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Meyers E, Della Porta D, Torta DM, van den Broeke EN. The effect of psychological manipulations on the development of secondary hyperalgesia: a critical review. Pain Rep 2025; 10:e1291. [PMID: 40444022 PMCID: PMC12119042 DOI: 10.1097/pr9.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 03/17/2025] [Accepted: 03/22/2025] [Indexed: 06/02/2025] Open
Abstract
As central sensitization is believed to contribute to persistent pain and psychological factors are increasingly acknowledged to play a role as well, the question arises of whether psychological factors can modulate the development of central sensitization. Secondary hyperalgesia is thought to be a manifestation of central sensitization and can be induced experimentally in humans. To define the state-of-the-art, we critically reviewed the existing evidence that psychological factors can influence the development of experimentally induced secondary hyperalgesia, a proxy of central sensitization. We retrieved 23 studies, 17 aimed at modulating the development of secondary hyperalgesia, 4 at modulating hyperalgesia when already established, and 2 observational studies. The psychological interventions in the 17 included papers focused on placebo/nocebo interventions (N = 5), attention and cognitive load (N = 6, 7 experiments), social support (N = 1), cognitive behavioral therapy (N = 1), threat/fear induction (N = 2), and emotional disclosure (N = 1). Interventions were considered effective if they successfully decreased or increased the magnitude and/or spatial extent of secondary hyperalgesia. Although some psychological manipulations might interfere with the development of secondary hyperalgesia, the number of studies is too low to draw firm conclusions. More studies and replications are needed to determine the impact of psychological factors on the development of secondary hyperalgesia. Factors that should be considered in future studies are (among others) the risk of bias, sufficient statistical power, the measurement of secondary hyperalgesia, the choice of sensitization protocol, the strength of the manipulation, and the role of sex.
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Affiliation(s)
- Elke Meyers
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Delia Della Porta
- Institute of Neuroscience, Faculty of Medicine, UCLouvain, Louvain-la-Neuve, Belgium
- Psychological Sciences Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Diana M. Torta
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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2
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Colasurdo M, Ahmed AK, Gandhi D. MR-guided Focused Ultrasound Thalamotomy for Chronic Pain. Magn Reson Imaging Clin N Am 2024; 32:661-672. [PMID: 39322355 DOI: 10.1016/j.mric.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
MR-guided focused ultrasound (FUS) represents a promising alternative for patients with chronic neuropathic who have failed medical management and other treatment options. Early single-center experience with chronic neuropathic pain and trigeminal neuralgia has demonstrated favorable long-term outcomes. Excellent safety profile with low risk of motor and sensory complications and so far anecdotal permanent neurologic deficits make FUS a powerful tool to treat patients who are otherwise hopeless. Neuromodulation may be the most influential factor driving outcomes and studies devised to detect neuroplasticity will be critical to guide such therapies.
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Affiliation(s)
- Marco Colasurdo
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Dheeraj Gandhi
- Department of Neurosurgery, University of Maryland School of Medicine; Division of Neurointerventional Surgery, Department of Diagnostic Radiology, University of Maryland School of Medicine, University of Maryland, 22 South Green Street, Baltimore, MD 21201, USA; Department of Radiology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; Department of Neurology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; Department of Neurosurgery, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA.
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3
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Lin CL, Lane HY, Sun CK, Chen MH, Lee CY, Li L, Lee JJ, Yeh PY. Effects of chronic daily headache with subclinical depression on brain volume: A systematic review and meta-analysis. Eur J Pain 2024; 28:1294-1310. [PMID: 38563383 DOI: 10.1002/ejp.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The relationship between chronic daily headache (CDH), depression symptoms, and brain volume remains unclear. METHODS To investigate the effects of CDH on brain volume and the impact of depressive symptoms (DSs) as well as the effects of demography and medication overuse, PubMed, Embase, and Web of Science databases were systematically searched using appropriate keyword strings to retrieve observational studies from inception to May 2023. RESULTS Two distinct comparisons were made in CDH patients: (1) those with DSs versus their pain-free counterparts and (2) those without DSs versus pain-free controls. The first comprised nine studies enrolling 225 CDH patients with DSs and 234 controls. Beck depression inventory, Hamilton depression scale, and Hospital anxiety/depression scale were used to assess DSs, revealing significantly more DSs in CDH patients with DSs compared to their controls (all p < 0.05). Besides, the second analysed four studies involving 117 CDH patients without DSs and 155 comparators. Compared to CDH patients without DSs, those with DSs had a smaller brain volume than controls (p = 0.03). Furthermore, CDH patients with DSs who did not overuse medications showed a smaller right cerebral cortical volume than overusers (p = 0.003). A significant inverse correlation between female prevalence and brain volume (p = 0.02) was revealed using regression analysis. CONCLUSIONS Pain-induced persistent depressive symptoms not only incur structural alterations but also encompass affective-motivational changes, involving medication use and gender-specific health concerns. SIGNIFICANCE This study highlighted the importance of an integrated CDH treatment, emphasizing psychological interventions for the affective-motivational component alongside pain management.
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Affiliation(s)
- Chih-Lung Lin
- Department of Neurosurgery, Asia University Hospital, Taichung, Taiwan
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiao-Yu Lee
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Lin Li
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jia-Jie Lee
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
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4
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Stewart BW, Keaser ML, Lee H, Margerison SM, Cormie MA, Moayedi M, Lindquist MA, Chen S, Mathur BN, Seminowicz DA. Pathological claustrum activity drives aberrant cognitive network processing in human chronic pain. Curr Biol 2024; 34:1953-1966.e6. [PMID: 38614082 DOI: 10.1016/j.cub.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Abstract
Aberrant cognitive network activity and cognitive deficits are established features of chronic pain. However, the nature of cognitive network alterations associated with chronic pain and their underlying mechanisms require elucidation. Here, we report that the claustrum, a subcortical nucleus implicated in cognitive network modulation, is activated by acute painful stimulation and pain-predictive cues in healthy participants. Moreover, we discover pathological activity of the claustrum and a region near the posterior inferior frontal sulcus of the right dorsolateral prefrontal cortex (piDLPFC) in migraine patients during acute pain and cognitive task performance. Dynamic causal modeling suggests a directional influence of the claustrum on activity in this piDLPFC region, and diffusion weighted imaging verifies their structural connectivity. These findings advance understanding of claustrum function during acute pain and provide evidence of a possible circuit mechanism driving cognitive impairments in chronic pain.
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Affiliation(s)
- Brent W Stewart
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA
| | - Hwiyoung Lee
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Wade Avenue, Catonsville, MD 21228, USA
| | - Sarah M Margerison
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA; Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Penn Street, Baltimore, MD 21201, USA
| | - Matthew A Cormie
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Edward Street, Toronto, ON M5G 1E2, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Edward Street, Toronto, ON M5G 1E2, Canada; Department of Dentistry, Mount Sinai Hospital, University Avenue, Toronto, ON M5G 1X5, Canada; Division of Clinical & Computational Neuroscience, Krembil Brain Institute, University Health Network, Nassau Street, Toronto, ON M5T 1M8, Canada
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, N Wolfe Street, Baltimore, MD 21205, USA
| | - Shuo Chen
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Wade Avenue, Catonsville, MD 21228, USA
| | - Brian N Mathur
- Department of Pharmacology, University of Maryland School of Medicine, W Baltimore Street, Baltimore, MD 21201, USA; Department of Psychiatry, University of Maryland School of Medicine, W Baltimore Street, Baltimore, MD 21201, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, Richmond Street, London, ON N6A 5C1, Canada.
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5
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Gianola M, Llabre MM, Losin EAR. Does pain hurt more in Spanish? The neurobiology of pain among Spanish-English bilingual adults. Soc Cogn Affect Neurosci 2023; 19:nsad074. [PMID: 38102223 PMCID: PMC10868134 DOI: 10.1093/scan/nsad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
We previously found Spanish-English bilingual adults reported higher pain intensity when exposed to painful heat in the language of their stronger cultural orientation. Here, we elucidate brain systems involved in language-driven alterations in pain responses. During separate English- and Spanish-speaking fMRI scanning runs, 39 (21 female) bilingual adults rated painful heat intermixed between culturally evocative images and completed sentence reading tasks. Surveys of cultural identity and language use measured relative preference for US-American vs Hispanic culture (cultural orientation). Participants produced higher intensity ratings in Spanish compared to English. Group-level whole-brain differences in pain-evoked activity between languages emerged in somatosensory, cingulate, precuneus and cerebellar cortex. Regions of interest associated with semantic, attention and somatosensory processing showed higher average pain-evoked responses in participants' culturally preferred language, as did expression of a multivariate pain-predictive pattern. Follow-up moderated mediation analyses showed somatosensory activity mediated language effects on pain intensity, particularly for Hispanic oriented participants. These findings relate to distinct ('meddler', 'spotlight' and 'inducer') hypotheses about the nature of language effects on perception and cognition. Knowledge of language influences on pain could improve efficacy of culturally sensitive treatment approaches across the diversity of Hispanic adults to mitigate documented health disparities in this population.
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Affiliation(s)
- Morgan Gianola
- Psychology, University of Miami, Coral Gables, Florida 33146, USA
| | - Maria M Llabre
- Psychology, University of Miami, Coral Gables, Florida 33146, USA
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6
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Stewart BW, Keaser ML, Lee H, Margerison SM, Cormie MA, Moayedi M, Lindquist MA, Chen S, Mathur BN, Seminowicz DA. Pathological claustrum activity drives aberrant cognitive network processing in human chronic pain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.01.564054. [PMID: 37961503 PMCID: PMC10635040 DOI: 10.1101/2023.11.01.564054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Aberrant cognitive network activity and cognitive deficits are established features of chronic pain. However, the nature of cognitive network alterations associated with chronic pain and their underlying mechanisms require elucidation. Here, we report that the claustrum, a subcortical nucleus implicated in cognitive network modulation, is activated by acute painful stimulation and pain-predictive cues in healthy participants. Moreover, we discover pathological activity of the claustrum and a lateral aspect of the right dorsolateral prefrontal cortex (latDLPFC) in migraine patients. Dynamic causal modeling suggests a directional influence of the claustrum on activity in this latDLPFC region, and diffusion weighted imaging (DWI) verifies their structural connectivity. These findings advance understanding of claustrum function during acute pain and provide evidence of a possible circuit mechanism driving cognitive impairments in chronic pain.
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Affiliation(s)
- Brent W. Stewart
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Hwiyoung Lee
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Catonsville, MD, USA
| | - Sarah M. Margerison
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
- Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew A. Cormie
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada
- Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Clinical & Computational Neuroscience, Krembil Brain Institute, University Health Network
| | | | - Shuo Chen
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Catonsville, MD, USA
| | - Brian N. Mathur
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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7
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McNabb CT, Salcido CA, Argenbright CM, Fuchs PN. The role of the male rat infralimbic cortex in distraction analgesia. Behav Brain Res 2023; 452:114552. [PMID: 37352978 DOI: 10.1016/j.bbr.2023.114552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
Cognitive interventions, including distraction, have been successfully utilized in the manipulation of experimental pain and the treatment of clinical pain. Attentional diversions can reduce the experience of pain, a phenomenon known as distraction analgesia (DA). Prior research has suggested that variations in stimulus intensity may influence the magnitude of DA. However, the neural substrates of DA remain largely unknown. Converging evidence suggests that the infralimbic cortex (IL) in the brains of rats may contribute to the phenomenon of DA. The function of the rat IL in DA has never been directly investigated, therefore, this study sought to identify the role of the IL at two levels of noxious stimulus intensity among brain-intact and IL lesioned male rats within an established rat model of DA. A distractor object reduced formalin-induced nociceptive behavior in brain-intact rats, and this DA effect was detectable during low- (0.5% formalin) and high-intensity (1% formalin) stimulation. IL lesion resulted in a near-complete elimination of the DA effect and an overall reduction in formalin pain. These results provide the first known evidence that (i) the IL is involved in processing DA in rats, (ii) the IL contributes to formalin-induced nociceptive behavior irrespective of distraction, and (iii) a high-intensity stimulation was generally more susceptible to DA than low-intensity stimulation. These findings may further inform the mechanisms and future development of non-pharmacological strategies to reduce pain.
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Affiliation(s)
- Christopher T McNabb
- Bayer US LLC, Medical Affairs, Oncology, 100 Bayer Blvd, Whippany, NJ 07981, United States; The University of Texas at Arlington, Department of Psychology, Life Science Building, Room 313, 501 S Nedderman Dr., Arlington, TX 76013, United States.
| | - Celina A Salcido
- The University of Texas at Arlington, Department of Psychology, Life Science Building, Room 313, 501 S Nedderman Dr., Arlington, TX 76013, United States; University of the Incarnate Word, School of Osteopathic Medicine, 7615 Kennedy Hill, Building 1, San Antonio, TX 78235, United States
| | - Cassie M Argenbright
- The University of Texas at Arlington, Department of Psychology, Life Science Building, Room 313, 501 S Nedderman Dr., Arlington, TX 76013, United States
| | - Perry N Fuchs
- The University of Texas at Arlington, Department of Psychology, Life Science Building, Room 313, 501 S Nedderman Dr., Arlington, TX 76013, United States
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8
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Meyers E, Vlaeyen JWS, van den Broeke EN, von Leupoldt A, Palmer AJ, Torta DM. The effect of high versus low cognitive load on the development of nociceptive hypersensitivity: The roles of sympathetic arousal, sex and pain-related fear. Eur J Pain 2023. [PMID: 36807466 DOI: 10.1002/ejp.2098] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND According to limited-capacity theories of attention, less attentional resources remain available when engaging in a high- versus a low-demanding cognitive task. This may reduce the perceived intensity and the evoked cortical responses of concomitant nociceptive stimuli. Whether and how the competition for limited attentional resources between a cognitive task and pain impacts the development of long-lasting hypersensitivity is unclear. METHODS Eighty-four healthy participants were randomized into a low or high cognitive load group. Low-frequency electrical stimulation (LFS) of the skin was used to induce secondary hypersensitivity. We hypothesized that performing the high-load task during LFS would reduce the development of hypersensitivity. We examined whether painfulness, nonpain-related sympathetic arousal, or sex related to hypersensitivity, by assessing intensity and unpleasantness of mechanical pinprick stimulation. During task execution, we recorded steady-state evoked potentials evoked by LFS and skin conductance level for sympathetic arousal. Afterwards, participants reported task difficulty and LFS-related fear. For the primary outcomes, we used mixed analysis of variances. RESULTS The results confirmed the difference in cognitive load. Although LFS successfully induced hypersensitivity, the high-load task did not reduce its development. Next, the steady-state evoked potentials did not differ between groups. Hypersensitivity correlated positively with pain-related fear and negatively with skin conductance level before LFS, despite the lack of group differences in skin conductance level. We did not find any sex differences in hypersensitivity. CONCLUSIONS These results do not confirm that high cognitive load or sex modulate hypersensitivity, but show associations with pain-related fear and non-pain-related sympathetic arousal. SIGNIFICANCE Previous research has mainly focused on cognitive load effects on the perception of acute painful stimuli. Yet this study extends our understanding by investigating cognitive load effects on the development of long-lasting secondary hypersensitivity, a common aspect in numerous persistent pain conditions. As cognitive tasks are presented during a painful procedure inducing secondary hypersensitivity, we test the long-lasting effects of cognitive load. Additionally, we used psychophysiological measurements to explored potential underlying mechanisms involving limited attentional resources and sympathetic arousal.
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Affiliation(s)
- Elke Meyers
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | - Andreas von Leupoldt
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Andrew J Palmer
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Diana M Torta
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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9
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Ashton-James CE, Anderson SR, Hirsh AT. Understanding the contribution of racially and ethnically discordant interactions to pain disparities: proximal mechanisms and potential solutions. Pain 2023; 164:223-229. [PMID: 35594518 PMCID: PMC9675882 DOI: 10.1097/j.pain.0000000000002698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/12/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Claire E Ashton-James
- Sydney Medical School, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Steven R Anderson
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
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10
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Mosch B, Hagena V, Herpertz S, Ruttorf M, Diers M. Neural correlates of control over pain in fibromyalgia patients. Neuroimage Clin 2023; 37:103355. [PMID: 36848728 PMCID: PMC9982683 DOI: 10.1016/j.nicl.2023.103355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
The perceived lack of control over the experience of pain is arguably-one major cause of agony and impaired life quality in patients with chronic pain disorders as fibromyalgia (FM). The way perceived control affects subjective pain as well as the underlying neural mechanisms have so far not been investigated in chronic pain. We used functional magnetic resonance imaging (fMRI) to examine the neural correlates of self-controlled compared to computer-controlled heat pain in healthy controls (HC, n = 21) and FM patients (n = 23). Contrary to HC, FM failed to activate brain areas usually involved in pain modulation as well as reappraisal processes (right ventrolateral (VLPFC), dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC)). Computer-controlled (compared to self-controlled) heat revealed significant activations of the orbitofrontal cortex (OFC) in HC, whereas FM activated structures that are typically involved in neural emotion processing (amygdala, parahippocampal gyrus). Additionally, FM displayed disrupted functional connectivity (FC) of the VLPFC, DLPFC and dACC with somatosensory and pain (inhibition)-related areas during self-controlled heat stimulation as well as significantly decreased gray matter (GM) volumes compared to HC in DLPFC and dACC. The described functional and structural changes provide evidence for far-reaching impairments concerning pain-modulatory processes in FM. Our investigation represents a first demonstration of dysfunctional neural pain modulation through experienced control in FM according to the extensive functional and structural changes in relevant sensory, limbic and associative brain areas. These areas may be targeted in clinical pain therapeutic methods involving TMS, neurofeedback or cognitive behavioral trainings.
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Affiliation(s)
- Benjamin Mosch
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Verena Hagena
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Michaela Ruttorf
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany; Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim 68167, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany.
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11
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Rischer KM, Anton F, González-Roldán AM, Montoya P, van der Meulen M. Better Executive Functions Are Associated With More Efficient Cognitive Pain Modulation in Older Adults: An fMRI Study. Front Aging Neurosci 2022; 14:828742. [PMID: 35875790 PMCID: PMC9302198 DOI: 10.3389/fnagi.2022.828742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Growing evidence suggests that aging is associated with less efficient endogenous pain modulation as demonstrated by reduced conditioned pain modulation, and that these changes may be mediated by differences in frontal functioning. Yet, little is known about potential age-related changes in cognitive pain modulation, such as distraction from pain. In a first session, 30 healthy young (19-35 years) and 30 healthy older (59-82 years) adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (high vs. low) and concurrently received individually adjusted heat stimuli (warm vs. painful). In both age groups, completing the high load task was associated with a significant reduction in the perceived intensity and unpleasantness of painful stimuli and a reduction in activation of brain regions involved in pain processing. Group comparisons revealed that young adults showed a stronger de-activation of brain regions involved in pain processing during the high load vs. the low load task, such as the right insula, right mid cingulate cortex and left supramarginal gyrus, compared to older adults. Older adults, on the other hand, showed an increased activation in the anterior cingulate cortex during the high load vs. low load task, when compared to young adults. Covariate analyses indicated that executive functions significantly predicted neural pain modulation in older adults: Better executive functions were associated with a more pronounced de-activation of the insula, thalamus and primary somatosensory cortex and increased activation of prefrontal regions during the high vs. low load task. These findings suggest that cognitive pain modulation is altered in older age and that the preservation of executive functions may have beneficial effects on the efficacy of distraction from pain.
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Affiliation(s)
- Katharina M. Rischer
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Fernand Anton
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ana M. González-Roldán
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences, Balearic Islands Health Research Institute, University of the Balearic Islands, Palma, Spain
| | - Pedro Montoya
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences, Balearic Islands Health Research Institute, University of the Balearic Islands, Palma, Spain
| | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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12
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Tonic pain alters functional connectivity of the descending pain modulatory network involving amygdala, periaqueductal gray, parabrachial nucleus and anterior cingulate cortex. Neuroimage 2022; 256:119278. [PMID: 35523367 PMCID: PMC9250649 DOI: 10.1016/j.neuroimage.2022.119278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC accompanying tonic pain in pain-free persons are rare. A network we term the Descending Pain Modulatory Network (DPMN) is implicated in healthy and pathologic pain modulation. Here, we evaluate the effect of tonic pain on FC of specific nodes of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN). METHODS In 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. functional MRI measured resting BOLD signal during pain-free rest with a 32°C thermode and then tonic pain where participants experienced a previously warm temperature combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity during both states. We hypothesized tonic pain would diminish FC dyads within the DPMN. RESULTS Of all hypothesized FC dyads, only PAG and subgenual ACC was weakly altered during pain (F=3.34; p=0.074; pain-free>pain d=0.25). After pain induction sACC-PAG FC became positively correlated with pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During pain, this connection's FC was diminished (paired t=-3.17; p=0.0026). In whole-brain analyses, during pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During pain, FC between left AMYG and right inferior temporal gyrus negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC with right claustrum; right primary visual cortex and right temporo-occipitoparietal junction Conclusion: We demonstrate sACC-PAG tonic pain FC positively correlates with experienced pain and resting right PBN-PAG FC correlates with subsequent pain and is diminished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which correlate with subsequently experienced pain intensity. Our findings suggest specific connectivity patterns within the DPMN at rest are associated with subsequently experienced pain and modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation or biomarkers to guide interventions.
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Huber FA, Toledo TA, Newsom G, Rhudy JL. The relationship between sleep quality and emotional modulation of spinal, supraspinal, and perceptual measures of pain. Biol Psychol 2022; 171:108352. [DOI: 10.1016/j.biopsycho.2022.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/18/2022] [Accepted: 05/08/2022] [Indexed: 11/02/2022]
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Lier EJ, van Rijn CM, de Vries M, van Goor H, Oosterman JM. The interaction between pain and cognition: on the roles of task complexity and pain intensity. Scand J Pain 2022; 22:385-395. [PMID: 34727588 DOI: 10.1515/sjpain-2021-0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The interaction between pain and cognition includes a concurrent negative effect of pain on cognitive performance and an analgesic effect of cognitive distraction on pain experience. The purpose of this exploratory study was to investigate the role of pain intensity and task complexity on this interaction. METHODS Two experiments were conducted in healthy volunteers. In both experiments, participants completed 3 conditions: a pain only condition (consisting of the cold pressor test), a cognition only condition (consisting of the cognitive task) and a combined condition (concurrent administration of the cold pressor and cognitive task). In experiment I, participants performed one out of three possible tasks that differed in cognitive load (low, medium, high). In experiment II the parameters of the pain stimulus, induced by a cold pressor test, were adapted and only the high load cognitive task was employed. Pain scores, reaction times, and accuracy rates were recorded. RESULTS In experiment I, cognitive distraction significantly decreased pain scores, irrespective of the cognitive load of the task. Pain did not affect cognitive performance. In experiment II, pain diminished accuracy rates. No effect of cognitive distraction on pain was observed. Individual characteristics did not noticeably influence the interaction between pain and cognition. CONCLUSIONS The results of this study suggest a two-way interaction, however no evidence for a simultaneous bidirectional relationship was found. Cognitive distraction successfully reduces pain, up until a certain point where this relationship is reversed, and pain starts to interfere with cognitive performance. This may imply that priorities shift at a certain pain-threshold, however further research should confirm this hypothesis. This study could contribute to further understanding of cognitive mechanisms related to pain perception.
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Affiliation(s)
- Elisabeth J Lier
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Clementina M van Rijn
- Radboud University, Donders Institute for Brain, Cognition and Behaviour Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Joukje M Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
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Alhajri N, Boudreau SA, Graven-Nielsen T. Angular gyrus connectivity at alpha and beta oscillations is reduced during tonic pain - Differential effect of eye state. Neuroimage Clin 2022; 33:102907. [PMID: 34915329 PMCID: PMC8683773 DOI: 10.1016/j.nicl.2021.102907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Tonic pain differentially altered AG connectivity during eyes closed and eyes open. Negative mood and/or sleep quality can influence pain-related connectivity. Eyes closed baseline may allow for a reliable detection of pain-related changes. Eyes-closed-eyes-open sequence is crucial for assessing pain-related connectivity.
The angular gyrus (AG) is a common hub in the pain networks. The role of the AG during pain perception, however, is still unclear. This crossover study examined the effect of tonic pain on resting state functional connectivity (rsFC) of the AG under eyes closed (EC) and eyes open (EO). It included two sessions (placebo/pain) separated by 24 hours. Pain was induced using topical capsaicin (or placebo as control) on the right forearm. Electroencephalographic rsFC assessed by Granger causality was acquired from 28 healthy participants (14 women) before (baseline) and 1-hour following the application of placebo/capsaicin. Subjects were randomly assigned and balanced to groups of recording sequence (EC-EO, EO-EC). Decreased rsFC at alpha-1 and beta, but not alpha-2, oscillations was found during pain compared to baseline during EC only. For alpha-1, EC-EO group showed a pain-induced decrease only among connections between the right AG and each of the posterior cingulate cortex (PCC, P = 0.002), medial prefrontal cortex (mPFC, P = 0.005), and the left AG (P = 0.023). For beta rsFC, the EC-EO group showed a bilateral decrease in rsFC spanning the connections between the right AG and mPFC (P = 0.015) and between the left AG and each of PCC (P = 0.004) and mPFC (P = 0.026). In contrast, the EO-EC group showed an increase in beta rsFC only among connections between the left AG and each of PCC (P = 0.012) and mPFC (P = 0.036). No significant change in the AG rsFC was found during EO. These results provide insight into the involvement of the AG in pain perception and reveal methodological considerations when assessing rsFC during EO and EC.
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Affiliation(s)
- Najah Alhajri
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Shellie Ann Boudreau
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Whibley D, Williams DA, Clauw DJ, Sliwinski M, Kratz AL. Within-day rhythms of pain and cognitive function in people with and without fibromyalgia: synchronous or syncopated? Pain 2022; 163:474-482. [PMID: 34393201 PMCID: PMC8669069 DOI: 10.1097/j.pain.0000000000002370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cognitive dysfunction is a common fibromyalgia (FM) symptom and can impact on the daily lives of those affected. We investigated whether within-day pain intensity ratings were associated with contemporaneous objective and subjective measures of cognitive function and whether within-day increases in pain intensity preceded increases in cognitive dysfunction or vice versa. Inclusion of a non-FM group allowed us to examine whether effects were specific to FM. Fifty people with FM and 50 non-FM controls provided 7 days of data. Cognitive tests (processing speed and working memory) and ecological momentary assessments (pain intensity and self-reported cognitive functioning) were conducted ×5/day. Three-level multilevel models examined contemporaneous and within-day 1-lag pain intensity-cognitive functioning associations. Interaction terms assessed possible moderating effects of FM status. Momentary increase in pain was associated with increased self-reported cognitive dysfunction, more strongly so for those with FM (B = 0.27, 95% confidence interval 0.22-0.32; non-FM B = 0.17, 95% confidence interval 0.10-0.23). For the FM group, higher pain was associated with longer processing speed; for the non-FM group, higher pain was associated with shorter processing speed. Pain increase did not precede change in subjective or objective cognitive function in the FM group, but reduction in working memory preceded increase in pain intensity. This finding warrants further research attention and, if replicated, could hold prognostic and/or therapeutic potential.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J. Clauw
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Sliwinski
- Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Lyu Y, Zidda F, Radev ST, Liu H, Guo X, Tong S, Flor H, Andoh J. Gamma Band Oscillations Reflect Sensory and Affective Dimensions of Pain. Front Neurol 2022; 12:695187. [PMID: 35082742 PMCID: PMC8784749 DOI: 10.3389/fneur.2021.695187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Pain is a multidimensional process, which can be modulated by emotions; however, the mechanisms underlying this modulation are unknown. We used pictures with different emotional valence (negative, positive, and neutral) as primes and applied electrical painful stimuli as targets to healthy participants. We assessed pain intensity and unpleasantness ratings and recorded electroencephalograms (EEGs). We found that pain unpleasantness and not pain intensity ratings were modulated by emotion, with increased ratings for negative and decreased ratings for positive pictures. We also found two consecutive gamma band oscillations (GBOs) related to pain processing from time frequency analyses of the EEG signals. The early GBO had a cortical distribution contralateral to the painful stimulus and its amplitude was positively correlated with intensity and unpleasantness ratings, but not with prime valence. The late GBO had a centroparietal distribution and its amplitude was larger for negative compared to neutral and positive pictures. The emotional modulation effect (negative vs. positive) of the late GBO amplitude was positively correlated with pain unpleasantness. The early GBO might reflect the overall pain perception, possibly involving the thalamocortical circuit, while the late GBO might be related to the affective dimension of pain and top-down-related processes.
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Affiliation(s)
- Yuanyuan Lyu
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Francesca Zidda
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Stefan T Radev
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Hongcai Liu
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Xiaoli Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jamila Andoh
- Department of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
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Attention Bias to Pain Words Comes Early and Cognitive Load Matters: Evidence from an ERP Study on Experimental Pain. Neural Plast 2021; 2021:9940889. [PMID: 34754306 PMCID: PMC8572635 DOI: 10.1155/2021/9940889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/19/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
Attention bias (AB) is a common cognitive challenge for patients with pain. In this study, we tested at what stage AB to pain occurs in participants with experimental pain (EP) and tested whether cognitive load interferes with it. We recruited 40 healthy adults aged 18-27 years, and randomized them into control and EP groups. We sprayed the participants in the EP group with 10% capsaicin paste to mimic acute pain and those in the control group with water, accessing both groups' behavioral results and event-related potential data. We found that high-load tasks had longer response times and lower accuracies than low-load tasks did and that different neural processing of words occurred between the groups. The EP group exhibited AB to pain at an early stage with both attentional avoidance (N1 latency) and facilitated attention (P2 amplitude) to pain words. The control group coped with semantic differentiation (N1) at first, followed by pain word discrimination (P2). In addition, AB to pain occurred only in low-load tasks. As the cognitive load multiplied, we did not find AB in the EP group. Therefore, our study adds further evidence for AB to pain, suggesting the implementation of cognitive load in future AB therapy.
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19
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Phelps CE, Navratilova E, Porreca F. Chronic Pain Produces Reversible Memory Deficits That Depend on Task Difficulty in Rats. THE JOURNAL OF PAIN 2021; 22:1467-1476. [PMID: 34023503 PMCID: PMC8578143 DOI: 10.1016/j.jpain.2021.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/05/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
Cognitive impairment associated with chronic pain remains relatively poorly understood. Use of analgesic drugs and often present co-morbidities in patients can preclude conclusions of causative relationships between chronic pain and cognitive deficits. Here, the impact of pain resulting from spinal nerve ligation (SNL) injury in rats on short and long-term memory was assessed in the novel object recognition task. To understand if chronic pain seizes the limited cognitive resources that are available at any given time, task difficulty was varied by using either very different (ie, easy task) or similar (ie, difficult task) pairs of objects. Nerve-injured, male rats exhibited no short or long-term memory deficits under easy task conditions. However, unlike sham-operated controls, injured rats showed deficits in both short and long-term memory by failing to differentiate similar objects in the difficult task version. In SNL rats, duloxetine produced anti-allodynic effects and ameliorated long-term memory deficits in the difficult task suggesting benefits of pain relief possibly complemented by noradrenergic mediated cognitive enhancement. Together these data suggest chronic pain reversibly takes up a significant amount of limited cognitive resources, leaving sufficient available for easy, but not difficult, tasks. PERSPECTIVE: Memory deficits in a rat model of chronic pain were only seen when the cognitive load was high, ie, in a difficult task. Acute treatment with duloxetine was sufficient to relieve memory deficits, suggesting chronic pain induces memory deficits by seizing limited cognitive resources to the detriment of task-related stimuli.
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Affiliation(s)
- Caroline E Phelps
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, Arizona
| | - Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, Arizona
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, Arizona.
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20
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Kerekes N, Sanchéz-Pérez AM, Landry M. Neuroinflammation as a possible link between attention-deficit/hyperactivity disorder (ADHD) and pain. Med Hypotheses 2021; 157:110717. [PMID: 34717072 DOI: 10.1016/j.mehy.2021.110717] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/01/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and pathological pain are two complex syndromes of multifactorial origin. Despite their prevalence and broad impacts, these conditions are seldom recognized and managed simultaneously. The co-existence of neuropsychiatric conditions (such as ADHD) and altered pain perception and chronic pain has been noted in children, and the comorbidity of ADHD and chronic pain is well documented in adults. Pathophysiological studies have suggested dysfunction of the dopaminergic system as a common neurochemical basis for comorbid ADHD and pain. Considerable evidence supports the role of neuroinflammation in the pathophysiology of both. We suggest that central neuroinflammation underlies altered pain perception and pain sensitization in persons with ADHD. Based on our hypothesis, targeting neuroinflammation may serve as a potential new therapeutic intervention to treat ADHD and comorbid pain in children and adolescents and a preventive strategy for the development of chronic pain in adults with ADHD.
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Affiliation(s)
- Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan 461 86, Sweden.
| | - Ana Maria Sanchéz-Pérez
- Neurobiotechnology Laboratory, Faculty of Health Sciences, Institute of Advanced Materials (INAM), University Jaume I, Castellon 120 71, Spain
| | - Marc Landry
- University of Bordeaux, CNRS, Institute for Neurodegenrative Diseases, IMN, UMR 5293, F-33000 Bordeaux, France
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21
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Jones SP, Walsh J. The disruptive effects of pain on the early allocation of attentional resources: An attentional blink study. Eur J Pain 2021; 25:2202-2211. [PMID: 34184353 DOI: 10.1002/ejp.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent evidence suggests that pain dampens attentional processes. However, much of this work has been based on higher-order attentional tasks that involve only spatial attention. Other aspects of the process through which pain engages and holds attention are relatively understudied, in particular, temporal attention. The present set of studies explored how naturally occurring pain (i.e. acute headache) and pain-valenced stimuli affect the ability to recall the second of two targets presented in rapid succession. METHODS Across both experiments participants were required to indicate the presence of a predefined probe (T2) and, in the dual task, identify a target (T1). The probe (T2) was placed in three different temporal proximities (ranging from 70 to 1000 ms) following presentation of the target (T1). In Experiment 1, 36 participants completed a task that comprised a rapid stream of letters. Experiment 2 manipulated the threat value, and the complexity, of the stimuli by replacing letters with words. In the dual task condition, T1 was a word from one of four valence categories (neutral, positive, negative, pain). RESULTS Being in acute pain reduced the accuracy of identification. This reduction in performance occurred regardless of the temporal positioning of the probe, consistent with previous work that suggests pain has an overall dampening effect. Furthermore, when the valence category of the word was pain-related, T2 accuracy performance was negatively affected. CONCLUSION These findings add to the previous evidence that pain has a general dampening effect on attention and that pain-related stimuli are difficult to disengage from. SIGNIFICANCE Pain captures attention to allow cognate resources to be directed appropriately in response. However, the temporal effects of this attentional capture are poorly understood. Findings indicate that acute headache pain has a negative impact on participants' performance when identifying the second of two targets presented in close temporal proximity, and that pain-valenced stimuli exacerbate this effect. These findings demonstrate how pain affects early attention and highlights the potential role of disengagement, rather than orientation, of attention in the pain experience.
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Affiliation(s)
- Scott P Jones
- Psychology Centre for Health and Cognition, Bath Spa University, Bath, UK
| | - Joseph Walsh
- Psychology Centre for Health and Cognition, Bath Spa University, Bath, UK
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22
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The dynamics of pain reappraisal: the joint contribution of cognitive change and mental load. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 20:276-293. [PMID: 31950439 PMCID: PMC7105446 DOI: 10.3758/s13415-020-00768-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study was designed to investigate the neural mechanism of cognitive modulation of pain via a reappraisal strategy with high temporal resolution. The EEG signal was recorded from 29 participants who were instructed to down-regulate, up-regulate, or maintain their pain experience. The L2 minimum norm source reconstruction method was used to localize areas in which a significant effect of the instruction was present. Down-regulating pain by reappraisal exerted a robust effect on pain processing from as early as ~100 ms that diminished the activity of limbic brain regions: the anterior cingulate cortex, right orbitofrontal cortex, left anterior temporal region, and left insula. However, compared with the no-regulation condition, the neural activity was similarly attenuated in the up- and down-regulation conditions. We suggest that this effect could be ascribed to the cognitive load that was associated with the execution of a cognitively demanding reappraisal task that could have produced a general attenuation of pain-related areas regardless of the aim of the reappraisal task (i.e., up- or down-regulation attempts). These findings indicate that reappraisal effects reflect the joint influence of both reappraisal-specific (cognitive change) and unspecific (cognitive demand) factors, thus pointing to the importance of cautiously selected control conditions that allow the modulating impact of both processes to be distinguished.
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Gaultney WM, Dahlquist LM, Quiton RL. Cognitive load and the effectiveness of distraction for acute pain in children. Eur J Pain 2021; 25:1568-1582. [PMID: 33756023 DOI: 10.1002/ejp.1770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in some healthy adult samples. We examined the effects of a high-demand 'working memory' 1-back task compared to a low-demand 'motor control' task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness was examined to explore the mechanisms of distraction on the affective processing of pain. METHODS Fifty-seven children (9-13 years old) experienced three randomly presented heat levels (not painful, slightly painful, moderately painful) during two distraction conditions involving different levels of cognitive load (a high load 'working memory' task and a low load 'motor' control task) in counter-balanced order. Children completed measures of dispositional mindfulness, and attentional control and emotional control. RESULTS As predicted, children's pain intensity and pain unpleasantness ratings were lower in the high load condition compared to the low load condition. These differences were amplified in the moderately painful heat trials. In contrast with predictions, dispositional mindfulness did not significantly predict the effectiveness of distraction. Dispositional mindfulness was significantly related to measures of children's attentional and emotional control abilities; however, an exploratory serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction. CONCLUSIONS Results demonstrate that distraction that places higher demand on executive resources is more effective for acute pain management for children. Further research is needed to explore cognitive and affective moderators of the effectiveness of distraction for children. SIGNIFICANCE This study is one of the first to demonstrate that working-memory engagement can attenuate pain intensity and pain unpleasantness in children aged 9-13. The findings suggest that distraction tasks used in clinical settings for moderately painful medical procedures may benefit more children if they are adequately demanding of cognitive resources.
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Affiliation(s)
- Wendy M Gaultney
- Department of Psychology, University of Maryland, Baltimore County, MD, USA
| | - Lynnda M Dahlquist
- Department of Psychology, University of Maryland, Baltimore County, MD, USA
| | - Raimi L Quiton
- Department of Psychology, University of Maryland, Baltimore County, MD, USA
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Distinct neural networks subserve placebo analgesia and nocebo hyperalgesia. Neuroimage 2021; 231:117833. [PMID: 33549749 DOI: 10.1016/j.neuroimage.2021.117833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 12/19/2022] Open
Abstract
Neural networks involved in placebo analgesia and nocebo hyperalgesia processes have been widely investigated with neuroimaging methods. However, few studies have directly compared these two processes and it remains unclear whether common or distinct neural circuits are involved. To address this issue, we implemented a coordinate-based meta-analysis and compared neural representations of placebo analgesia (30 studies; 205 foci; 677 subjects) and nocebo hyperalgesia (22 studies; 301 foci; 401 subjects). Contrast analyses confirmed placebo-specific concordance in the right ventral striatum, and nocebo-specific concordance in the dorsal anterior cingulate cortex (dACC), left posterior insula and left parietal operculum during combined pain anticipation and administration stages. Importantly, no overlapping regions were found for these two processes in conjunction analyses, even when the threshold was low. Meta-analytic connectivity modeling (MACM) and resting-state functional connectivity (RSFC) analyses on key regions further confirmed the distinct brain networks underlying placebo analgesia and nocebo hyperalgesia. Together, these findings indicate that the placebo analgesia and nocebo hyperalgesia processes involve distinct neural circuits, which supports the view that the two phenomena may operate via different neuropsychological processes.
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25
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Jensen AM, Andersen JQ, Quisth L, Ramstrand N. Finger orthoses for management of joint hypermobility disorders: Relative effects on hand function and cognitive load. Prosthet Orthot Int 2021; 45:36-45. [PMID: 33834743 PMCID: PMC7978036 DOI: 10.1177/0309364620956866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Joint hypermobility refers to joints that move beyond their normal limits. Individuals with hypermobility of the fingers experience difficulties in activities of daily living. Finger orthoses are available for managing hypermobility of the fingers, but their effectiveness has received little attention in scholarly literature. OBJECTIVES To determine if use of custom fit finger orthoses leads to improvements in time needed to perform standardised hand function tests, and attentional demand required to perform these tests, in individuals with joint hypermobility syndrome, Hypermobile Ehlers-Danlos syndrome or Classical Ehlers-Danlos syndrome. STUDY DESIGN Repeated-measures study. METHODS Fourteen participants performed three different hand function tests (target box and block test, writing and picking up coins), with and without their finger orthoses. Time to complete each test was recorded as a measure of functional performance. Brain activity was recorded in the pre-frontal cortices as a measure of attentional demand. RESULTS Functional performance significantly improved for all but one test (picking up coins with non-dominant hand) when participants wore finger orthoses (p < 0.05). Activity in the pre-frontal cortex was lower when using the orthosis to perform the coin test (dominant hand; p < 0.05). No differences were observed in other tests (p > 0.05). CONCLUSIONS Results suggested that finger orthoses improved hand function and provided limited evidence to suggest that they may also affect attentional demand. While the limited sample does not provide conclusive evidence supporting the use of finger orthosis in this clinical population, results warrant further investigation in large scale longitudinal studies or randomised controlled trials.
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Affiliation(s)
| | | | | | - Nerrolyn Ramstrand
- CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Lee JJ, Kim HJ, Čeko M, Park BY, Lee SA, Park H, Roy M, Kim SG, Wager TD, Woo CW. A neuroimaging biomarker for sustained experimental and clinical pain. Nat Med 2021; 27:174-182. [PMID: 33398159 DOI: 10.1038/s41591-020-1142-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.
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Affiliation(s)
- Jae-Joong Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hong Ji Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Marta Čeko
- Institute of Cognitive Science, University of Colorado, Boulder CO, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder CO, USA
| | - Bo-Yong Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,McConnell Brain Imaging Centre, Montreal Neurological institute and Hospital, McGill University, Montreal, QC, Canada
| | - Soo Ahn Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover NH, USA.
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea. .,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea. .,Biomedical Institute for Convergence at SKKU, Sungkyunkwan University, Suwon, South Korea. .,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea.
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Šimić G, Vukić V, Kopić J, Krsnik Ž, Hof PR. Molecules, Mechanisms, and Disorders of Self-Domestication: Keys for Understanding Emotional and Social Communication from an Evolutionary Perspective. Biomolecules 2020; 11:E2. [PMID: 33375093 PMCID: PMC7822183 DOI: 10.3390/biom11010002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
The neural crest hypothesis states that the phenotypic features of the domestication syndrome are due to a reduced number or disruption of neural crest cells (NCCs) migration, as these cells differentiate at their final destinations and proliferate into different tissues whose activity is reduced by domestication. Comparing the phenotypic characteristics of modern and prehistoric man, it is clear that during their recent evolutionary past, humans also went through a process of self-domestication with a simultaneous prolongation of the period of socialization. This has led to the development of social abilities and skills, especially language, as well as neoteny. Disorders of neural crest cell development and migration lead to many different conditions such as Waardenburg syndrome, Hirschsprung disease, fetal alcohol syndrome, DiGeorge and Treacher-Collins syndrome, for which the mechanisms are already relatively well-known. However, for others, such as Williams-Beuren syndrome and schizophrenia that have the characteristics of hyperdomestication, and autism spectrum disorders, and 7dupASD syndrome that have the characteristics of hypodomestication, much less is known. Thus, deciphering the biological determinants of disordered self-domestication has great potential for elucidating the normal and disturbed ontogenesis of humans, as well as for the understanding of evolution of mammals in general.
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Affiliation(s)
- Goran Šimić
- Department of Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, 10000 Zagreb, Croatia; (V.V.); (J.K.); (Ž.K.)
| | - Vana Vukić
- Department of Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, 10000 Zagreb, Croatia; (V.V.); (J.K.); (Ž.K.)
| | - Janja Kopić
- Department of Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, 10000 Zagreb, Croatia; (V.V.); (J.K.); (Ž.K.)
| | - Željka Krsnik
- Department of Neuroscience, Croatian Institute for Brain Research, University of Zagreb Medical School, 10000 Zagreb, Croatia; (V.V.); (J.K.); (Ž.K.)
| | - Patrick R. Hof
- Nash Family Department of Neuroscience, Friedman Brain Institute, and Ronald M. Loeb Center for Alzheimer’s disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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Wilkinson ID, Teh K, Heiberg-Gibbons F, Awadh M, Kelsall A, Shillo P, Sloan G, Tesfaye S, Selvarajah D. Determinants of Treatment Response in Painful Diabetic Peripheral Neuropathy: A Combined Deep Sensory Phenotyping and Multimodal Brain MRI Study. Diabetes 2020; 69:1804-1814. [PMID: 32471808 DOI: 10.2337/db20-0029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/26/2020] [Indexed: 11/13/2022]
Abstract
Painful diabetic peripheral neuropathy (DPN) is difficult to manage, as treatment response is often varied. The primary aim of this study was to examine differences in pain phenotypes between responders and nonresponders to intravenous lidocaine treatment using quantitative sensory testing. The secondary aim was to explore differences in brain structure and functional connectivity with treatment response. Forty-five consecutive patients who received intravenous lidocaine treatment for painful DPN were screened. Twenty-nine patients who met the eligibility criteria (responders, n = 14, and nonresponders, n = 15) and 26 healthy control subjects underwent detailed sensory profiling. Subjects also underwent multimodal brain MRI. A greater proportion of patients with the irritable (IR) nociceptor phenotype were responders to intravenous lidocaine treatment compared with nonresponders. The odds ratio of responding to intravenous lidocaine was 8.67 times greater (95% CI 1.4-53.8) for the IR nociceptor phenotype. Responders to intravenous lidocaine also had significantly greater mean primary somatosensory cortex cortical volume and functional connectivity between the insula cortex and the corticolimbic circuitry. This study provides preliminary evidence for a mechanism-based approach for individualizing therapy in patients with painful DPN.
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Affiliation(s)
- Iain David Wilkinson
- Academic Department of Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, U.K
| | - Kevin Teh
- Academic Department of Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, U.K
| | | | - Mohammad Awadh
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, U.K
| | - Alan Kelsall
- Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Pallai Shillo
- Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Gordon Sloan
- Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Solomon Tesfaye
- Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, U.K.
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Wang K, Cai G, Huang S, Li Y, Li R, Wu W. Performance of healthy persons under pain in different cognitive load tasks: An event-related potential study on experimental pain individuals. Brain Behav 2020; 10:e01713. [PMID: 32558280 PMCID: PMC7428486 DOI: 10.1002/brb3.1713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aims to determine how brain activities underlying task with different cognitive load would be modulated by the painful state using electroencephalography. METHODS The pain state was established by spraying capsaicin on subjects' left inner forearm. A total of 20 experimental pain subjects and 20 matched nonpain controls underwent cognitive tasks with electroencephalogram recording. We collected and analyzed behavioral and event-related potential (ERP) data. RESULTS High cognitive tasks exhibited significantly longer response times and lower accuracies than low-load tasks. The experimental pain group displayed a significantly lower accuracy than the control group. In addition, the experimental pain group showed no significance between high and low cognitive tasks in early ERP components (amplitude of N1, P2, N2, and early part of late positive potential), whereas the control group exhibited significance between different load tasks. Furthermore, we observed a delay peak energy for delta and theta oscillation in Fz 500-800 ms after the onset for pain persons and high cognitive load tasks. CONCLUSIONS Inadequate early attention modulation, along with delayed peak energy for brain oscillation (delta and theta), could be accountable for a worse performance in cognitive tasks in the experimental pain group. Thus, cognitive load is a highly considerable factor. Overall, this study offers more insights into how healthy population works with cognitive tasks under pain neurologically.
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Affiliation(s)
- Kangling Wang
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Guiyuan Cai
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Shimin Huang
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yuqi Li
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Rongdong Li
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Wen Wu
- Department of Rehabilitation MedicineZhujiang HospitalSouthern Medical UniversityGuangzhouChina
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30
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Cognitive Biases Toward Pain: Implications for a Neurocognitive Processing Perspective in Chronic Pain and its Interaction With Depression. Clin J Pain 2020; 35:252-260. [PMID: 30499835 DOI: 10.1097/ajp.0000000000000674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Information-processing biases such as attentional, interpretation, and memory biases are supposed to play a role in the exacerbation and maintenance of chronic pain. Current research in the area of cognitive biases shows that all these biases seem to have an influence on attention to, interpretation of, and recall of pain and can lead to maladaptive strategies and the exacerbation of pain. METHODS We conducted a narrative literature review, considering evidence extracted from various databases including PubMed, MEDLINE, Science Direct, and ProQuest. Search terms included cognitive biases, neurocognitive processing, chronic pain, and depression. RESULTS The literature on attentional, interpretative, and memory biases in experimental and chronic pain, as well as their neuronal underpinnings, suggests that the depression of chronic pain patients may differ from the depression of patients without pain. Depressed pain patients show a recall bias for illness-related and health-related stimuli, whereas depressed patients without pain show a bias for depression-related stimuli. In addition, research has shown that catastrophizing, helplessness/hopelessness, and thought suppression as psychological responses to pain are mediators of the relationship between chronic pain and depression. CONCLUSIONS Current research supports the importance of individual diagnosis of chronic pain patients and their response patterns of pain, psychological processing, and information processing. This leads to the conclusion that depressed pain patients need other clinical interventions when compared with depressed patients without pain. Previous research showed that a combination of a cognitive-behavioral therapy with mindfulness meditation seems to be a promising approach.
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31
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Boissoneault J, Sevel L, Stennett B, Alappattu M, Bishop M, Robinson M. Regional increases in brain signal variability are associated with pain intensity reductions following repeated eccentric exercise bouts. Eur J Pain 2020; 24:818-827. [PMID: 31976587 DOI: 10.1002/ejp.1532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/19/2019] [Accepted: 01/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traditional pain interventions limit fluctuations in pain sensation, which may paradoxically impair endogenous pain modulatory systems (EPMS). However, controlled exposures to clinically relevant pain (e.g. delayed onset muscle soreness [DOMS]) may build capacity in the EPMS. Emerging evidence suggests that regional signal variability (RSV) may be an important indicator of efficiency and modulatory capacity within brain regions. This study sought to determine the role of RSV in both susceptibility to and trainability of pain response following repeated DOMS inductions. METHODS Baseline and follow-up resting-state fMRI was performed on 12 healthy volunteers ~40 days apart. Between scanning visits, participants received four weekly DOMS inductions in alternating elbow flexors and were supplied seven days of post-induction pain ratings. Voxel-wise standard deviation of signal intensity was calculated to measure RSV. Associations among DOMS-related pain and RSV were assessed with regression. Relationships among baseline and change measurements were probed (i.e. susceptibility to DOMS; trainability following multiple inductions). RESULTS Significant association between baseline RSV in left middle frontal gyrus (MFG) and right cerebellum and reductions in DOMS-related pain unpleasantness were detected. Furthermore, increases in RSV were associated with reduced DOMS pain intensity (left lingual gyrus, right MTG, left MTG, left precuneus) and unpleasantness (left MTG, right SFG). DISCUSSION Findings suggest that RSV may be an indicator of EPMS resilience and responsivity to training, as well as an indicator that is responsive to training. Involved regions underlie cognitive, affective and representation processes. Results further clarify the potential role of RSV as an indicator of pain modulation and resilience. SIGNIFICANCE Regional signal variability may be an important indicator of endogenous pain modulatory system responsivity to training following repeated bouts of clinically relevant pain and may in fact be responsive to training itself.
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Affiliation(s)
- Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Landrew Sevel
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bethany Stennett
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Meryl Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Mark Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Attenuation of capsaicin-induced ongoing pain and secondary hyperalgesia during exposure to an immersive virtual reality environment. Pain Rep 2019; 4:e790. [PMID: 31984295 PMCID: PMC6903343 DOI: 10.1097/pr9.0000000000000790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/24/2019] [Accepted: 09/01/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: There is growing evidence that virtual reality (VR) can be used in the treatment of chronic pain conditions. However, further research is required to better understand the analgesic mechanisms during sensitised pain states. Objectives: We examined the effects of an immersive polar VR environment on capsaicin-induced ongoing pain and secondary hyperalgesia. We also investigated whether the degree of analgesia was related to baseline conditioned pain modulation (CPM) responses. Methods: Nineteen subjects had baseline CPM and electrical pain perception (EPP) thresholds measured before the topical application of capsaicin cream. Visual analogue scale ratings were measured to track the development of an ongoing pain state, and EPP thresholds were used to measure secondary hyperalgesia. The effects of a passive polar VR environment on ongoing pain and secondary hyperalgesia were compared with sham VR (ie, 2D monitor screen) in responders to capsaicin (n = 15). Results: Virtual reality was associated with a transient reduction in ongoing pain and an increase in EPP thresholds in an area of secondary hyperalgesia. Baseline CPM measurements showed a significant correlation with VR-induced changes in secondary hyperalgesia, but not with VR-induced changes in ongoing pain perception. There was no correlation between VR-induced changes in pain perception and VR-induced changes in secondary hyperalgesia. Conclusion: Virtual reality can reduce the perception of capsaicin-induced ongoing pain and secondary hyperalgesia. We also show that CPM may provide a means by which to identify individuals likely to respond to VR therapy.
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Michelle Welman FHS, Smit AE, Jongen JLM, Tibboel D, van der Geest JN, Holstege JC. Pain Experience is Somatotopically Organized and Overlaps with Pain Anticipation in the Human Cerebellum. THE CEREBELLUM 2019; 17:447-460. [PMID: 29480507 PMCID: PMC6028829 DOI: 10.1007/s12311-018-0930-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many fMRI studies have shown activity in the cerebellum after peripheral nociceptive stimulation. We investigated whether the areas in the cerebellum that were activated after nociceptive thumb stimulation were separate from those after nociceptive toe stimulation. In an additional experiment, we investigated the same for the anticipation of a nociceptive stimulation on the thumb or toe. For his purpose, we used fMRI after an electrical stimulation of the thumb and toe in 19 adult healthy volunteers. Following nociceptive stimulation, different areas were activated by stimulation on the thumb (lobule VI ipsilaterally and Crus II mainly contralaterally) and toe (lobules VIII-IX and IV-V bilaterally and lobule VI contralaterally), i.e., were somatotopically organized. Cerebellar areas innervated non-somatotopically by both toe and thumb stimulation were the posterior vermis and Crus I, bilaterally. In the anticipation experiment, similar results were found. However, here, the somatotopically activated areas were relatively small for thumb and negligible for toe stimulation, while the largest area was innervated non-somatotopically and consisted mainly of Crus I and lobule VI bilaterally. These findings indicate that nociceptive stimulation and anticipation of nociceptive stimulation are at least partly processed by the same areas in the cerebellum. This was confirmed by an additional conjunction analysis. Based on our findings, we hypothesize that input that is organized in a somatotopical manner reflects direct input from the spinal cord, while non-somatotopically activated parts of the cerebellum receive their information indirectly through cortical and subcortical connections, possibly involved in processing contextual emotional states, like the expectation of pain.
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Affiliation(s)
- F H S Michelle Welman
- Department of Neuroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Albertine E Smit
- Department of Neuroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Joost L M Jongen
- Department of Neurology, Erasmus MC, Room G3-78, Groene Hilledijk 301, 3075 EA, Rotterdam, the Netherlands.
| | - Dick Tibboel
- Department of Intensive Care and Pediatric Surgery, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Jan C Holstege
- Department of Neuroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
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Corticomotor excitability reduction induced by experimental pain remains unaffected by performing a working memory task as compared to staying at rest. Exp Brain Res 2019; 237:2205-2215. [DOI: 10.1007/s00221-019-05587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
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35
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Strategy-dependent modulation of cortical pain circuits for the attenuation of pain. Cortex 2019; 113:255-266. [PMID: 30711854 DOI: 10.1016/j.cortex.2018.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/13/2018] [Accepted: 12/13/2018] [Indexed: 01/08/2023]
Abstract
The effectiveness of cognitive strategies to attenuate pain has been reported in various behavioural studies, however the underlying neuronal mechanisms are only now beginning to be understood. Using a 7 T fMRI, we investigated three different pain attenuation strategies in 20 healthy subjects via: (a) non-imaginal distraction by counting backwards in steps of seven; (b) imaginal distraction by imagining a safe place; and (c) reinterpretation of the pain valence (reappraisal). Although we found considerable variability in the performances, all strategies exhibited a significant relief of pain compared to an unmodulated pain condition. Our finding argues against a subject's potential predisposition for a certain attenuation approach, as some of the subjects performed well on all attenuation tasks yet others performed low on all attenuation tasks. We further investigated the variability of performance within-subjects and explored the cortical regions that contribute to successful single attempts of pain attenuation at trial level. For each of the three tasks, we found a different pattern of brain activity that reflects the performance of pain attenuation. The more successful trials are related to reduced activity of different parts of the insular cortex. Behavioural data suggest that distraction is the preferable cognitive strategy to modulate pain perception. For three different cognitive strategies we revealed brain regions that are suggested to reliably modulate the perception of pain. The findings could be of utmost benefit for future attempts to integrate neuroscientific techniques into the treatment of pain. Further studies are necessary to investigate whether the present results are transferable to patients as an essential part of the multimodal therapy for chronic pain. These patients may also benefit from additional neurofeedback techniques by combining the strategies with the cortical feedback in order to modulate pain-related brain activity.
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36
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Bao C, Liu P, Liu H, Jin X, Shi Y, Wu L, Zeng X, Zhang J, Wang D, Calhoun VD, Tian J, Wu H. Difference in regional neural fluctuations and functional connectivity in Crohn's disease: a resting-state functional MRI study. Brain Imaging Behav 2018; 12:1795-1803. [PMID: 29464530 PMCID: PMC6218319 DOI: 10.1007/s11682-018-9850-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with Crohn's disease (CD) are shown to have abnormal changes in brain structures. This study aimed to further investigate whether these patients have abnormal brain activities and network connectivity. Sixty patients with CD and 40 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were used to assess differences in spontaneous regional brain activity and functional connectivity. Compared to the HCs, patients with CD showed significantly higher ALFF values in hippocampus and parahippocampus (HIPP/paraHIPP), anterior cingulate cortex, insula, superior frontal cortex and precuneus. The ALFF values were significantly lower in secondary somatosensory cortex (S2), precentral gyrus, and medial prefrontal cortex. Functional connectivities between left HIPP and left inferior temporal cortex, and right middle cingulate cortex, HIPP, and fusiform area were significantly lower. The functional connectivities between right HIPP and right inferior orbitofrontal cortex and left HIPP were also significantly lower. Patients with CD showed higher or lower spontaneous activity in multiple brain regions. Altered activities in these brain regions may collectively reflect abnormal function and regulation of visceral pain and sensation, external environmental monitoring, and cognitive processing in these patients. Lower functional connectivity of the hippocampus-limbic system was observed in these patients. These findings may provide more information to elucidate the neurobiological mechanisms of the disease.
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Affiliation(s)
- Chunhui Bao
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Peng Liu
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Huirong Liu
- Outpatient Department, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
| | - Xiaoming Jin
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yin Shi
- Outpatient Department, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Luyi Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Xiaoqing Zeng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jianye Zhang
- Department of Radiology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200030, China
| | - Di Wang
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, 87131, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jie Tian
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Huangan Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
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Liu P, Liu Y, Wang G, Yang X, Jin L, Sun J, Qin W. Aberrant default mode network in patients with primary dysmenorrhea: a fMRI study. Brain Imaging Behav 2018; 11:1479-1485. [PMID: 27738992 DOI: 10.1007/s11682-016-9627-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary dysmenorrhea (PDM), characterized by cramping pain in the lower abdomen, is a common gynecological disorder in women of child-bearing age. An increasing number of neuroimaging studies have emphasized that PDM is associated with functional and structural abnormalities in the regions related to the default mode network (DMN). Based on resting-state functional magnetic resonance imaging (fMRI), the aim of this study was to use amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) to investigate changes of the intrinsic brain activity in the DMN in PDM. Pearson correlation analysis was conducted to assess relationships between the neuroimaging findings and clinical symptoms. Forty-eight PDM patients and thirty-eight matched healthy controls participated in this study. Compared to healthy controls, PDM patients had increased ALFF in the precuneus, dorsomedial prefrontal cortex (dmPFC) and anterior cingulate cortex (ACC) and decreased ALFF in the thalamus. PDM patients also had decreased connectivity between the precuneus and left dmPFC and right ACC, while increased connectivity between the precuneus and left thalamus. In addition, the ALFF in the left dmPFC in PDM patients positively correlated with disease duration. Our findings provide further evidence of the DMN-related abnormalities in PDM patients which might contribute to a better understanding of the pathophysiology of this disease.
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Affiliation(s)
- Peng Liu
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China.
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China.
| | - Yanfei Liu
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Geliang Wang
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Xuejuan Yang
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Lingmin Jin
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Jinbo Sun
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Wei Qin
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China.
- Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China.
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Moayedi M, Salomons TV, Atlas LY. Pain Neuroimaging in Humans: A Primer for Beginners and Non-Imagers. THE JOURNAL OF PAIN 2018; 19:961.e1-961.e21. [PMID: 29608974 PMCID: PMC6192705 DOI: 10.1016/j.jpain.2018.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 03/19/2018] [Indexed: 01/06/2023]
Abstract
Human pain neuroimaging has exploded in the past 2 decades. During this time, the broader neuroimaging community has continued to investigate and refine methods. Another key to progress is exchange with clinicians and pain scientists working with other model systems and approaches. These collaborative efforts require that non-imagers be able to evaluate and assess the evidence provided in these reports. Likewise, new trainees must design rigorous and reliable pain imaging experiments. In this article we provide a guideline for designing, reading, evaluating, analyzing, and reporting results of a pain neuroimaging experiment, with a focus on functional and structural magnetic resonance imaging. We focus in particular on considerations that are unique to neuroimaging studies of pain in humans, including study design and analysis, inferences that can be drawn from these studies, and the strengths and limitations of the approach.
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Affiliation(s)
- Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Tim V Salomons
- School of Psychology and Clinical Language Science, University of Reading, Reading, UK; Centre for Integrated Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland; National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Schmidt K, Gamer M, Forkmann K, Bingel U. Pain Affects Visual Orientation: an Eye-Tracking Study. THE JOURNAL OF PAIN 2018; 19:135-145. [DOI: 10.1016/j.jpain.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/04/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
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Ordaz Jurado DG, Budia Alba A, Bahilo Mateu P, Trassierra Villa M, López-Acón D, Boronat Tormo F. Shockwave lithotripsy with music: Less painful and more satisfactory treatment. Actas Urol Esp 2017; 41:584-589. [PMID: 28412009 DOI: 10.1016/j.acuro.2017.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.
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Affiliation(s)
- D G Ordaz Jurado
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - A Budia Alba
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - P Bahilo Mateu
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Trassierra Villa
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - D López-Acón
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Boronat Tormo
- Unidad de Litotricia y Endourología, Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Moore DJ, Eccleston C, Keogh E. Cognitive load selectively influences the interruptive effect of pain on attention. Pain 2017; 158:2035-2041. [DOI: 10.1097/j.pain.0000000000001011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geuter S, Boll S, Eippert F, Büchel C. Functional dissociation of stimulus intensity encoding and predictive coding of pain in the insula. eLife 2017; 6:e24770. [PMID: 28524817 PMCID: PMC5470871 DOI: 10.7554/elife.24770] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/18/2017] [Indexed: 01/08/2023] Open
Abstract
The computational principles by which the brain creates a painful experience from nociception are still unknown. Classic theories suggest that cortical regions either reflect stimulus intensity or additive effects of intensity and expectations, respectively. By contrast, predictive coding theories provide a unified framework explaining how perception is shaped by the integration of beliefs about the world with mismatches resulting from the comparison of these beliefs against sensory input. Using functional magnetic resonance imaging during a probabilistic heat pain paradigm, we investigated which computations underlie pain perception. Skin conductance, pupil dilation, and anterior insula responses to cued pain stimuli strictly followed the response patterns hypothesized by the predictive coding model, whereas posterior insula encoded stimulus intensity. This novel functional dissociation of pain processing within the insula together with previously observed alterations in chronic pain offer a novel interpretation of aberrant pain processing as disturbed weighting of predictions and prediction errors.
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Affiliation(s)
- Stephan Geuter
- Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, United States
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, United States
| | - Sabrina Boll
- Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Falk Eippert
- Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, United Kingdom
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Abstract
Pain is a complex sensory and emotional experience that is heavily influenced by prior experience and expectations of pain. Before the development of noninvasive human brain imaging, our grasp of the brain's role in pain processing was limited to data from postmortem studies, direct recording of brain activity, patient experience and stimulation during neurosurgical procedures, and animal models of pain. Advances made in neuroimaging have bridged the gap between brain activity and the subjective experience of pain and allowed us to better understand the changes in the brain that are associated with both acute and chronic pain. Additionally, cognitive influences on pain such as attention, anticipation, and fear can now be directly observed, allowing for the interpretation of the neural basis of the psychological modulation of pain. The use of functional brain imaging to measure changes in endogenous neurochemistry has increased our understanding of how states of increased resilience and vulnerability to pain are maintained.
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Affiliation(s)
- Debbie L Morton
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Javin S Sandhu
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Anthony Kp Jones
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Asad ABA, Seah S, Baumgartner R, Feng D, Jensen A, Manigbas E, Henry B, Houghton A, Evelhoch JL, Derbyshire SWG, Chin CL. Distinct BOLD fMRI Responses of Capsaicin-Induced Thermal Sensation Reveal Pain-Related Brain Activation in Nonhuman Primates. PLoS One 2016; 11:e0156805. [PMID: 27309348 PMCID: PMC4911046 DOI: 10.1371/journal.pone.0156805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 05/18/2016] [Indexed: 01/05/2023] Open
Abstract
Background Approximately 20% of the adult population suffer from chronic pain that is not adequately treated by current therapies, highlighting a great need for improved treatment options. To develop effective analgesics, experimental human and animal models of pain are critical. Topically/intra-dermally applied capsaicin induces hyperalgesia and allodynia to thermal and tactile stimuli that mimics chronic pain and is a useful translation from preclinical research to clinical investigation. Many behavioral and self-report studies of pain have exploited the use of the capsaicin pain model, but objective biomarker correlates of the capsaicin augmented nociceptive response in nonhuman primates remains to be explored. Methodology Here we establish an aversive capsaicin-induced fMRI model using non-noxious heat stimuli in Cynomolgus monkeys (n = 8). BOLD fMRI data were collected during thermal challenge (ON:20 s/42°C; OFF:40 s/35°C, 4-cycle) at baseline and 30 min post-capsaicin (0.1 mg, topical, forearm) application. Tail withdrawal behavioral studies were also conducted in the same animals using 42°C or 48°C water bath pre- and post- capsaicin application (0.1 mg, subcutaneous, tail). Principal Findings Group comparisons between pre- and post-capsaicin application revealed significant BOLD signal increases in brain regions associated with the ‘pain matrix’, including somatosensory, frontal, and cingulate cortices, as well as the cerebellum (paired t-test, p<0.02, n = 8), while no significant change was found after the vehicle application. The tail withdrawal behavioral study demonstrated a significant main effect of temperature and a trend towards capsaicin induced reduction of latency at both temperatures. Conclusions These findings provide insights into the specific brain regions involved with aversive, ‘pain-like’, responses in a nonhuman primate model. Future studies may employ both behavioral and fMRI measures as translational biomarkers to gain deeper understanding of pain processing and evaluate the preclinical efficacy of novel analgesics.
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Affiliation(s)
- Abu Bakar Ali Asad
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
- * E-mail:
| | - Stephanie Seah
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
| | - Richard Baumgartner
- Biometrics Research, Biostatistics & Research Decision Sciences, Merck Research Laboratories, Merck & Co., Rahway, NJ, United States of America
| | - Dai Feng
- Biometrics Research, Biostatistics & Research Decision Sciences, Merck Research Laboratories, Merck & Co., Rahway, NJ, United States of America
| | - Andres Jensen
- Early Discovery Pharmacology, Merck Research Laboratories, MSD, Singapore, Singapore
| | | | - Brian Henry
- Early Discovery Pharmacology, Merck Research Laboratories, MSD, Singapore, Singapore
| | - Andrea Houghton
- Early Discovery Pharmacology, Merck Research Laboratories, Merck & Co., West Point, PA, United States of America
| | - Jeffrey L. Evelhoch
- Translational Biomarkers, Merck Research Laboratories, Merck & Co., West Point, PA, United States of America
| | - Stuart W. G. Derbyshire
- Dept of Psychology, National University of Singapore, Singapore, Singapore
- A*STAR-NUS Clinical Imaging Research Centre, Singapore, Singapore
| | - Chih-Liang Chin
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore, Singapore
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Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee. J Orthop Sports Phys Ther 2016; 46:168-76. [PMID: 26721229 DOI: 10.2519/jospt.2016.6259] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN An experimental laboratory study with a repeated-measures crossover design. BACKGROUND Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. OBJECTIVE To examine the effect of joint mobilization on impaired CPM. METHODS An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. RESULTS Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. CONCLUSION Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.
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Darbari DS, Hampson JP, Ichesco E, Kadom N, Vezina G, Evangelou I, Clauw DJ, Taylor Vi JG, Harris RE. Frequency of Hospitalizations for Pain and Association With Altered Brain Network Connectivity in Sickle Cell Disease. THE JOURNAL OF PAIN 2015; 16:1077-86. [PMID: 26291276 PMCID: PMC4986827 DOI: 10.1016/j.jpain.2015.07.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/11/2015] [Accepted: 07/28/2015] [Indexed: 12/23/2022]
Abstract
UNLABELLED Sickle cell disease (SCD) is a hemoglobinopathy that affects more than 100,000 individuals in the United States. The disease is characterized by the presence of sickle hemoglobin and recurrent episodes of pain. Some individuals with SCD experience frequent hospitalizations and a high burden of pain. The role of central mechanisms in SCD pain has not been explored. Twenty-five adolescents and young adults with SCD underwent functional magnetic resonance imaging. Participants were stratified into groups with high pain or low pain based on the number of hospitalizations for pain in the preceding 12 months. Resting state functional connectivity was analyzed using seed-based and dual regression independent component analysis. Intrinsic brain connectivity was compared between the high pain and low pain groups, and association with fetal hemoglobin, a known modifier of SCD, was explored. Patients in the high pain group displayed an excess of pronociceptive connectivity such as between anterior cingulate and default mode network structures, such as the precuneus, whereas patients in the low pain group showed more connectivity to antinociceptive structures such as the perigenual and subgenual cingulate. Although a similar proportion of patients in both groups reported that they were on hydroxyurea, the fetal hemoglobin levels were significantly higher in the low pain group and were associated with greater connectivity to antinociceptive structures. These findings support the role of central mechanisms in SCD pain. Intrinsic brain connectivity should be explored as a complementary and objective outcome measure in SCD pain research. PERSPECTIVE Altered connectivity patterns associated with high pain experience in patients with sickle cell disease suggest a possible role of central mechanisms in sickle cell pain. Resting state brain connectivity studies should be explored as an effective methodology to investigate pain in SCD.
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Affiliation(s)
- Deepika S Darbari
- Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| | - Johnson P Hampson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Nadja Kadom
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts
| | - Gilbert Vezina
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia
| | - Iordanis Evangelou
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - James G Taylor Vi
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Garza-Villarreal EA, Jiang Z, Vuust P, Alcauter S, Vase L, Pasaye EH, Cavazos-Rodriguez R, Brattico E, Jensen TS, Barrios FA. Music reduces pain and increases resting state fMRI BOLD signal amplitude in the left angular gyrus in fibromyalgia patients. Front Psychol 2015; 6:1051. [PMID: 26257695 PMCID: PMC4510313 DOI: 10.3389/fpsyg.2015.01051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/10/2015] [Indexed: 11/13/2022] Open
Abstract
Music reduces pain in fibromyalgia (FM), a chronic pain disease, but the functional neural correlates of music-induced analgesia (MIA) are still largely unknown. We recruited FM patients (n = 22) who listened to their preferred relaxing music and an auditory control (pink noise) for 5 min without external noise from fMRI image acquisition. Resting state fMRI was then acquired before and after the music and control conditions. A significant increase in the amplitude of low frequency fluctuations of the BOLD signal was evident in the left angular gyrus (lAnG) after listening to music, which in turn, correlated to the analgesia reports. The post-hoc seed-based functional connectivity analysis of the lAnG showed found higher connectivity after listening to music with right dorsolateral prefrontal cortex (rdlPFC), the left caudate (lCau), and decreased connectivity with right anterior cingulate cortex (rACC), right supplementary motor area (rSMA), precuneus and right precentral gyrus (rPreG). Pain intensity (PI) analgesia was correlated (r = 0.61) to the connectivity of the lAnG with the rPreG. Our results show that MIA in FM is related to top-down regulation of the pain modulatory network by the default mode network (DMN).
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Affiliation(s)
- Eduardo A Garza-Villarreal
- Subdireccion de Investigaciones Clinicas, Instituto Nacional de Psiquiatria "Dr. Ramón de la Fuente Muñiz," Mexico City, Mexico ; Cátedras, National Council of Science and Technology (CONACYT) Mexico City, Mexico ; Department of Neurology, Faculty of Medicine and University Hospital "Dr. Jose E. Gonzalez" and Neuroscience Unit, Center for Research and Development in the Health Sciences, Universidad Autónoma de Nuevo León Monterrey, Mexico ; Music in the Brain, Center of Functionally Integrative Neuroscience, Aarhus University Aarhus, Denmark
| | - Zhiguo Jiang
- Human Performance and Engineering, Kessler Foundation West Orange, NJ, USA ; Department of Biomedical Engineering, New Jersey Institute of Technology Newark, NJ, USA
| | - Peter Vuust
- Music in the Brain, Center of Functionally Integrative Neuroscience, Aarhus University Aarhus, Denmark ; Royal Academy of Music Aarhus, Denmark
| | - Sarael Alcauter
- Department of Behavioral and Cognitive Neurobiology, Institute of Neurobiology, Universidad Nacional Autonoma de Mexico Queretaro, Mexico
| | - Lene Vase
- Department of Psychology and Behavioral Sciences, University of Aarhus Aarhus, Denmark ; Danish Pain Research Center, Aarhus University Hospital Aarhus, Denmark
| | - Erick H Pasaye
- Department of Behavioral and Cognitive Neurobiology, Institute of Neurobiology, Universidad Nacional Autonoma de Mexico Queretaro, Mexico
| | - Roberto Cavazos-Rodriguez
- Department of Neurology, Faculty of Medicine and University Hospital "Dr. Jose E. Gonzalez" and Neuroscience Unit, Center for Research and Development in the Health Sciences, Universidad Autónoma de Nuevo León Monterrey, Mexico
| | - Elvira Brattico
- Helsinki Collegium for Advanced Studies, University of Helsinki Helsinki, Finland
| | - Troels S Jensen
- Department of Psychology and Behavioral Sciences, University of Aarhus Aarhus, Denmark
| | - Fernando A Barrios
- Department of Behavioral and Cognitive Neurobiology, Institute of Neurobiology, Universidad Nacional Autonoma de Mexico Queretaro, Mexico
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Sturgeon JA, Tieu MM, Jastrzab LE, McCue R, Gandhi V, Mackey SC. Nonlinear Effects of Noxious Thermal Stimulation and Working Memory Demands on Subjective Pain Perception. PAIN MEDICINE 2015; 16:1301-10. [PMID: 25929747 DOI: 10.1111/pme.12774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 03/06/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE A bidirectional relationship between working memory (WM) and acute pain has long been assumed, but equivocal evidence exists regarding this relationship. This study characterized the relationship between WM and acute pain processing in healthy individuals using an adapted Sternberg WM task. DESIGN Participants completed a Sternberg task while receiving noxious thermal stimulation. Participants received a pseudorandom presentation of four different temperatures (baseline temperatures and individually determined low-, medium-, and high-temperature stimuli) and four levels of Sternberg task difficulty (0-, 3-, 6-, and 9-letter strings). SUBJECTS Twenty-eight healthy participants were recruited from Stanford University and the surrounding community to complete this study. RESULTS A nonlinear interaction between intensity of thermal stimulation and difficulty of the Sternberg task was noted. Increased cognitive load from the Sternberg task resulted in increased perception of pain in low-intensity thermal stimulation but suppressed pain perception in high-intensity thermal stimulation. Thermal stimulation had no significant effect on participants' response time or accuracy on the Sternberg task regardless of intensity level. CONCLUSIONS Pain perception appears to decrease as a function of WM load only for sufficiently noxious stimuli. However, increasing noxious stimuli did not affect cognitive performance. These complex relationships may reflect a shared cognitive space that can become "overloaded" with input of multiple stimuli of sufficient intensity.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University, Palo Alto, California, USA
| | - Meghan M Tieu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University, Palo Alto, California, USA
| | - Laura E Jastrzab
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebecca McCue
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University, Palo Alto, California, USA
| | - Vanisha Gandhi
- Native American Health Center, Lutheran Medical Center, San Francisco, California, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University, Palo Alto, California, USA
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Asghar MS, Pereira MP, Werner MU, Mårtensson J, Larsson HBW, Dahl JB. Secondary hyperalgesia phenotypes exhibit differences in brain activation during noxious stimulation. PLoS One 2015; 10:e0114840. [PMID: 25615578 PMCID: PMC4304709 DOI: 10.1371/journal.pone.0114840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/14/2014] [Indexed: 01/08/2023] Open
Abstract
Noxious stimulation of the skin with either chemical, electrical or heat stimuli leads to the development of primary hyperalgesia at the site of injury, and to secondary hyperalgesia in normal skin surrounding the injury. Secondary hyperalgesia is inducible in most individuals and is attributed to central neuronal sensitization. Some individuals develop large areas of secondary hyperalgesia (high-sensitization responders), while others develop small areas (low-sensitization responders). The magnitude of each area is reproducible within individuals, and can be regarded as a phenotypic characteristic. To study differences in the propensity to develop central sensitization we examined differences in brain activity and anatomy according to individual phenotypical expression of secondary hyperalgesia by magnetic resonance imaging. Forty healthy volunteers received a first-degree burn-injury (47°C, 7 min, 9 cm2) on the non-dominant lower-leg. Areas of secondary hyperalgesia were assessed 100 min after the injury. We measured neuronal activation by recording blood-oxygen-level-dependent-signals (BOLD-signals) during mechanical noxious stimulation before burn injury and in both primary and secondary hyperalgesia areas after burn-injury. In addition, T1-weighted images were used to measure differences in gray-matter density in cortical and subcortical regions of the brain. We found significant differences in neuronal activity between high- and low-sensitization responders at baseline (before application of the burn-injury) (p < 0.05). After the burn-injury, we found significant differences between responders during noxious stimulation of both primary (p < 0.01) and secondary hyperalgesia (p ≤ 0.04) skin areas. A decreased volume of the right (p = 0.001) and left caudate nucleus (p = 0.01) was detected in high-sensitization responders in comparison to low-sensitization responders. These findings suggest that brain-structure and neuronal activation to noxious stimulation differs according to secondary hyperalgesia phenotype. This indicates differences in central sensitization according to phenotype, which may have predictive value on the susceptibility to development of high-intensity acute and persistent pain.
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Affiliation(s)
- Mohammad Sohail Asghar
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Manuel Pedro Pereira
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Mads Utke Werner
- Multidisciplinary Pain Centre, Neuroscience Centre, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Johan Mårtensson
- Max Planck Institute for Human Development, Berlin, Germany; Department of Psychology, Lund University, Lund, Sweden
| | - Henrik B W Larsson
- Functional Imaging Unit, Hospital, Glostrup, Copenhagen University Hospitals, Glostrup, Denmark
| | - Jørgen Berg Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
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Mathur VA, Khan SA, Keaser ML, Hubbard CS, Goyal M, Seminowicz DA. Altered cognition-related brain activity and interactions with acute pain in migraine. NEUROIMAGE-CLINICAL 2015; 7:347-58. [PMID: 25610798 PMCID: PMC4297882 DOI: 10.1016/j.nicl.2015.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/10/2014] [Accepted: 01/02/2015] [Indexed: 01/01/2023]
Abstract
Little is known about the effect of migraine on neural cognitive networks. However, cognitive dysfunction is increasingly being recognized as a comorbidity of chronic pain. Pain appears to affect cognitive ability and the function of cognitive networks over time, and decrements in cognitive function can exacerbate affective and sensory components of pain. We investigated differences in cognitive processing and pain–cognition interactions between 14 migraine patients and 14 matched healthy controls using an fMRI block-design with two levels of task difficulty and concurrent heat (painful and not painful) stimuli. Across groups, cognitive networks were recruited in response to a difficult cognitive task, and a pain–task interaction was found in the right (contralateral to pain stimulus) posterior insula (pINS), such that activity was modulated by decreasing the thermal pain stimulus or by engaging the difficult cognitive task. Migraine patients had less task-related deactivation within the left dorsolateral prefrontal cortex (DLPFC) and left dorsal anterior midcingulate cortex (aMCC) compared to controls. These regions have been reported to have decreased cortical thickness and cognitive-related deactivation within other pain populations, and are also associated with pain regulation, suggesting that the current findings may reflect altered cognitive function and top-down regulation of pain. During pain conditions, patients had decreased task-related activity, but more widespread task-related reductions in pain-related activity, compared to controls, suggesting cognitive resources may be diverted from task-related to pain-reduction-related processes in migraine. Overall, these findings suggest that migraine is associated with altered cognitive-related neural activity, which may reflect altered pain regulatory processes as well as broader functional restructuring. Migraine patients had blunted task-related deactivations in DLPFC, aMCC, and cerebellum in the absence of pain, vs. controls. Unlike in healthy controls, these task-related deactivations were not modulated by the presence of an acute pain stimulus. Migraine patients had less task-related activity during pain, compared to controls. Acute pain disturbs cognitive processing more in patients than controls.
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Affiliation(s)
- Vani A. Mathur
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, 8 South, Baltimore, MD 21201, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Suite 100, 5510 Nathan Shock Dr., Baltimore, MD 21224, USA
| | - Shariq A. Khan
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, 8 South, Baltimore, MD 21201, USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, 8 South, Baltimore, MD 21201, USA
| | - Catherine S. Hubbard
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, 8 South, Baltimore, MD 21201, USA
| | - Madhav Goyal
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 East Monument Street, Baltimore, MD 21287, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, 8 South, Baltimore, MD 21201, USA
- Corresponding author at: Department of Neural & Pain Sciences, University of Maryland School of Dentistry, 650 W. Baltimore Street, 8 South, Baltimore, MD 21201, USA. Tel: 410 706 3476; fax: 410 706 0865.
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