Brain dynamics of scalp evoked potentials and current source densities to repetitive (5-pulse train) painful stimulation of skin and muscle: central correlate of temporal summation

What Is the de-qi-Related Pattern of BOLD Responses? A Review of Acupuncture Studies in fMRI

de-qi, comprising mostly subjective sensations during acupuncture, is traditionally considered as a very important component for the possible therapeutic effects of acupuncture. However, the neural correlates of de-qi are still unclear. In this paper, we reviewed previous fMRI studies from the viewpoint of the neural responses of de-qi. We searched on Pubmed and identified 111 papers. Fourteen studies distinguishing de-qi and sharp pain and eight studies with the mixed sensations were included in further discussions. We found that the blood oxygenation level-dependent (BOLD) responses associated with de-qi were activation dominated, mainly around cortical areas relevant to the processing of somatosensory or pain signals. More intense and extensive activations were shown for the mixed sensations. Specific activations of sharp pain were also shown. Similar BOLD response patterns between de-qi evoked by acupuncture stimulation and de-qi-like sensations evoked by deep pain stimulation were shown. We reckon that a standardized method of qualification and quantification of de-qi, deeper understanding of grouping strategy of de-qi and sharp pain, and making deep pain stimulation as a control, as well as a series of improvements in the statistical method, are crucial factors for revealing the neural correlates of de-qi and neural mechanisms of acupuncture.

Partly Separated Activations in the Spatial Distribution between de-qi and Sharp Pain during Acupuncture Stimulation: An fMRI-Based Study

Nowadays, functional magnetic resonance imaging (fMRI) has become one of the most important ways to explore the central mechanism of acupuncture. Among these studies, activations around the somatosensory-related brain network had the most robust blood oxygen level-dependent (BOLD) responses. However, due to the insufficient control of the subjective sensations during acupuncture stimulation, whether these robust activations reflected the pattern of de-qi, sharp pain, or mixed (de-qi + sharp pain) sensations was largely unknown. The current study recruited 50 subjects and grouped them into two groups according to whether he/she experienced sharp pain during acupuncture stimulation to give a definite answer to the aforesaid question. Our results indicated that BOLD responses associated with de-qi during acupuncture stimulation at ST36 were activation dominated. Furthermore, both the quantitative and qualitative differences of BOLD responses between de-qi and mixed sensations evoked by acupuncture stimulation were significant. The pattern of BOLD responses of sharp pain might be partly separated from that of de-qi in the spatial distribution. Therefore, we proposed that in order to explore the specific central mechanism of acupuncture, subjects with sharp pain should be excluded from those with only de-qi.

Cortical activation changes during repeated laser stimulation: a magnetoencephalographic study

Repeated warm laser stimuli produce a progressive increase of the sensation of warmth and heat and eventually that of a burning pain. The pain resulting from repetitive warm stimuli is mediated by summated C fibre responses. To shed more light on the cortical changes associated with pain during repeated subnoxious warm stimution, we analysed magnetoencephalographic (MEG) evoked fields in eleven subjects during application of repetitive warm laser stimuli to the dorsum of the right hand. One set of stimuli encompassed 10 laser pulses occurring at 2.5 s intervals. Parameters of laser stimulation were optimised to elicit a pleasant warm sensation upon a single stimulus with a rise of skin temperature after repeated stimulation not exceeding the threshold of C mechano-heat fibres. Subjects reported a progressive increase of the intensity of heat and burning pain during repeated laser stimulation in spite of only mild (4.8°C) increase of skin temperature from the first stimulus to the tenth stimulus. The mean reaction time, evaluated in six subjects, was 1.33 s, confirming involvement of C fibres. The neuromagnetic fields were modelled by five equivalent source dipoles located in the occipital cortex, cerebellum, posterior cingulate cortex, and left and right operculo-insular cortex. The only component showing statistically significant changes during repetitive laser stimulation was the late component of the contralateral operculo-insular source peaking at 1.05 s after stimulus onset. The amplitude increases of the late component of the contralateral operculo-insular source dipole correlated with the subjects' numerical ratings of warmth and pain. Results point to a pivotal role of the contralateral operculo-insular region in processing of C-fibre mediated pain during repeated subnoxious laser stimulation.

Nociceptive contribution to the evoked potentials after painful intramuscular electrical stimulation

Our study aimed at investigating the nociceptive contribution to the somatosensory evoked potentials after electrical intramuscular stimulation (mSEPs) at painful intensity. Scalp mSEPs were recorded in 10 healthy subjects after electrical stimulation of the left brachioradialis muscle at three intensities: non-painful (I2), slightly painful (I4) and moderately painful (I6). For each intensity, mSEPs were recorded in a neutral condition (NC) in which subjects did not have any task, and in an attention condition (AC) in which subjects were asked to count the number of stimuli. In both NC and AC, the N120 and P220 amplitudes were significantly higher at I6 than at I2. While the N120 amplitude did not vary between NC and AC, the P220 amplitude was significantly higher in AC than in NC at all stimulus intensities. Our results suggest that nociceptive inputs contribute to the N120 amplitude increase at painful stimulus intensity, while the P220 amplitude is more sensitive to changes of subjects' attention level. Therefore, the N120 amplitude increase to moderately painful stimuli, as compared to non-painful stimuli, may represent a marker of the activation of the muscular thin myelinated afferents.

Central processing of acute muscle pain in chronic low back pain patients: an EEG mapping study

The presence of perceptual sensitization and related brain responses was examined in 14 chronic low back pain (CLBP) patients and 13 healthy controls comparable in age and sex. Multichannel EEG recordings and pain ratings were obtained during the presentation of 800 painful electrical intramuscular and intracutaneous stimuli each to the left m. erector spinae and the left m. extensor digitorum. Perception and pain thresholds were not significantly different between the two groups, though patients showed significantly more perceptual sensitization. Across all stimulation conditions, a larger EEG component 80 milliseconds after stimulation was observed in the CLBP group. No significant group differences were found for the N150. The component 260 milliseconds after stimulus onset was significantly smaller in the CLBP group. N80, N150, and perceptual sensitization were significantly positively correlated. These results indicate enhanced perceptual sensitization and enhanced processing of the sensory-discriminative aspect of pain, as expressed in the N80 component, in CLBP patients. This may be one neurophysiologic basis of sensitization and the chronicity process. The lower P260 component in the patients may be explained in terms of tonic pain inhibiting phasic pain or may be related to the affective distress observed in this patient group.

Mode and site of acupuncture modulation in the human brain: 3D (124-ch) EEG power spectrum mapping and source imaging

This study determined: (a) if acupuncture stimulation at a traditional site might modulate ongoing EEG as compared with stimulation of a control site; (b) if high-frequency vs. low-frequency stimulation could exert differential effects of acupuncture; (c) if the observed effects of acupuncture were specific to certain EEG bands; and (d) if the acupuncture effect could be isolated at a specific scalp field, with its putative underlying intracranial source. Twelve healthy male volunteers (age range 22-35) participated in two experimental sessions separated by 1 week, which involved transcutaneous acupoint stimulation at selected acupoint (Li 4, HeGu) vs. a mock point at the fourth interosseous muscle area on the left hand in high (HF: 100 Hz) vs. low-frequency (LF: 2 Hz) stimulation by counter-balanced order. 124-ch EEG data were used to analyze the Delta, Theta, Alpha-1, Alpha-2, Beta, and Gamma bands. The absolute EEG powers (muv2) at focal maxima across three stages (baseline, stimulation, post) were examined by two-way (condition, stage) repeated measures ANOVA. The activity of the Theta power significantly decreased (P = 0.02), compared with control during HF but not LF stimulation at acupoint stimulation, however, there was no study effect at the mock point. A decreased Theta EEG power was prominent at the frontal midline sites (FCz, Fz) and the contralateral right hemisphere front site (FCC2h). In contrast, the Theta power of low-frequency stimulation showed an increase from the baseline as those in both controlled mock point stimulations. The observed high-frequency acupoint stimulation effects of Theta EEG were only present during, but not after, simulation. The topographic Theta activity was tentatively identified to originate from the intracranial current source in cingulate cortex, likely ACC. It is likely that short-term cortical plasticity occurs during high-frequency but not low-frequency stimulation at the HeGu point, but not mock point. We suggest that HeGu acupuncture stimulation modulates limbic cingulum by a frequency modulation mode, which then may damp nociceptive processing in the brain.

Spatiotemporal brain dynamics in response to muscle stimulation

The objective of the present study was to assess the spatiotemporal scenario of brain activity associated with sensory stimulation of the abductor pollicis brevis muscle. Spatiotemporal dipole models, using realistic individual boundary element head models, were built from somatosensory evoked potentials (SEPs; 64 Ch. EEG) to nonpainful and painful intramuscular electrostimulation (IMES) as well as to cutaneous electrostimulation delivered to the distal phalanx of the thumb. Nonpainful and painful muscle stimuli resulted in activation of the same brain regions. In temporal order, these were: the contralateral primary sensorimotor cortex, contralateral dorso-lateral premotor area (PM), bilateral operculo-insular cortices, caudal cingulate motor area (CMA), and posterior cingulate cortex/precuneus. Brain processing induced by muscle sensory input showed a characteristic pattern in contrast to cutaneous sensory input, namely: (1) no early SEP components to IMES; (2) an initial IMES component likely generated by proprioceptive input is not present for digit stimulation; (3) one source was located in the PM only for IMES. This source was unmasked by the lower stimulus intensity; (4) a source for IMES was located in the contralateral caudal CMA rather than being located in the cingulate gyrus. Cerebral sensory processing of input from the muscle involved several sensory and motor areas and likely occurs in two parallel streams subserving higher order somatosensory processing as well as sensory-motor integration. The two streams might on one hand involve sensory discrimination via SI and SII and on the other hand integration of sensory feedback for further motor processing via MI, lateral PM area, and caudal CMA.

Event-related functional MRI study on central representation of acute muscle pain induced by electrical stimulation

Although pathological muscle pain involves a significantly larger population than any other pain condition, the central mechanisms are less explored than those of cutaneous pain. The aims of the study were to establish the pain matrix for muscle pain in the full head volume and, further, to explore the possibility of a functional segregation to nonpainful and painful stimuli within the area of the parasylvian cortex corresponding to the secondary somatosensory area. Additionally, we speculate that a randomization of nonpainful and painful stimuli may target specific structures related to stimulus salience. We used event-related functional magnetic resonance imaging (MRI) and the high sensitivity of the 3-T MRI scanner to study the central processing of acute muscle pain induced by intramuscular electrostimulation. Brief nonpainful and painful stimuli (1-ms duration, interstimulus interval = 12 s) were randomly applied to the left abductor pollicis brevis of 10 subjects. The data disclose a pain matrix for muscle pain similar to that for cutaneous pain. Individual analysis suggests separate representations within the area bounded by the upper bank of the Sylvian fissure (SF) and the circular sulcus of insula (CSI). Nonpainful stimulation activated the superficial parietal operculum adjoining the SF, while the painful condition additionally targeted the deeper parietal operculum bordering the CSI. Randomization of stimuli of different intensities likely introduces cognitive components that engage neural substrates servicing the appreciation of stimulus salience in the context of affect-laden pain imposition.

Spatial summation of pain processing in the human brain as assessed by cerebral event related potentials

To understand spatial summation of pain processing in the brain, we investigated the cerebral evoked responses to non-painful and painful contact heat stimulation (70 degrees C/s fast onset; intensity 2,4,6, corresponding to the individual's non-, slight and moderate pain) comparing one (1s) vs. two spots (2s) in 11 subjects while electroencephalographic signals were recorded. Significant spatial summation effects were shown only for the pain levels. For moderate pain, global field power examination isolated two peak activations for the vertex (Cz) N550 and P750 components. The single dipole modelling identified as likely the supplementary motor area, SMA area-6 source for N550, and posterior cingulate area-23 for P750. These source components showed a significantly faster (41.2 ms) latency and a shift in location from dorsal to ventral SMA of N550 toward cingulate area-31 between the 1s and 2s conditions. The temporal and spatial shift during spatial summation may reflect speeding up of the limbic affective reaction and prefrontal cognitive preparation in impending aversion and is deemed essential for integration of bodily sensations, such as pain.