Claudia P. Sanmiguel
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
| | - Lisa A. Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity Program, University of California Los Angeles (UCLA)
- David Geffen School of Medicine, University of California Los Angeles (UCLA)
- Vatche and Tamar Manoukin Division of Digestive Diseases, University of California Los Angeles (UCLA)
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26
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Gupta A, Woodworth DC, Ellingson BM, Rapkin AJ, Naliboff B, Kilpatrick LA, Stains J, Masghati S, Tillisch K, Mayer EA, Labus JS. Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia. J Pain 2018; 19:528.e1-528.e15. [PMID: 29391213 DOI: 10.1016/j.jpain.2017.12.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/06/2017] [Accepted: 12/17/2017] [Indexed: 12/13/2022]
Abstract
Provoked vestibulodynia (PVD) is a chronic pelvic pain disorder affecting 16% of the female population. Neuroimaging studies have highlighted central abnormalities in PVD, similar to other chronic pelvic pain disorders, including brain regions involved in sensory processing and modulation of pain. The aim of the study was to determine alterations in the subvoxel, microstructural organization within tissues in PVD compared with healthy control participants (HCs) and a disease control group (irritable bowel syndrome [IBS]). Diffusion tensor imaging magnetic resonance imaging was conducted in 87 age-matched premenopausal women (29 PVD, 29 HCs, 29 IBS). Statistical parameter mapping of fractional anisotropy (FA) and mean diffusivity (MD) maps were used to identify microstructural difference in the brain specific to PVD or shared with IBS. PVD alterations in microstructural organization of the brain were predominantly observed in fibers associated with sensorimotor integration and pain processing that relay information between the thalamus, basal ganglia, sensorimotor, and insular cortex. PVD, compared with HCs, showed extensive increases in the FA of somatosensory and basal ganglia regions. In contrast, PVD and IBS subjects did not show any FA-related group differences. PVD subjects showed greater MD in the basal ganglia compared with HCs (higher MD in the internal capsule and pallidum) and IBS (higher MD in the putamen and pallidum). Increases in MD were associated with increased vaginal muscle tenderness and vulvar pain. The current findings highlight possible shared mechanisms between 2 different pelvic pain disorders, but also highlight the widespread alterations observed specifically in PVD compared with HCs. PERSPECTIVE Alterations in microstructure in PVD were observed in fibers associated with sensorimotor integration and pain processing, which were also associated with increased vaginal muscle tenderness and vulvar pain. These alterations may be contributing to increased pain sensitivity and tenderness, highlighting the need for new therapies targeting the central nervous system.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Davis C Woodworth
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Benjamin M Ellingson
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Department of Radiology at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrea J Rapkin
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lisa A Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jean Stains
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California
| | - Salome Masghati
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Kirsten Tillisch
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California.
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27
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Lai HH, Jemielita T, Sutcliffe S, Bradley CS, Naliboff B, Williams DA, Gereau RW, Kreder K, Clemens JQ, Rodriguez LV, Krieger JN, Farrar JT, Robinson N, Landis JR. Characterization of Whole Body Pain in Urological Chronic Pelvic Pain Syndrome at Baseline: A MAPP Research Network Study. J Urol 2017; 198:622-631. [PMID: 28373134 DOI: 10.1016/j.juro.2017.03.132] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE We characterized the location and spatial distribution of whole body pain in patients with urological chronic pelvic pain syndrome using a body map. We also compared the severity of urinary symptoms, pelvic pain, nonpelvic pain and psychosocial health among patients with different pain patterns. MATERIALS AND METHODS A total of 233 women and 191 men with urological chronic pelvic pain syndrome enrolled in a multicenter, 1-year observational study completed a battery of baseline measures, including a body map describing the location of pain during the last week. Participants were categorized with pelvic pain if they reported pain in the abdomen and pelvis only. Participants who reported pain beyond the pelvis were further divided into 2 subgroups based on the number of broader body regions affected by pain, including an intermediate group with 1 or 2 additional regions outside the pelvis and a widespread pain group with 3 to 7 additional regions. RESULTS Of the 424 enrolled patients 25% reported pelvic pain only and 75% reported pain beyond the pelvis, of whom 38% reported widespread pain. Participants with a greater number of pain locations had greater nonpelvic pain severity (p <0.0001), sleep disturbance (p = 0.035), depression (p = 0.005), anxiety (p = 0.011), psychological stress (p = 0.005) and negative affect scores (p = 0.0004), and worse quality of life (p ≤0.021). No difference in pelvic pain and urinary symptom severity was observed according to increasing pain distribution. CONCLUSIONS Three-quarters of the men and women with urological chronic pelvic pain syndrome reported pain outside the pelvis. Widespread pain was associated with greater severity of nonpelvic pain symptoms, poorer psychosocial health and worse quality of life but not with worse pelvic pain or urinary symptoms.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery and Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri.
| | - Thomas Jemielita
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa School of Medicine, Iowa City, Iowa
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California School of Medicine, Los Angeles, California
| | - David A Williams
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Robert W Gereau
- Department of Surgery and Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Karl Kreder
- Department of Urology, University of Iowa School of Medicine, Iowa City, Iowa
| | - J Quentin Clemens
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - John N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - John T Farrar
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nancy Robinson
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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28
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Gupta A, Mayer EA, Acosta JR, Hamadani K, Torgerson C, van Horn JD, Chang L, Naliboff B, Tillisch K, Labus JS. Early adverse life events are associated with altered brain network architecture in a sex- dependent manner. Neurobiol Stress 2017; 7:16-26. [PMID: 28239631 PMCID: PMC5318542 DOI: 10.1016/j.ynstr.2017.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/25/2017] [Accepted: 02/11/2017] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Early adverse life events (EALs) increase the risk for chronic medical and psychiatric disorders by altering early neurodevelopment. The aim of this study was to examine associations between EALs and network properties of core brain regions in the emotion regulation and salience networks, and to test the influence of sex on these associations. METHODS Resting-state functional and diffusion tensor magnetic resonance imaging were obtained in healthy individuals (61 men, 63 women). Functional and anatomical network properties of centrality and segregation were calculated for the core regions of the two networks using graph theory. Moderator analyses were applied to test hypotheses. RESULTS The type of adversity experienced influences brain wiring differently, as higher general EALs were associated with decreased functional and anatomical centrality in salience and emotion regulation regions, while physical and emotional EALs were associated with increased anatomical centrality and segregation in emotion regulation regions. Sex moderated the associations between EALs and measures of centrality; with decreased centrality of salience and emotion regulation regions with increased general EALs in females, and increased centrality in salience regions with higher physical and emotional EALs in males. Increased segregation of salience regions was associated with increased general EALs in males. Centrality of the amygdala was associated with physical symptoms, and segregation of salience regions was correlated with higher somatization in men only. CONCLUSIONS Emotion regulation and salience regions are susceptible to topological brain restructuring associated with EALs. The male and female brains appear to be differently affected by specific types of EALs.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States; Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA, United States
| | - Jonathan R Acosta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States
| | - Kareem Hamadani
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States
| | - Carinna Torgerson
- The Institute for Neuroimaging and Informatics (INI) and Laboratory of NeuroImaging (LONI), Keck School of Medicine at USC, Los Angeles, CA, United States
| | - John D van Horn
- The Institute for Neuroimaging and Informatics (INI) and Laboratory of NeuroImaging (LONI), Keck School of Medicine at USC, Los Angeles, CA, United States
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States; UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Kirsten Tillisch
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States; Department of Integrative Medicine, GLA VHA, Los Angeles, CA, United States
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, United States; Department of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry, UCLA, Los Angeles, CA, United States; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, United States; UCLA Brain Research Institute, Los Angeles, CA, United States
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Gupta A, Love A, Kilpatrick LA, Labus JS, Bhatt R, Chang L, Tillisch K, Naliboff B, Mayer EA. Morphological brain measures of cortico-limbic inhibition related to resilience. J Neurosci Res 2016; 95:1760-1775. [PMID: 28029706 DOI: 10.1002/jnr.24007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
Resilience is the ability to adequately adapt and respond to homeostatic perturbations. Although resilience has been associated with positive health outcomes, the neuro-biological basis of resilience is poorly understood. The aim of the study was to identify associations between regional brain morphology and trait resilience with a focus on resilience-related morphological differences in brain regions involved in cortico-limbic inhibition. The relationship between resilience and measures of affect were also investigated. Forty-eight healthy subjects completed structural MRI scans. Self-reported resilience was measured using the Connor and Davidson Resilience Scale. Segmentation and regional parcellation of images was performed to yield a total of 165 regions. Gray matter volume (GMV), cortical thickness, surface area, and mean curvature were calculated for each region. Regression models were used to identify associations between morphology of regions belonging to executive control and emotional arousal brain networks and trait resilience (total and subscales) while controlling for age, sex, and total GMV. Correlations were also conducted between resilience scores and affect scores. Significant associations were found between GM changes in hypothesized brain regions (subparietal sulcus, intraparietal sulcus, amygdala, anterior mid cingulate cortex, and subgenual cingulate cortex) and resilience scores. There were significant positive correlations between resilience and positive affect and negative correlations with negative affect. Resilience was associated with brain morphology of regions involved in cognitive and affective processes related to cortico-limbic inhibition. Brain signatures associated with resilience may be a biomarker of vulnerability to disease. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arpana Gupta
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA
| | - Aubrey Love
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,Department of Sociology, UCLA
| | - Lisa A Kilpatrick
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA
| | - Jennifer S Labus
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA.,Department of Psychiatry, UCLA
| | - Ravi Bhatt
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Pediatric Pain and Palliative Care Program, UCLA
| | - Lin Chang
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA
| | - Kirsten Tillisch
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA.,Department of Psychiatry, UCLA
| | - Bruce Naliboff
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA.,Department of Psychiatry, UCLA
| | - Emeran A Mayer
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA.,David Geffen School of Medicine, UCLA.,Vatche and Tamar Manoukin Division of Digestive Diseases, UCLA.,Department of Psychiatry, UCLA.,Ahmanson-Lovelace Brain Mapping Center, UCLA
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Davydov DM, Naliboff B, Shahabi L, Shapiro D. Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices. Physiol Behav 2016; 157:102-8. [PMID: 26836276 DOI: 10.1016/j.physbeh.2016.01.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study was conducted to present evidence of differences in autonomic regulation of cardiovascular activity and its role in the severity of specific (disease-related) and non-specific (negative affect and chronic pain-related) symptoms in individuals with Irritable Bowel Syndrome (IBS). METHODS Seventy-eight female patients with IBS and 27 healthy women age 18-62 years were assessed for IBS symptoms, negative affect, and baroreceptor sensitivity (BRS), blood pressure (BP), heart rate, and heart rate variability (HRV) at rest. Direct and indirect regression effects were examined with application of the bootstrap procedure to validate findings. RESULTS IBS was reliably related to lower resting BRS, higher BP, and higher negative affect compared to healthy controls. Longer disease duration (chronicity) was related to BRS decrease coupled with systolic BP increase (95% CIs=-0.14 to -0.01). Three autonomic mechanisms associated with BRS decrease were found to further regulate severity of IBS symptoms. Lower BRS was related to higher IBS severity in general if the effect was transferred through the decrease of low frequency power of HRV (e.g., 95% CIs=-0.039 to -0.001 for abdominal pain severity). However, lower BRS was related to lower IBS severity in general if the effect was transferred through diastolic BP increase (95% CIs=0.01-0.11 for abdominal pain severity). Lower BRS was related to higher abdominal pain severity coupled with high negative affect if the effect was transferred through the decrease of higher frequency power of HRV (95% CIs=-0.026 to -0.003). CONCLUSIONS These findings indicate that different cardiovascular mechanisms are associated with IBS development and the increase and decrease of severity of IBS symptoms. Their assessment suggests ways to personalize treatment of IBS.
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Affiliation(s)
- Dmitry M Davydov
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 8 Baltiyskaia ul., Moscow 125315, Russia.
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States.
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States.
| | - David Shapiro
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States.
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Hong JY, Naliboff B, Labus JS, Gupta A, Kilpatrick LA, Ashe-McNalley C, Stains J, Heendeniya N, Smith SR, Tillisch K, Mayer EA. Altered brain responses in subjects with irritable bowel syndrome during cued and uncued pain expectation. Neurogastroenterol Motil 2016; 28:127-38. [PMID: 26526698 PMCID: PMC4943658 DOI: 10.1111/nmo.12710] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND A majority of the subjects with irritable bowel syndrome (IBS) show increased behavioral and brain responses to expected and delivered aversive visceral stimuli during controlled rectal balloon distension, and during palpation of the sigmoid colon. We aimed to determine if altered brain responses to cued and uncued pain expectation are also seen in the context of a noxious somatic pain stimulus applied to the same dermatome as the sigmoid colon. METHODS A task-dependent functional magnetic resonance imaging technique was used to investigate the brain activity of 37 healthy controls (18 females) and 37 IBS subjects (21 females) during: (i) a cued expectation of an electric shock to the abdomen vs a cued safe condition; and (ii) an uncued cross-hair condition in which the threat is primarily based on context vs a cued safe condition. KEY RESULTS Regions within the salience, attention, default mode, and emotional arousal networks were more activated by the cued abdominal threat condition and the uncued condition than in the cued safe condition. During the uncued condition contrasted to the cued safe condition, IBS subjects (compared to healthy control subjects) showed greater brain activations in the affective (amygdala, anterior insula) and attentional (middle frontal gyrus) regions, and in the thalamus and precuneus. These disease-related differences were primarily seen in female subjects. CONCLUSIONS & INFERENCES The observed greater engagement of cognitive and emotional brain networks in IBS subjects during contextual threat may reflect the propensity of IBS subjects to overestimate the likelihood and severity of future abdominal pain.
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Affiliation(s)
- Jui-Yang Hong
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Bioengineering, University of California, Los Angeles, California 90095
| | - Bruce Naliboff
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jennifer S. Labus
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Lisa A. Kilpatrick
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Cody Ashe-McNalley
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jean Stains
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Nuwanthi Heendeniya
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Suzanne R. Smith
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Kirsten Tillisch
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Emeran A. Mayer
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Psychiatry, University of California, Los Angeles, California 90095,Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine, University of California, Los Angeles, California 90095
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Jarcho JM, Feier NA, Labus JS, Naliboff B, Smith SR, Hong JY, Colloca L, Tillisch K, Mandelkern MA, Mayer EA, London ED. Placebo analgesia: Self-report measures and preliminary evidence of cortical dopamine release associated with placebo response. Neuroimage Clin 2015; 10:107-14. [PMID: 26759785 PMCID: PMC4683423 DOI: 10.1016/j.nicl.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/25/2022]
Abstract
Placebo analgesia is measured by self-report, yet current, expected, and recalled efficacy may be differentially related to brain function. Here we used a human thermal pain model to compare self-reports of expected, concurrent, and recalled efficacy of a topical placebo analgesic, and tested associations of the three measures of efficacy with changes in dopamine D2/D3 receptor availability in brain using [18F]fallypride with positron emission tomography (PET). Participants (15 healthy women) were assessed on three test days. The first test day included a laboratory visit, during which the temperature needed to evoke consistent pain was determined, placebo analgesia was induced via verbal and experience-based expectation, and the placebo response was measured. On two subsequent test days, PET scans were performed in Control and Placebo conditions, respectively, in counterbalanced order. During Visit 1, concurrent and recalled placebo efficacy were unrelated; during the Placebo PET visit, expected and recalled efficacy were highly correlated (ρ = 0.68, p = 0.005), but concurrent efficacy was unrelated to expected or recalled efficacy. Region of interest analysis revealed dopamine D2/D3 receptor availability was lower in left ventrolateral prefrontal cortex in the Placebo condition (p < 0.001, uncorrected), and greater change in this measure was associated with higher levels of recalled analgesic efficacy (ρ = 0.58, p = 0.02). These preliminary findings underscore the need to consider how self-reported symptom improvement is assessed in clinical trials of analgesics and suggest that dopaminergic activity in the ventrolateral prefrontal cortex may promote recalled efficacy of placebo. Healthy women reported on expected, concurrent, and recalled placebo analgesia. Measures were obtained in the lab and during PET scanning with [18F]fallypride. Dopamine D2/D3 receptor availability in PFC was associated with placebo analgesia. This relationship was specific to recalled placebo analgesia efficacy.
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Affiliation(s)
- Johanna M Jarcho
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychology, Stony Brook University, NY, USA
| | - Natasha A Feier
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Alan Edwards Centre for Research on Pain, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit
| | - Bruce Naliboff
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit
| | - Suzanne R Smith
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit
| | - Jui-Yang Hong
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit
| | - Luana Colloca
- School of Nursing, University of Maryland, Baltimore, MD, USA; School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology, UCLA, Los Angeles, CA, United States; Pain and Interoception Network (PAIN), UCLA, Los Angeles, CA, Unit
| | - Edythe D London
- Department of Physiology, UCLA, Los Angeles, CA, United States; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Lowén MBO, Mayer E, Tillisch K, Labus J, Naliboff B, Lundberg P, Thorell LH, Ström M, Engström M, Walter S. Deficient habituation to repeated rectal distensions in irritable bowel syndrome patients with visceral hypersensitivity. Neurogastroenterol Motil 2015; 27:646-55. [PMID: 25777251 DOI: 10.1111/nmo.12537] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/03/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) patients show evidence of altered central processing of visceral signals. One of the proposed alterations in sensory processing is an altered engagement of endogenous pain modulation mechanisms. The aim was to test the hypothesis that IBS patients with (IBS-S) and without visceral hypersensitivity (IBS-N) differ in their ability to engage endogenous pain modulation mechanism during habituation to repeated visceral stimuli. METHODS Brain blood oxygen level dependent (BOLD) response was measured during repeated rectal distension and its anticipation in 33 IBS patients with and without visceral hypersensitivity and 18 healthy controls (HCs). BOLD response to early and late phase of the distension series was compared within and between groups. KEY RESULTS While BOLD response was similar during the early phase of the experiment, IBS-S showed greater BOLD response than IBS-N and HCs during the late phase of the distension series. IBS-S showed increasing BOLD response both to the anticipation and delivery of low intensity rectal distensions in brain regions including insula, anterior and mid cingulate cortex. IBS-N showed decreasing BOLD response to repeated rectal distensions in brain regions including insula, prefrontal cortex and amygdala. CONCLUSIONS & INFERENCES These findings are consistent with compromised ability of IBS-S to respond to repeated delivery of rectal stimuli, both in terms of sensitization of sensory pathways and habituation of emotional arousal. The fact that both IBS subgroups met Rome criteria, and did not differ in terms of reported symptom severity demonstrates that similar symptom patterns can result from different underlying neurobiological mechanisms.
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Affiliation(s)
- M B O Lowén
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Labus JS, Naliboff B, Kilpatrick L, Liu C, Ashe-McNalley C, Dos Santos IR, Alaverdyan M, Woodworth D, Gupta A, Ellingson BM, Tillisch K, Mayer EA. Pain and Interoception Imaging Network (PAIN): A multimodal, multisite, brain-imaging repository for chronic somatic and visceral pain disorders. Neuroimage 2015; 124:1232-1237. [PMID: 25902408 DOI: 10.1016/j.neuroimage.2015.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 12/11/2022] Open
Abstract
The Pain and Interoception Imaging Network (PAIN) repository (painrepository.org) is a newly created NIH (NIDA/NCCAM) funded neuroimaging data repository that aims to accelerate scientific discovery regarding brain mechanisms in pain and to provide more rapid benefits to pain patients through the harmonization of efforts and data sharing. The PAIN Repository consists of two components, an Archived Repository and a Standardized Repository. Similar to other 'open' imaging repositories, neuroimaging researchers can deposit any dataset of chronic pain patients and healthy controls into the Archived Repository. Scans in the Archived Repository can be very diverse in terms of scanning procedures and clinical metadata, complicating the merging of datasets for analyses. The Standardized Repository overcomes these limitations through the use of standardized scanning protocols along with a standardized set of clinical metadata, allowing an unprecedented ability to perform pooled analyses. The Archived Repository currently includes 741 scans and is rapidly growing. The Standardized Repository currently includes 433 scans. Pain conditions currently represented in the PAIN repository include: irritable bowel syndrome, vulvodynia, migraine, chronic back pain, and inflammatory bowel disease. Both the PAIN Archived and Standardized Repositories promise to be important resources in the field of chronic pain research. The enhanced ability of the Standardized Repository to combine imaging, clinical and other biological datasets from multiple sites in particular make it a unique resource for significant scientific discoveries.
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Affiliation(s)
- Jennifer S Labus
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology at UCLA, Los Angeles, CA, USA; Department of Psychiatry at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Bruce Naliboff
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology at UCLA, Los Angeles, CA, USA; Department of Psychiatry at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Lisa Kilpatrick
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Cathy Liu
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Cody Ashe-McNalley
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Ivani R Dos Santos
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Mher Alaverdyan
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA
| | - Davis Woodworth
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Arpana Gupta
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Benjamin M Ellingson
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kirsten Tillisch
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology at UCLA, Los Angeles, CA, USA; Department of Psychiatry at UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA
| | - Emeran A Mayer
- Oppenheimer Family Center for the Neurobiology of Stress at UCLA, Los Angeles, CA, USA; Department of Medicine at UCLA, Los Angeles, CA, USA; Department of Physiology at UCLA, Los Angeles, CA, USA; Department of Psychiatry at UCLA, Los Angeles, CA, USA; Pain and Interoception Network (PAIN) at UCLA, Los Angeles, CA 90095, USA.
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Griffith J, Edwards T, Hong B, Sutcliffe S, Pontari M, Afari N, Krieger J, Lloyd R, Tu F, Williams D, Patrick D, Kim J, Naliboff B, Lai H, Bradley C, Mullins C, Landis R. MP27-04 A PSYCHOMETRIC ANALYSIS OF PAIN AND URINARY SYMPTOMS IN PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME AND CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: FINDINGS FROM MAPP RESEARCH NETWORK. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lackner JM, Gudleski GD, Ma CX, Dewanwala A, Naliboff B. Fear of GI symptoms has an important impact on quality of life in patients with moderate-to-severe IBS. Am J Gastroenterol 2014; 109:1815-23. [PMID: 25223577 PMCID: PMC5110208 DOI: 10.1038/ajg.2014.241] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Because irritable bowel syndrome (IBS) is a functional medical condition for which there is no curative therapy, treatment goals emphasize relieving gastrointestinal (GI) symptoms and optimizing the quality of life (QOL). This study sought to characterize the magnitude of the associations between QOL impairment, fear of IBS symptoms, and confounding variables. METHODS Subjects included 234 Rome III-diagnosed IBS patients (mean age, 41 years, 79%, female) without comorbid organic GI disease who were referred to two specialty care clinics of an National Institutes of Health trial for IBS. Subjects completed a testing battery that included the IBS-specific QOL (IBS-QOL), SF-12 (generic QOL), the UCLA GI Symptom Severity Scale, the Visceral Sensitivity Index, Trait Anxiety Inventory, and Brief Symptom Inventory. RESULTS Multiple linear regression was used to develop a model for predicting QOL. Data supported an overall model that included sociodemographic, clinical (e.g., current severity of GI symptoms), and psychosocial (e.g., fear of GI symptoms, distress, neuroticism) variables, accounting for 48.7% of the variance in IBS-QOL (F=15.1, P <0.01). GI symptom fear was the most robust predictor of IBS-QOL (β=-0.45 P <0.01), accounting for 14.4% of the total variance. CONCLUSIONS Patients' fear that GI symptoms have aversive consequences, is a predictor of QOL impairment that cannot be fully explained by the severity of their GI symptoms, overall emotional well-being, neurotic personality style, or other clinical features of IBS. An understanding of the unique impact that GI symptom fears have on QOL can inform treatment planning and help gastroenterologists to better manage more severe IBS patients seen in tertiary care clinics.
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Affiliation(s)
- Jeffrey M. Lackner
- Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, New York, USA
| | - Gregory D. Gudleski
- Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, New York, USA
| | - Chang-Xing Ma
- Department of Biostatistics, School of Public Health and Health Professions University at Buffalo, Buffalo, New York, USA
| | - Akriti Dewanwala
- Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, New York, USA
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Waters AM, Nazarian M, Mineka S, Zinbarg RE, Griffith JW, Naliboff B, Ornitz EM, Craske MG. Context and explicit threat cue modulation of the startle reflex: preliminary evidence of distinctions between adolescents with principal fear disorders versus distress disorders. Psychiatry Res 2014; 217:93-9. [PMID: 24679992 PMCID: PMC4041703 DOI: 10.1016/j.psychres.2014.01.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/13/2013] [Accepted: 01/30/2014] [Indexed: 02/02/2023]
Abstract
Anxiety and depression are prevalent, impairing disorders. High comorbidity has raised questions about how to define and classify them. Structural models emphasise distinctions between "fear" and "distress" disorders while other initiatives propose they be defined by neurobiological indicators that cut across disorders. This study examined startle reflex (SR) modulation in adolescents with principal fear disorders (specific phobia; social phobia) (n=20), distress disorders (unipolar depressive disorders, dysthymia, generalised anxiety disorder; post-traumatic stress disorder) (n=9), and controls (n=29) during (a) baseline conditions, (b) threat context conditions (presence of contraction pads over the biceps muscle), and (c) an explicit threat cue paradigm involving phases that signalled safety from aversive stimuli (early and late stages of safe phases; early stages of danger phases) and phases that signalled immediate danger of an aversive stimulus (late stages of danger phases). Adolescents with principal fear disorders showed larger SRs than other groups throughout safe phases and early stages of danger phases. SRs did not differ between groups during late danger phases. Adolescents with principal distress disorders showed attenuated SRs during baseline and context conditions compared to other groups. Preliminary findings support initiatives to redefine emotional disorders based on neurobiological functioning.
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Affiliation(s)
- Allison M. Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | | | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA,The Family Institute at Northwestern University, Evanston, IL, USA
| | - James W. Griffith
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Bruce Naliboff
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Edward M. Ornitz
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA,Brain Research Institute, UCLA, Los Angeles, CA, USA
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Seidman L, Lung K, Naliboff B, Zeltzer L, Tsao J. (310) Sensitization to laboratory pain stimuli in healthy children and adolescents is associated with higher ratings of anxiety, pain intensity, and pain bother. The Journal of Pain 2014. [DOI: 10.1016/j.jpain.2014.01.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wolitzky-Taylor K, Vrshek-Schallhorn S, Waters AM, Mineka S, Zinbarg R, Ornitz E, Naliboff B, Craske MG. Adversity in early and mid-adolescence is associated with elevated startle responses to safety cues in late adolescence. Clin Psychol Sci 2014; 2:202-213. [PMID: 25473591 PMCID: PMC4249685 DOI: 10.1177/2167702613495840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Elevated responding to safety cues in the context of threat is associated with anxiety disorder onset, but pathways underlying such responding remain unclear. This study examined whether childhood/adolescent adversity was associated with larger startle reflexes during safe phases of a fear potentiation startle paradigm (following delivery of an aversive stimulus) that predict anxiety disorders. Participants (N = 104) came from the Youth Emotion Project, a longitudinal study of risk factors for emotional disorders. Participants with no baseline psychopathology underwent a startle modulation protocol and were assessed for childhood and adolescent adversities using a validated interview. Adolescent adversity was associated with larger startle reflexes during the safe phases following an aversive stimulus. Neither child nor adolescent adversities were associated with responding during any other phase of the protocol. These findings suggest a pathway between adolescent adversity and a risk factor for anxiety disorders wherein adolescent adversity contributes to impaired responding to safety cues.
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Labus JS, Gupta A, Coveleskie K, Tillisch K, Kilpatrick L, Jarcho J, Feier N, Bueller J, Stains J, Smith S, Suyenobu B, Naliboff B, Mayer EA. Sex differences in emotion-related cognitive processes in irritable bowel syndrome and healthy control subjects. Pain 2013; 154:2088-2099. [PMID: 23791896 DOI: 10.1016/j.pain.2013.06.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/29/2013] [Accepted: 06/17/2013] [Indexed: 12/12/2022]
Abstract
Greater responsiveness of emotional arousal circuits in relation to delivered visceral pain has been implicated as underlying central pain amplification in irritable bowel syndrome (IBS), with female subjects showing greater responses than male subjects. Functional magnetic resonance imaging was used to measure neural responses to an emotion recognition paradigm, using faces expressing negative emotions (fear and anger). Sex and disease differences in the connectivity of affective and modulatory cortical circuits were studied in 47 IBS (27 premenopausal female subjects) and 67 healthy control subjects (HCs; 38 premenopausal female subjects). Male subjects (IBS+HC) showed greater overall brain responses to stimuli than female subjects in prefrontal cortex, insula, and amygdala. Effective connectivity analyses identified major sex- and disease-related differences in the functioning of brain networks related to prefrontal regions, cingulate, insula, and amygdala. Male subjects had stronger connectivity between anterior cingulate subregions, amygdala, and insula, whereas female subjects had stronger connectivity to and from the prefrontal modulatory regions (medial/dorsolateral cortex). Male IBS subjects demonstrate greater engagement of cortical and affect-related brain circuitry compared to male control subjects and female subjects, when viewing faces depicting emotions previously shown to elicit greater behavioral and brain responses in male subjects.
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Affiliation(s)
- Jennifer S Labus
- Oppenheimer Family Center for Neurobiology of Stress and Pain and Interoception Network (PAIN) Repository, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA National Institute of Mental Health (NIMH), Section of Developmental and Affective Neuroscience, Bethesda, MD, USA Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, CA, USA
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Lowén MB, Mayer EA, Sjöberg M, Tillisch K, Naliboff B, Labus J, Lundberg P, Ström M, Engström M, Walter SA. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther 2013; 37:1184-97. [PMID: 23617618 PMCID: PMC4084976 DOI: 10.1111/apt.12319] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/10/2013] [Accepted: 04/01/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy can reduce IBS symptoms, but the mechanisms underlying this therapeutic effect remain unknown. AIM To determine the effect of hypnotherapy and educational intervention on brain responses to cued rectal distensions in IBS patients. METHODS Forty-four women with moderate-to-severe IBS and 20 healthy controls (HCs) were included. Blood oxygen level dependent (BOLD) signals were measured by functional Magnetic Resonance Imaging (fMRI) during expectation and delivery of high- (45 mmHg) and low-intensity (15 mmHg) rectal distensions. Twenty-five patients were assigned to hypnotherapy (HYP) and 16 to educational intervention (EDU). Thirty-one patients completed treatments and posttreatment fMRI. RESULTS Similar symptom reduction was achieved in both groups. Clinically successful treatment (all responders) was associated with significant BOLD attenuation during high-intensity distension in the dorsal and ventral anterior insula (cluster size 142, P = 0.006, and cluster size 101, P = 0.005 respectively). Moreover HYP responders demonstrated a pre-post treatment BOLD attenuation in posterior insula (cluster sizes 59, P = 0.05) while EDU responders had a BOLD attenuation in prefrontal cortex (cluster size 60, P = 0.05). Pre-post differences for expectation conditions were almost exclusively seen in the HYP group. Following treatment, the brain response to distension was similar to that observed in HCs, suggesting that the treatment had a normalising effect on the central processing abnormality of visceral signals in IBS. CONCLUSIONS The abnormal processing and enhanced perception of visceral stimuli in IBS can be normalised by psychological interventions. Symptom improvement in the treatment groups may be mediated by different brain mechanisms. CLINICAL TRIAL NUMBER NCT01815164.
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Affiliation(s)
- Mats B.O. Lowén
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - Emeran A. Mayer
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | | | - Kirsten Tillisch
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Bruce Naliboff
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jennifer Labus
- The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Lundberg
- Center for Medical Image Science and Visualization, CMIV; Radiation Physics, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University; Department of Radiation Physics UHL, County Council of Östergötland, Linköping, Sweden Center for Medical Image Science and Visualization, CMIV; Radiology, Department of Medical and Health Sciences, Faculty of Health Sciences Linköping University; Department of Radiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Magnus Ström
- Department of Clinical and Experimental Medicine/Gastroenterology, Linköping University, Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - Maria Engström
- Department of Medical and Health Sciences (IMH)/Radiology, Linköping University, Sweden, Center for Medical Image Science and Visualization (CMIV) Linköping University, Sweden
| | - Susanna A. Walter
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
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Le Nevé B, Posserud I, Böhn L, Guyonnet D, Rondeau P, Tillisch K, Naliboff B, Mayer EA, Simrén M. A combined nutrient and lactulose challenge test allows symptom-based clustering of patients with irritable bowel syndrome. Am J Gastroenterol 2013; 108:786-95. [PMID: 23588235 DOI: 10.1038/ajg.2013.75] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the present pilot study was to evaluate the usefulness of a test meal containing lactulose in the non-invasive assessment of visceral sensitivity in irritable bowel syndrome (IBS), and to identify subsets of IBS patients based on gastrointestinal (GI) symptom generation. METHODS We included 43 patients with IBS (Rome III) and 29 healthy controls. The fasted subjects were served three test meals consisting of a 400-ml liquid breakfast alone or containing lactulose (15 or 25 g) in a double-blind crossover design. Seven GI symptoms, overall digestive comfort, and exhaled H2/CH4 were assessed at baseline and every 15 min during 4 h after meal intake. Anxiety and depression were assessed only at baseline. A mapping of the seven GI symptoms was done using a Principal Component Analysis (4 h mean area under the curve, AUC). Independently, a hierarchical cluster analysis was performed on the same parameters to identify GI symptom-based IBS clusters. RESULTS All three tests were well tolerated. The 25 g lactulose challenge enabled discrimination of IBS from healthy controls according to the symptom response. This challenge also enabled clustering of IBS subjects in two subgroups based mainly on bloating, distension, and discomfort symptoms (2,457 (2,043-2,872), 2,450 (1,910-2,990), 2,602 (2,126-3,079) vs. 537 (383-691), 619 (458-780), 643 (432-854); 4 h mean AUC; P<0.0001), overall digestive comfort (1807 (1318-2295) vs. 3350 (2942-3758); 4 h mean AUC; P<0.0001), and anxiety at baseline (9.2 (7.0-11.5) vs. 5.5 (4.2-6.9); Hospital Anxiety and Depression scale anxiety mean scores; P=0.003). This clustering was independent of the Rome III subtype and the amount of exhaled H2/CH4. CONCLUSIONS The lactulose challenge test seems to be a promising tool to assess visceral sensitivity in IBS, and to subgroup IBS patients based on their symptom pattern.
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Affiliation(s)
- B Le Nevé
- Department of Digestive Health, Danone Research, Palaiseau, France.
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43
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Larsson MBO, Tillisch K, Craig A(B, Engström M, Labus J, Naliboff B, Lundberg P, Ström M, Mayer EA, Walter SA. Brain responses to visceral stimuli reflect visceral sensitivity thresholds in patients with irritable bowel syndrome. Gastroenterology 2012; 142:463-472.e3. [PMID: 22108191 PMCID: PMC3288538 DOI: 10.1053/j.gastro.2011.11.022] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Only a fraction of patients with irritable bowel syndrome (IBS) have increased perceptual sensitivity to rectal distension, indicating differences in processing and/or modulation of visceral afferent signals. We investigated the brain mechanisms of these perceptual differences. METHODS We analyzed data from 44 women with IBS and 20 female healthy subjects (controls). IBS symptom severity was determined by a severity scoring system. Anxiety and depression symptoms were assessed using the hospital anxiety and depression score. Blood oxygen level-dependent signals were measured by functional magnetic resonance imaging during expectation and delivery of high (45 mmHg) and low (15 mmHg) intensity rectal distensions. Perception thresholds to rectal distension were determined in the scanner. Brain imaging data were compared among 18 normosensitive and 15 hypersensitive patients with IBS and 18 controls. Results were reported significant if peak P-values were ≤.05, with family-wise error correction in regions of interest. RESULTS The subgroups of patients with IBS were similar in age, symptom duration, psychological symptoms, and IBS symptom severity. Although brain responses to distension were similar between normosensitive patients and controls, hypersensitive patients with IBS had greater activation of insula and reduced deactivation in pregenual anterior cingulate cortex during noxious rectal distensions, compared to controls and normosensitive patients with IBS. During expectation of rectal distension, normosensitive patients with IBS had more activation in right hippocampus than controls. CONCLUSIONS Despite similarities in symptoms, hyper- and normosensitive patients with IBS differ in cerebral responses to standardized rectal distensions and their expectation, consistent with differences in ascending visceral afferent input.
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Affiliation(s)
- MBO Larsson
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University; Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - K Tillisch
- Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive, Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - A.D. (Bud) Craig
- Barrow Neurological Institute, Phoenix, AZ, USA; Visiting Professor at the Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - M Engström
- Department of Medical and Health Sciences (IMH)/Radiology, Linköping University, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
| | - J Labus
- Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - B Naliboff
- Oppenheimer Family Center for Neurobiology of Stress, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - P Lundberg
- Center for Medical Image Science and Visualization, CMIV; Radiation Physics, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University; Department of Radiation Physics UHL, County Council of Östergötland, Linköping, Sweden; Center for Medical Image Science and Visualization, CMIV; Radiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University; Department of Radiology UHL, County Council of Östergötland, Linköping, Sweden
| | - M Ström
- Department of Clinical and Experimental Medicine/Gastroenterology, Linköping University; Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
| | - EA Mayer
- Oppenheimer Family Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - SA Walter
- Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University; Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
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Tillisch K, Labus J, Nam B, Bueller J, Smith S, Suyenobu B, Siffert J, McKelvy J, Naliboff B, Mayer E. Neurokinin-1-receptor antagonism decreases anxiety and emotional arousal circuit response to noxious visceral distension in women with irritable bowel syndrome: a pilot study. Aliment Pharmacol Ther 2012; 35:360-7. [PMID: 22221140 PMCID: PMC4073664 DOI: 10.1111/j.1365-2036.2011.04958.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Irritable bowel syndrome is characterised by chronic abdominal pain and frequent comorbid anxiety. The substance P ⁄ neurokinin-1 receptor system is implicated in the regulation of both pain and anxiety, suggesting a potential therapeutic target in IBS. AIM To determine whether inhibition of the neurokinin-1 receptor (NK1R) will change pain ratings and brain responses to experimental visceral pain and anxiety symptoms in women with IBS or not. METHODS Rome II positive IBS women were recruited for a double-blind, placebo-controlled, cross-over study of NK1R antagonist AV608. Treatment periods were 3 weeks with a 2-week washout period. Functional MRI during a visceral distension paradigm was performed before first treatment and after treatment blocks. SPM8 was used to compare brain activity during painful and nonpainful visceral stimuli in regions associated with emotional arousal and interoception. Negative affect, anxiety symptoms and pain ratings were assessed. RESULTS Eleven subjects completed the study and eight subjects provided fMRI data. AV608, compared with placebo, was associated with reduced anxiety, negative affect, and pain ratings. During AV608 treatment, the amygdala, hippocampus and anterior cingulate gyrus showed decreased activity during visceral distension. AV608 was also associated with decreases in activity in brain regions associated with interoception (posterior insula, anterior mid-cingulate gyrus). CONCLUSIONS Chronic treatment with AV608 in IBS is associated with improved mood and pain ratings and activity of emotional arousal related brain regions. This suggests that further exploration of NK1R antagonists is warranted in visceral pain disorders, particularly in patients with comorbid anxiety symptoms.
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Affiliation(s)
- K Tillisch
- Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Craske MG, Wolitzky-Taylor KB, Mineka S, Zinbarg R, Waters AM, Vrshek-Schallhorn S, Epstein A, Naliboff B, Ornitz E. Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation. J Abnorm Psychol 2011; 121:315-24. [PMID: 21988452 DOI: 10.1037/a0025738] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study evaluated the degree to which startle reflexes (SRs) in safe conditions versus danger conditions were predictive of the onset of anxiety disorders. Specificity of these effects to anxiety disorders was evaluated in comparison to unipolar depressive disorders and with consideration of level of neuroticism. A startle paradigm was administered at baseline to 132 nondisordered adolescents as part of a longitudinal study examining risk factors for emotional disorders. Participants underwent a repetition of eight safe-danger sequences and were told that delivery of an aversive stimulus leading to a muscle contraction of the arm would occur only in the late part of danger conditions. One aversive stimulus occurred midway in the safe-danger sequences. Participants were assessed for the onset of anxiety and unipolar depressive disorders annually over the next 3 to 4 years. Larger SR magnitude during safe conditions following delivery of the aversive stimulus predicted the subsequent first onset of anxiety disorders. Moreover, prediction of the onset of anxiety disorders remained significant above and beyond the effects of comorbid unipolar depression, neuroticism, and subjective ratings of intensity of the aversive stimulus. In sum, elevated responding to safe conditions following an aversive stimulus appears to be a specific, prospective risk factor for the first onset of anxiety disorders.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA 90095-1563, USA.
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Spiegel B, Harris L, Lucak S, Mayer E, Naliboff B, Bolus R, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Dulai G, Talley J, Chang L. Developing valid and reliable health utilities in irritable bowel syndrome: results from the IBS PROOF Cohort. Am J Gastroenterol 2009; 104:1984-91. [PMID: 19491835 PMCID: PMC3839573 DOI: 10.1038/ajg.2009.232] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES A "utility" is a measure of health-related quality of life (HRQOL) that ranges between 0 (death) and 1 (perfect health). Disease-targeted utilities are mandatory to conduct cost-utility analyses. Given the economic and healthcare burden of irritable bowel syndrome (IBS), cost-utility analyses will play an important role in guiding health economic decision-making. To inform future cost-utility analyses in IBS, we measured and validated the IBS utilities. METHODS We analyzed data from Rome III IBS patients in the Patient Reported Observed Outcomes and Function (PROOF) Cohort-a longitudinal multi-center IBS registry. At entry, the patients completed a multi-attribute utility instrument (EuroQOL), bowel symptom items, IBS severity measurements (IBS Severity Scale (IBSSS), Functional Bowel Disease Severity Index (FBDSI)), HRQOL indexes (IBS quality-of-life instrument (IBS-QOL), Center for disease control-4 (CDC-4)), and the Worker Productivity Activity Index for IBS (WPAI). We repeated assessments at 3 months. RESULTS There were 257 patients (79% women; age=43+/-15 years) at baseline and 85 at 3 months. The mean utilities in patients with severe vs. non-severe IBS were 0.70 and 0.80, respectively (P<0.001). There were no differences in utilities among IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and mixed IBS (IBS-M) subgroups. EuroQOL utilities correlated with FBDSI (r=0.31; P<0.01), IBSSS (r=0.36; P<0.01), IBS-QOL (r=0.36; P<0.01), CDC-4 (r=0.44; P<0.01), WPAI presenteeism (r=0.16; P<0.01), abdominal pain (r=0.43; P<0.01), and distension (r=0.18; P=0.01). The utilities in patients reporting "considerable relief" of symptoms at 3 months vs. those without considerable relief were 0.78 and 0.73, respectively (P=0.02). CONCLUSIONS EuroQOL utilities are valid and reliable in IBS. The utility of severe IBS (0.7) is similar to Class III congestive heart failure and rheumatoid arthritis. These validated utilities can be employed in future IBS cost-utility analyses.
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Affiliation(s)
- Brennan Spiegel
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA,Department of Gastroenterology, Columbia University, New York, New York, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | | | - Susan Lucak
- Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Emeran Mayer
- Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA
| | - Bruce Naliboff
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA
| | - Roger Bolus
- Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Eric Esrailian
- Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - William D. Chey
- Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anthony Lembo
- Harvard University Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hetal Karsan
- Department of Gastroenterology, Emory University, Atlanta, Georgia, USA,Atlanta Gastroenterology Associates, Atlanta, Georgia, USA
| | - Kirsten Tillisch
- Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA
| | - Gareth Dulai
- Kaiser Southern California, Los Angeles, California, USA
| | - Jennifer Talley
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Lin Chang
- Department of Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA Center for Neurobiology of Stress, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
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Mayer EA, Aziz Q, Coen S, Kern M, Labus J, Lane R, Kuo B, Naliboff B, Tracey I. Brain imaging approaches to the study of functional GI disorders: a Rome working team report. Neurogastroenterol Motil 2009; 21:579-96. [PMID: 19646070 PMCID: PMC3829384 DOI: 10.1111/j.1365-2982.2009.01304.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Progresses in the understanding of human brain-gut interactions in health and disease have been limited by the lack of non-invasive techniques to study brain activity. The advent of neuroimaging techniques has made it possible not only to study the structure and function of the brain, but also to characterize signaling system underlying brain function. This article gives a brief overview of relevant functional neuroanatomy, and of the most commonly used brain imaging techniques. It summarizes published functional brain imaging studies using acute visceral stimulation of the oesophagus, stomach and colon in healthy control subjects and patients with functional GI disorders, and briefly discusses pertinent findings from these studies. The article concludes with a critical assessment of published studies, and with recommendations for improved study paradigms and analysis strategies.
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Affiliation(s)
- Emeran A Mayer
- Center for Neurobiology of Stress, Departments of Medicine, Physiology and Psychiatry, UCLA, CURE Digestive Diseases Research Center, UCLA Division of Digestive Diseases, Los Angeles, CA
| | - Qasim Aziz
- Wingate Institute for Neurogastroenterology, Neurogastroenterology Group, School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Steven Coen
- Wingate Institute for Neurogastroenterology, Neurogastroenterology Group, School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Mark Kern
- Department of Medicine, Division of Gastroenterology and Hepatology, Medical College of Wisconsin Milwaukee, WI
| | - Jennifer Labus
- Center for Neurobiology of Stress, Departments of Medicine, Physiology and Psychiatry, UCLA, CURE Digestive Diseases Research Center, UCLA Division of Digestive Diseases, Los Angeles, CA
| | - Richard Lane
- Departments of Psychiatry, Psychology and Neuroscience, University of Arizona, AZ
| | - Brad Kuo
- Gastro Intestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bruce Naliboff
- Center for Neurobiology of Stress, Departments of Medicine, Physiology and Psychiatry, UCLA, CURE Digestive Diseases Research Center, UCLA Division of Digestive Diseases, Los Angeles, CA
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, FMRIB Centre, Oxford University Department of Clinical Neurology, John Radcliffe Hospital Oxford, UK
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Craske MG, Waters AM, Nazarian M, Mineka S, Zinbarg RE, Griffith JW, Naliboff B, Ornitz EM. Does neuroticism in adolescents moderate contextual and explicit threat cue modulation of the startle reflex? Biol Psychiatry 2009; 65:220-6. [PMID: 18789433 PMCID: PMC2648850 DOI: 10.1016/j.biopsych.2008.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/25/2008] [Accepted: 07/24/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study evaluated the relationship between neuroticism (N), a probable risk factor for emotional disorders, and modulation of startle reflexes (SRs). METHODS One hundred thirty-two adolescents with varying levels of N but without anxiety or depressive disorders were evaluated in contextual cue and explicit threat cue paradigms. RESULTS Within the explicit threat cue paradigm, N potentiated SRs more in conditions that were intermediately associated with threat of an aversive biceps contraction than conditions that were the furthest from and conditions that were the closest to the same threat. Also, N potentiated SRs across the entire experiment, regardless of experimental conditions, in male and not in female subjects. CONCLUSIONS These results suggest that adolescents with high levels of N show greater sensitivity to contexts intermediately associated with threat. Results are discussed in comparison with other studies of groups at risk for anxiety and depressive disorders.
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Affiliation(s)
| | | | | | - Susan Mineka
- Department of Psychology, Northwestern University
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, The Family Institute at Northwestern University
| | | | - Bruce Naliboff
- Department of Psychiatry and Biobehavioral Sciences, UCLA, VA Greater Los Angeles Healthcare System
| | - Edward M. Ornitz
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Brain Research Institute, UCLA
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Craske MG, Waters AM, Lindsey Bergman R, Naliboff B, Lipp OV, Negoro H, Ornitz EM. Is aversive learning a marker of risk for anxiety disorders in children? Behav Res Ther 2008; 46:954-67. [PMID: 18539262 DOI: 10.1016/j.brat.2008.04.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/09/2008] [Accepted: 04/18/2008] [Indexed: 10/22/2022]
Abstract
Aversive conditioning and extinction were evaluated in children with anxiety disorders (n=23), at-risk for anxiety disorders (n=15), and controls (n=11). Participants underwent 16 trials of discriminative conditioning of two geometric figures, with (CS+) or without (CS-) an aversive tone (US), followed by 8 extinction trials (4 CS+, 4 CS-), and 8 extinction re-test trials averaging 2 weeks later. Skin conductance responses and verbal ratings of valence and arousal to the CS+/CS- stimuli were measured. Anxiety disordered children showed larger anticipatory and unconditional skin conductance responses across conditioning, and larger orienting and anticipatory skin conductance responses across extinction and extinction re-test, all to the CS+ and CS-, relative to controls. At-risk children showed larger unconditional responses during conditioning, larger orienting responses during the first block of extinction, and larger anticipatory responses during extinction re-test, all to the CS+ and CS-, relative to controls. Also, anxiety disordered children rated the CS+ as more unpleasant than the other groups. Elevated skin conductance responses to signals of threat (CS+) and signals of safety (CS-; CS+ during extinction) are discussed as features of manifestation of and risk for anxiety in children, compared to the specificity of valence judgments to the manifestation of anxiety.
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Affiliation(s)
- Michelle G Craske
- UCLA Department of Psychology, Franz Hall, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
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Spiegel B, Schoenfeld P, Naliboff B. Systematic review: the prevalence of suicidal behaviour in patients with chronic abdominal pain and irritable bowel syndrome. Aliment Pharmacol Ther 2007; 26:183-93. [PMID: 17593064 DOI: 10.1111/j.1365-2036.2007.03357.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic abdominal pain syndromes may increase the risk of suicidal behaviour - a feature well described in non-visceral pain syndromes. AIM To perform a systematic review to summarize and interpret published data linking chronic abdominal pain syndromes and suicidal behaviour. METHODS We performed a structured search to identify studies pertaining to the following questions: (i) What is the prevalence of suicidal behaviour in patients with chronic abdominal pain syndromes, including bowel syndrome (IBS)? (ii) Is the prevalence of suicidal behaviour in chronic abdominal pain syndromes higher than in matched controls? And (iii) is suicidal behaviour in abdominal pain syndromes simply due to psychiatric co-morbidities? RESULTS Thirty-two relevant titles were identified, of which six manuscripts, describing eight studies, met inclusion criteria. Patients with non-IBS syndromes were 3-11 times more likely to demonstrate suicidal behaviour vs. controls, while patients with IBS were two to four times more likely to have suicidal behaviour. Chronic abdominal pain was an independent predictor of suicidal behaviour after adjusting for co-morbid psychiatric conditions. CONCLUSIONS Chronic abdominal pain syndromes increase the risk for suicidal behaviours. This relationship may exist independently of co-morbid depression, although additional research is needed to better understand this link. These data indicate that clinicians should survey for suicidal behaviour in chronic abdominal pain patients.
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Affiliation(s)
- B Spiegel
- Division of Gastroenterology and Hepatology, VA Greater Los Angeles Healthcare System, CA, USA
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