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Sandström A, Ellerbrock I, Tour J, Kadetoff D, Jensen K, Kosek E. Dysfunctional Activation of the Dorsolateral Prefrontal Cortex During Pain Anticipation Is Associated With Altered Subsequent Pain Experience in Fibromyalgia Patients. THE JOURNAL OF PAIN 2023; 24:1731-1743. [PMID: 37354157 DOI: 10.1016/j.jpain.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/26/2023]
Abstract
The ability to accurately predict pain is an adaptive feature in healthy individuals. However, in chronic pain, this mechanism may be selectively impaired and can lead to increased anxiety and excessive avoidance behavior. Recently, we reported the first data demonstrating brain activation in fibromyalgia (FM) patients during conditioned pain responses, in which FM patients revealed a tendency to form new pain-related associations rather than extinguishing irrelevant ones. The aim of the present study was to extend our previous analysis, to elucidate potential neural divergences between subjects with FM (n = 65) and healthy controls (HCs) (n = 33) during anticipatory information (ie, prior to painful stimulus onset). Using functional magnetic resonance imaging (fMRI), the current analyses include 1) a congruently cued paradigm of low and high pain predictive cues, followed by 2) an incongruently cued paradigm where low and high pain predictive cues were followed by an identical mid-intensity painful pressure. During incongruently cued high-pain associations, FM exhibited reduced left dorsolateral prefrontal cortex (dlPFC) activation compared to HCs, which was followed by an altered subsequent pain experience in FM, as patients continued to rate the following painful stimuli as high, even though the pressure had been lowered. During congruently cued low pain anticipation, FM exhibited decreased right dlPFC activation compared to HCs, as well as decreased brain connectivity between brain regions implicated in cognitive modulation of pain (dlPFC) and nociceptive processing (primary somatosensory cortex/postcentral gyrus [S1] and supplementary motor area [SMA]/midcingulate cortex [MCC]). These results may reflect an important feature of validating low pain expectations in HCs and help elucidate behavioral reports of impaired safety processing in FM patients. PERSPECTIVE: FM exhibited a stronger conditioned pain response for high-pain associations, which was associated with reduced dlPFC activation during the incongruent trial. During (congruent and incongruent) low pain associations, FM dlPFC brain activation remained indifferent. Imbalances in threat and safety pain perception may be an important target for psychotherapeutic interventions.
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Affiliation(s)
- Angelica Sandström
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Isabel Ellerbrock
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Surgery, Blekinge Hospital, Karlskrona, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Minervini A, LaVarco A, Zorns S, Propper R, Suriano C, Keenan JP. Excitatory Dorsal Lateral Prefrontal Cortex Transcranial Magnetic Stimulation Increases Social Anxiety. Brain Sci 2023; 13:989. [PMID: 37508921 PMCID: PMC10377502 DOI: 10.3390/brainsci13070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Social exclusion refers to the experience of rejection by one or more people during a social event and can induce pain-related sensations. Cyberball, a computer program, is one of the most common tools for analyzing social exclusion. Regions of the brain that underlie social pain include networks linked to the dorsal lateral prefrontal cortex (DLPFC). Specifically, self-directed negative socially induced exclusion is associated with changes in DLPFC activity. Direct manipulation of this area may provide a better understanding of how the DLPFC can influence the perception of social exclusion and determine a causal role of the DLPFC. Transcranial magnetic stimulation (TMS) was applied to both the left and right DLPFC to gauge different reactions to the Cyberball experience. It was found that there were elevated exclusion indices following right DLPFC rTMS; participants consistently felt more excluded when the right DLPFC was excited. This may relate to greater feelings of social pain when the right DLPFC is manipulated. These data demonstrate that direct manipulation of the DLPFC results in changes in responses to social exclusion.
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Affiliation(s)
- Anthony Minervini
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Adriana LaVarco
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Samantha Zorns
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Ruth Propper
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Christos Suriano
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Julian Paul Keenan
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
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Zhou J, Zeng F, Cheng S, Dong X, Jiang N, Zhang X, Tang C, He W, Chen Y, Sun N, Zhou Y, Li X, Hu S, Sun R, Wintermark M, Yang W, Liang F, Li Z. Modulation effects of different treatments on periaqueductal gray resting state functional connectivity in knee osteoarthritis knee pain patients. CNS Neurosci Ther 2023. [PMID: 36890655 DOI: 10.1111/cns.14153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The analgesic effect of acupuncture is widely recognized, but the mechanical characteristics of acupuncture for pain relief, compared to non-steroidal anti-inflammatory (NSAIDs) and placebo medication, remain unknown. AIMS To compare the modulation effects of acupuncture treatment with NSAIDs and placebo medication on descending pain modulation system (DPMS) in knee osteoarthritis (KOA) patients. METHODS This study recruited 180 KOA patients with knee pain and 41 healthy controls (HCs). Individuals with KOA knee pain were divided randomly into groups of verum acupuncture (VA), sham acupuncture (SA), celecoxib (SC), placebo (PB), and waiting list (WT), with 36 patients in each group. VA and SA groups included ten sessions of puncturing acupoints or puncturing non-acupoints acupuncture treatment for two successive weeks. Celecoxib capsules were continuously given orally to patients in the SC group at a dosage of 200 mg daily for 2 weeks. In the PB group, patients received a placebo capsule once a day for 2 weeks at the same dosage as celecoxib capsules. In the WL group, patients did not receive any treatment. Patients underwent a resting-state BOLD-fMRI scan pre- and post-receiving the therapy, whereas HCs only underwent a baseline scan. Seed (ventrolateral periaqueductal gray, vlPAG, a key node in DPMS) based resting-state functional connectivity (rs-FC) was applied in the data analysis. RESULTS All groups demonstrated improved knee pain scores relative to the initial state. There was no statistical difference between the VA and SA groups in all clinical outcomes, and vlPAG rs-FC alterations. KOA knee pain individuals reported higher vlPAG rs-FC in the bilateral thalamus than HCs. KOA knee pain patients in the acupuncture group (verum + sham, AG) exhibited increased vlPAG rs-FC with the right dorsolateral prefrontal cortex (DLPFC) and the right angular, which is associated with knee pain improvement. In contrast with the SC and PB group, the AG exhibited significantly increased vlPAG rs-FC with the right DLPFC and angular. Contrary to the WT group, the AG showed greater vlPAG rs-FC with the right DLPFC and precuneus. CONCLUSIONS Acupuncture treatment, celecoxib, and placebo medication have different modulation effects on vlPAG DPMS in KOA knee pain patients. Acupuncture could modulate vlPAG rs-FC with brain regions associated with cognitive control, attention, and reappraisal for knee pain relief in KOA patients, compared with celecoxib and placebo medication.
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Affiliation(s)
- Jun Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shirui Cheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohui Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Nannan Jiang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyue Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chenjian Tang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhua He
- The Second Affiliated Hospital of Shanxi, University of Traditional Chinese Medicine, Taiyuan, China
| | - Yang Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ning Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Yuanfang Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinling Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shengjie Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruirui Sun
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Max Wintermark
- Radiology Department, Stanford University, Stanford, California, USA
| | - Weihua Yang
- Dali Bai Autonomous Prefecture Chinese Medicine Hospital, Dali, China
| | - Fanrong Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhengjie Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Drusko A, Baumeister D, McPhee Christensen M, Kold S, Fisher VL, Treede RD, Powers A, Graven-Nielsen T, Tesarz J. A novel computational approach to pain perception modelling within a Bayesian framework using quantitative sensory testing. Sci Rep 2023; 13:3196. [PMID: 36823292 PMCID: PMC9950064 DOI: 10.1038/s41598-023-29758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Pain perception can be studied as an inferential process in which prior information influences the perception of nociceptive input. To date, there are no suitable psychophysical paradigms to measure this at an individual level. We developed a quantitative sensory testing paradigm allowing for quantification of the influence of prior expectations versus current nociceptive input during perception. Using a Pavlovian-learning task, we investigated the influence of prior expectations on the belief about the varying strength of association between a painful electrical cutaneous stimulus and a visual cue in healthy subjects (N = 70). The belief in cue-pain associations was examined with computational modelling using a Hierarchical Gaussian Filter (HGF). Prior weighting estimates in the HGF model were compared with the established measures of conditioned pain modulation (CPM) and temporal summation of pain (TSP) assessed by cuff algometry. Subsequent HGF-modelling and estimation of the influence of prior beliefs on perception showed that 70% of subjects had a higher reliance on nociceptive input during perception of acute pain stimuli, whereas 30% showed a stronger weighting of prior expectations over sensory evidence. There was no association between prior weighting estimates and CPM or TSP. The data demonstrates relevant individual differences in prior weighting and suggests an importance of top-down cognitive processes on pain perception. Our new psychophysical testing paradigm provides a method to identify individuals with traits suggesting greater reliance on prior expectations in pain perception, which may be a risk factor for developing chronic pain and may be differentially responsive to learning-based interventions.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Megan McPhee Christensen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sebastian Kold
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Victoria Lynn Fisher
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Heidelberg, Germany
| | - Albert Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Crawford LS, Boorman DC, Keay KA, Henderson LA. The pain conductor: brainstem modulation in acute and chronic pain. Curr Opin Support Palliat Care 2022; 16:71-77. [PMID: 35639572 DOI: 10.1097/spc.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW It is well established in experimental settings that brainstem circuits powerfully modulate the multidimensional experience of pain. This review summarizes current understanding of the roles of brainstem nuclei in modulating the intensity of pain, and how these circuits might be recruited therapeutically for pain relief in chronic and palliative settings. RECENT FINDINGS The development of ultra-high field magnetic resonance imaging and more robust statistical analyses has led to a more integrated understanding of brainstem function during pain. It is clear that a number of brainstem nuclei and their overlapping pathways are recruited to either enhance or inhibit incoming nociceptive signals. This review reflects on early preclinical research, which identified in detail brainstem analgesic function, putting into context contemporary investigations in humans that have identified the role of specific brainstem circuits in modulating pain, their contribution to pain chronicity, and even the alleviation of palliative comorbidities. SUMMARY The brainstem is an integral component of the circuitry underpinning pain perception. Enhanced understanding of its circuitry in experimental studies in humans has, in recent years, increased the possibility for better optimized pain-relief strategies and the identification of vulnerabilities to postsurgical pain problems. When integrated into the clinical landscape, these experimental findings of brainstem modulation of pain signalling have the potential to contribute to the optimization of pain management and patient care from acute, to chronic, to palliative states.
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Affiliation(s)
- Lewis S Crawford
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, NSW, Australia
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