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Martucci KT. Neuroimaging of opioid effects in humans across conditions of acute administration, chronic pain therapy, and opioid use disorder. Trends Neurosci 2024:S0166-2236(24)00063-8. [PMID: 38762362 DOI: 10.1016/j.tins.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
Evidence of central nervous system (CNS) exogenous opioid effects in humans has been primarily gained through neuroimaging of three participant populations: individuals after acute opioid administration, those with opioid use disorder (OUD), and those with chronic pain receiving opioid therapy. In both the brain and spinal cord, opioids alter processes of pain, cognition, and reward. Opioid-related CNS effects may persist and accumulate with longer opioid use duration. Meanwhile, opioid-induced benefits versus risks to brain health remain unclear. This review article highlights recent accumulating evidence for how exogenous opioids impact the CNS in humans. While investigation of CNS opioid effects has remained largely disparate across contexts of opioid acute administration, OUD, and chronic pain opioid therapy, integration across these contexts may enable advancement toward effective interventions.
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Affiliation(s)
- Katherine T Martucci
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA; Center for Translational Pain Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
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Roussin A, Cissé Z, Rousseau V, Roche G, Lestrade C, Cauchie A, Delage N, Donnet A, Van Obberghen E, Wood C, Lapeyre-Mestre M, Cantagrel N. Discordance between pain specialists and patients on the perception of dependence on pain medication: A multi-centre cross-sectional study. Therapie 2024:S0040-5957(24)00043-X. [PMID: 38653623 DOI: 10.1016/j.therap.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 04/25/2024]
Abstract
AIM Patients with chronic non-cancer pain are referred to pain centres to improve their pain treatment. The discontinuation of pain medications in case of poor efficacy can be difficult to accept for patients, particularly opioid analgesics. Previous research has described that from the patients' perspective, the psychological relief of a negative effect of chronic pain and withdrawal symptoms of prescription opioids represent drivers of persistent use and first stage of opioid use disorder, despite insufficient pain relief. There is no validated tool to investigate this psychological dependence. This study aimed to assess discordance between patients and pain specialists in their perception of dependence on pain medication and investigate associations with characteristics of patients, type of pain and iatrogenic pharmacodependence. METHODS Self-administered questionnaires (patients and physicians) were administered in six pain centres in France. A question on perceived dependence on pain medications was addressed to the patient and the physician in a matched pair. Discordance between them was evaluated by the Cohen kappa coefficient. Demographics, pain, anxiety and depression, pain medication withdrawal symptoms, diverted use, and craving represented variables studied in a multivariate model as potentially associated with patient-physician discordance. RESULTS According to the 212 pairs of completed questionnaires, a perceived dependence was reported by the majority of patients (65.6%) and physicians (68.4%). However, the concordance was fair (kappa=0.38; CI [95%]: 0.25-0.51). Almost all patients (89.3%) were treated with an opioid analgesic. A higher likelihood of discordance was observed when patients suffered from nociplastic pain (odds ratio [OR]: 2.72, 95% [CI]: 1.29-5.84). CONCLUSION Medical shared-decision for changing pain treatment could be improved by taking into account the perception of patient dependence on medications for pain relief and or psychoactive effects, particularly in nociplastic pain for which the treatment is challenging.
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Affiliation(s)
- Anne Roussin
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France.
| | - Zénab Cissé
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Vanessa Rousseau
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Guillaume Roche
- Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
| | - Alexandre Cauchie
- Centre d'évaluation et de traitement de la douleur, pôle neurosciences cliniques, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Timone Hospital, 13005 Marseille, France
| | - Elise Van Obberghen
- Pain Department, CHU de Nice, France - FHU InovPain, université Côte d'Azur, 06000 Nice, France; Department of Pharmacology and Toxicology, PharmacoVigilance Centre, University of Nice Medical Centre, 06000 Nice, France
| | - Chantal Wood
- Centre d'évaluation et de traitement de la douleur, Limoges University Hospital, 87042 Limoges, France
| | - Maryse Lapeyre-Mestre
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
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Park SH, Michael AM, Baker AK, Lei C, Martucci KT. Enhanced motor network engagement during reward gain anticipation in fibromyalgia. Cortex 2024; 173:161-174. [PMID: 38417389 PMCID: PMC10963137 DOI: 10.1016/j.cortex.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 03/01/2024]
Abstract
Reward motivation is essential in shaping human behavior and cognition. Both reward motivation and reward brain circuits are altered in chronic pain conditions, including fibromyalgia. In this study of fibromyalgia patients, we used a data-driven independent component analysis (ICA) approach to investigate how brain networks contribute to altered reward processing. From females with fibromyalgia (N = 24) and female healthy controls (N = 24), we acquired fMRI data while participants performed a monetary incentive delay (MID) reward task. After analyzing the task-based fMRI data using ICA to identify networks, we analyzed 3 networks of interest: motor network (left), value-driven attention network, and basal ganglia network. Then, we evaluated correlation coefficients between each network timecourse versus a task-based timecourse which modeled gain anticipation. Compared to controls, the fibromyalgia cohort demonstrated significantly stronger correlation between the left motor network timecourse and the gain anticipation timecourse, indicating the left motor network was more engaged with gain anticipation in fibromyalgia. In an exploratory analysis, we compared motor network engagement during early versus late phases of gain anticipation. Across cohorts, greater motor network engagement (i.e., stronger correlation between network and gain anticipation) occurred during the late timepoint, which reflected enhanced motor preparation immediately prior to response. Consistent with the main results, patients exhibited greater engagement of the motor network during both early and late phases compared with healthy controls. Visual-attention and basal ganglia networks revealed similar engagement in the task across groups. As indicated by post-hoc analyses, motor network engagement was positively related to anxiety and negatively related to reward responsiveness. In summary, we identified enhanced reward-task related engagement of the motor network in fibromyalgia using a novel data-driven ICA approach. Enhanced motor network engagement in fibromyalgia may relate to impaired reward motivation, heightened anxiety, and possibly to altered motor processing, such as restricted movement or dysregulated motor planning.
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Affiliation(s)
- Su Hyoun Park
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA; Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Andrew M Michael
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Anne K Baker
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA; Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carina Lei
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA; Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Katherine T Martucci
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA; Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
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Elyn A, Roussin A, Lestrade C, Franchitto N, Jullian B, Cantagrel N. Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study. Reg Anesth Pain Med 2024:rapm-2023-105035. [PMID: 38499357 DOI: 10.1136/rapm-2023-105035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Long-term opioid use is associated with pharmacological tolerance, a risk of misuse and hyperalgesia in patients with chronic pain (CP). Tapering is challenging in this context, particularly with comorbid opioid-use disorder (OUD). The antihyperalgesic effect of ketamine, through N-methyl-D-aspartate (NMDA) antagonism, could be useful. We aimed to describe the changes in the dose of opioids consumed over 1 year after a 5-day hospitalisation with ketamine infusion for CP patients with OUD. METHODS We performed a historical cohort study using a medical chart from 1 January 2014 to 31 December 2019. Patients were long-term opioid users with OUD and CP, followed by the Pain Center of the University Hospital of Toulouse, for which outpatient progressive tapering failed. Ketamine was administered at a low dose to initiate tapering during a 5-day hospitalisation. RESULTS 59 patients were included, with 64% of them female and a mean age of 48±10 years old. The most frequent CP aetiologies were back pain (53%) and fibromyalgia (17%). The baseline opioid daily dose was 207 mg (±128) morphine milligram equivalent (MME). It was lowered to 92±72 mg MME at discharge (p<0.001), 99±77 mg at 3 months (p<0.001) and 103±106 mg at 12 months. More than 50% tapering was achieved immediately for 40 patients (68%), with immediate cessation for seven patients (12%). 17 patients were lost to follow-up. CONCLUSIONS A 5-day hospitalisation with a low-dose ketamine infusion appeared useful to facilitate opioid tapering in long-term opioid users with CP and OUD. Ketamine was well tolerated, and patients did not present significant withdrawal symptoms. Prospective and comparative studies are needed to confirm our findings.
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Affiliation(s)
- Antoine Elyn
- Chronic Pain Center, University Hospital of Toulouse, Toulouse, France
- General and Family Medicine University Department, University of Toulouse III - Paul Sabatier, Toulouse, France
- RECaP F-CRIN - Réseau national de Recherche en Épidémiologie Clinique et en Santé Publique, Inserm, Toulouse, France
| | - Anne Roussin
- Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
- INSERM UMR1295, Pharmaco-épidémiologie, University of Toulouse III - Paul Sabatier, Toulouse, France
- University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France
| | - Cécile Lestrade
- Chronic Pain Center, University Hospital of Toulouse, Toulouse, France
| | - Nicolas Franchitto
- University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France
- Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France
- INSERM UMR1295, EQUITY "Embodiment, social inequalities, lifecourse epidemiology, cancer and chronic diseases, interventions, methodology", University of Toulouse III - Paul Sabatier, Toulouse, France
| | - Bénédicte Jullian
- Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France
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Park SH, Michael AM, Baker AK, Lei C, Martucci KT. Altered Functional Networks during Gain Anticipation in Fibromyalgia. medRxiv 2023:2023.04.28.23289290. [PMID: 37163010 PMCID: PMC10168512 DOI: 10.1101/2023.04.28.23289290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Reward motivation is essential in shaping human behavior and cognition. Previous studies have shown altered reward motivation and reward brain circuitry in chronic pain conditions, including fibromyalgia. Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, cognitive problems, and mood-related symptoms. In this study, we analyzed brain reward networks in patients with fibromyalgia by using a data-driven approach with task-based fMRI data. fMRI data from 24 patients with fibromyalgia and 24 healthy controls were acquired while subjects performed a monetary incentive delay (MID) reward task. Functional networks were derived using independent component analysis (ICA) focused on the gain anticipation phase of the reward task. Functional activity in the motor, value-driven attention, and basal ganglia networks was evaluated during gain anticipation in both patient and healthy control groups. Compared to controls, the motor network was more engaged during gain anticipation in patients with fibromyalgia. Our findings suggest that reward motivation may lead to hyperactivity in the motor network, possibly related to altered motor processing, such as restricted movement or dysregulated motor planning in fibromyalgia. As an exploratory analysis, we compared levels of motor network engagement during early and late timepoints of the gain anticipation phase. Both groups showed greater motor network engagement during the late timepoint (i.e., closer to response), which reflected motor preparation prior to target response. Importantly, compared to controls and consistent with the initial findings described above, patients exhibited greater engagement of the motor network during both early and late timepoints. In summary, by using a novel data-driven ICA approach to analyze task-based fMRI data, we identified elevated motor network engagement during gain anticipation in fibromyalgia.
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Affiliation(s)
- Su Hyoun Park
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Anne K. Baker
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carina Lei
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Katherine T. Martucci
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
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Park SH, Deng EZ, Baker AK, MacNiven KH, Knutson B, Martucci KT. Replication of neural responses to monetary incentives and exploration of reward-influenced network connectivity in fibromyalgia. Neuroimage Rep 2022; 2:100147. [PMID: 36618964 PMCID: PMC9815752 DOI: 10.1016/j.ynirp.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuroimaging research has begun to implicate alterations of brain reward systems in chronic pain. Previously, using functional magnetic resonance imaging (fMRI) and a monetary incentive delay (MID) task, Martucci et al. (2018) showed that neural responses to reward anticipation and outcome are altered in fibromyalgia. In the present study, we aimed to test the replicability of these altered neural responses to reward in a separate fibromyalgia cohort. In addition, the present study was conducted at a distinct U.S. location but involved a similar study design. For the present study, 20 patients with fibromyalgia and 20 healthy controls participated in MID task fMRI scan procedures and completed clinical/psychological questionnaires. fMRI analyses comparing patient and control groups revealed a consistent trend of main results which were largely similar to the prior reported results. Specifically, in the replication fibromyalgia cohort, medial prefrontal cortex (MPFC) response was reduced during gain anticipation and was increased during no-loss (non-punishment) outcome compared to controls. Also consistent with previous findings, the nucleus accumbens response to gain anticipation did not differ in patients vs. controls. Further, results from similarly-designed behavioral, correlational, and exploratory analyses were complementary to previous findings. Finally, a novel network-based functional connectivity analysis of the MID task fMRI data across patients vs. controls implied enhanced connectivity within the default mode network in participants with fibromyalgia. Together, based on replicating prior univariate results and new network-based functional connectivity analyses of MID task fMRI data, we provide further evidence of altered brain reward responses, particularly in the MPFC response to reward outcomes, in patients with fibromyalgia.
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Affiliation(s)
- Su Hyoun Park
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA,Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Eden Z. Deng
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA,Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anne K. Baker
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA,Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kelly H. MacNiven
- Department of Psychology, Symbiotic Project on Affective Neuroscience Laboratory, Stanford University, Stanford, CA, USA
| | - Brian Knutson
- Department of Psychology, Symbiotic Project on Affective Neuroscience Laboratory, Stanford University, Stanford, CA, USA
| | - Katherine T. Martucci
- Department of Anesthesiology, Human Affect and Pain Neuroscience Laboratory, Duke University School of Medicine, Durham, NC, USA,Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA,Corresponding author. Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC 27710 USA., (K.T. Martucci)
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Abdelsamad R, Al Disi Z, Abu-Dieyeh M, Al-Ghouti MA, Zouari N. Evidencing the role of carbonic anhydrase in the formation of carbonate minerals by bacterial strains isolated from extreme environments in Qatar. Heliyon 2022; 8:e11151. [PMID: 36311368 PMCID: PMC9614864 DOI: 10.1016/j.heliyon.2022.e11151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 01/01/2022] [Indexed: 11/05/2022] Open
Abstract
Calcium carbonate, one of the most abundant minerals in the geological records is considered as primary source of the carbon reservoir. The role of microorganisms in the biotic precipitation of calcium carbonate has been extensively investigated, especially at extreme life conditions. In Qatar, Sabkhas which are microbial ecosystems housing biomineralizing bacteria, have been carefully studied as unique sites of microbial dolomite formation. Dolomite (CaMg(CO3)2 is an important carbonate mineral forming oil reservoir rocks; however, dolomite is rarely formed in modern environments. The enzyme carbonic anhydrase is present in many living organisms, performs interconversion between CO2 and the bicarbonate ion. Thus, carbonic anhydrase is expected to accelerate both carbonate rock dissolution and CO2 uptake at the same time, serving as carbonite source to carbonites-forming bacteria. This study gathered cross-linked data on the potential role of the carbonic anhydrase excreted by mineral-forming bacteria, isolated from two different extreme environments in Qatar. Dohat Faishakh Sabkha, is a hypersaline coastal Sabkha, from where various strains of the bacterium Virgibacillus were isolated. Virgibacillus can -not only-mediate carbonate mineral formation, but also contributes to magnesium incorporation into the carbonate minerals, leading to the formation of high magnesium calcite. The latter is considered as precursor for dolomite formation. In addition, bacterial strains isolated from marine sediments, surrounding coral reef in Qatar sea, would provide additional knowledge on the role of carbonic anhydrase in mineral formation. Here, the quantification of the two mostly described activities of carbonic anhydrase; esterase and hydration reactions were performed. Mineral-forming strains were shown to exhibit high activities as opposed to the non-forming minerals, which confirms the relation between the presence of active carbonic anhydrase combined with elevated metabolic activity and the biomineralizing potential of the bacterial strains. The highest specific intracellular carbonic anhydrase activity; as both esterase and hydration (i.e., 66 ± 3 and 583000 ± 39000 WAU/108 cells respectively), was evidenced in mineral-forming strains as opposed to non-mineral forming strains (i.e., 6 ±. 0.5 and 1223 ± 61 WAU/108cells) respectively. These findings would contribute to the understanding of the mechanism of microbially mediated carbonate precipitation. This role may be both in capturing CO2 as source of carbonate, and partial solubilization of the formed minerals allowing incorporation of Mg instead of calcium, before catalyzing again the formation of more deposition of carbonates.
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Deng EZ, Weikel DP, Martucci KT. Evaluation by Survival Analysis of Cold Pain Tolerance in Patients with Fibromyalgia and Opioid Use. J Pain Res 2022; 15:2783-2799. [PMID: 36111289 PMCID: PMC9470281 DOI: 10.2147/jpr.s368805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The cold pressor test (CPT) is a clinical pain research method used to measure cold pain tolerance. During this test, participants immerse an extremity (ie, hand or foot) into cold water for as long as tolerable. The duration of the test (traditionally up to an experimentally imposed cut-off at 2 minutes) indicates the amount of cold pain tolerance by the participant. Prior research studies have investigated cold pain tolerance in patients with chronic pain. However, few of these studies have used survival analysis, which allows for proper handling of data censoring and is therefore, an optimal statistical method for CPT data analysis. The goal of the present study was to use survival analysis to evaluate cold pain tolerance in patients with fibromyalgia. Furthermore, we aimed to model relationships between psychological and clinical variables as well as opioid medication use and cold pain tolerance. Patients and Methods A total of 85 patients with fibromyalgia (42 who were taking opioids) and 47 healthy pain-free controls provided CPT and questionnaire data (collected across 2 study sites) for a case-control study. We used survival analysis using Cox regression to evaluate group differences (patients vs controls) in cold pain tolerance and to evaluate cold pain tolerance relationships with psychological, clinical, and medication use. Results As compared to healthy controls, patients with fibromyalgia exhibited significantly lower CPT survival (HR = 2.17, 95% CI: [1.42, 3.31], p = 0.00035). As indicated by Cox regression models, the significant group difference in CPT survival did not relate to our selected psychological and clinical measures (p > 0.05). The groups of non-opioid-taking patients and healthy controls showed consistent CPT survival across study sites. However, patients taking opioid pain medications showed differences in CPT survival across study sites. Conclusion By using survival analysis, an optimal method for time-to-event pain measures such as the CPT, we confirmed previously identified reductions in cold pain tolerance in patients with fibromyalgia. While our selected psychological and clinical measures were not significantly associated with cold pain tolerance, our data suggest that opioid medication use may impart greater cold pain tolerance in some patients.
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Affiliation(s)
- Eden Z Deng
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Daniel P Weikel
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Katherine T Martucci
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, USA
- Biostatistics Group, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
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Park SH, Baker AK, Krishna V, Mackey SC, Martucci KT. Altered resting-state functional connectivity within corticostriatal and subcortical-striatal circuits in chronic pain. Sci Rep 2022; 12:12683. [PMID: 35879602 PMCID: PMC9314446 DOI: 10.1038/s41598-022-16835-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
Brain corticostriatal circuits are important for understanding chronic pain and highly relevant to motivation and cognitive processes. It has been demonstrated that in patients with chronic back pain, altered nucleus accumbens (NAcc)-medial prefrontal cortex (MPFC) circuit fMRI-based activity is predictive of patient outcome. We evaluated the NAcc-MPFC circuit in patients with another chronic pain condition, fibromyalgia, to extend these important findings. First, we compared fMRI-based NAcc-MPFC resting-state functional connectivity in patients with fibromyalgia (N = 32) vs. healthy controls (N = 37). Compared to controls, the NAcc-MPFC circuit's connectivity was significantly reduced in fibromyalgia. In addition, within the fibromyalgia group, NAcc-MPFC connectivity was significantly correlated with trait anxiety. Our expanded connectivity analysis of the NAcc to subcortical brain regions showed reduced connectivity of the right NAcc with mesolimbic circuit regions (putamen, thalamus, and ventral pallidum) in fibromyalgia. Lastly, in an exploratory analysis comparing our fibromyalgia and healthy control cohorts to a separate publicly available dataset from patients with chronic back pain, we identified reduced NAcc-MPFC connectivity across both the patient groups with unique alterations in NAcc-mesolimbic connectivity. Together, expanding upon prior observed alterations in brain corticostriatal circuits, our results provide novel evidence of altered corticostriatal and mesolimbic circuits in chronic pain.
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Affiliation(s)
- Su Hyoun Park
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Anne K Baker
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Vinit Krishna
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
- Duke Center for Translational Pain Medicine, Durham, USA
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Katherine T Martucci
- Department of Anesthesiology, Duke University Medical Center, Durham, USA.
- Duke Center for Translational Pain Medicine, Durham, USA.
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Box DUMC 3094, Durham, NC, 27710, USA.
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Baker AK, Ericksen LC, Koppelmans V, Mickey BJ, Martucci KT, Zubieta JK, Love TM. Altered Reward Processing and Sex Differences in Chronic Pain. Front Neurosci 2022; 16:889849. [PMID: 35747210 PMCID: PMC9211769 DOI: 10.3389/fnins.2022.889849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic pain and reward processing are understood to be reciprocally related to one another. Previous studies of reward processing in chronic pain patients have reported incongruent findings. While several factors likely contribute to these disparate findings, these previous studies did not stratify their analyses by sex-a factor previously shown to robustly impact reward-related responses. Thus, we examined sex as a factor of interest in level of striatal activation during anticipation of monetary incentives among patients with chronic non-specific back pain and healthy controls (HC). This study utilized functional magnetic resonance imaging during a monetary incentive delay task to evaluate reward and loss responsivity in the striatum among males and females with and without chronic pain (N = 90). Group, sex, and group-by-sex interactions were analyzed via repeated measures analysis of variance. Among HC, males exhibited significantly greater blood oxygen level dependent (BOLD) signal in the striatum during reward anticipation, particularly during large reward trials. By contrast, no significant sex differences were observed among patients. A significant group-by-sex interaction was also observed, revealing diminished BOLD responses among males with chronic pain relative to control males. These results provide novel evidence of sex-specific reductions in anticipatory responses to reward in patients with chronic pain. Altered striatal reward responsivity among males, but not females, suggests that the reward systems of males and females are uniquely disrupted by chronic pain, and highlights the value of including sex as a factor of interest in future studies of reward responsivity in the context of persistent pain.
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Affiliation(s)
- Anne K. Baker
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
| | - Lauren C. Ericksen
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
| | - Vincent Koppelmans
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
| | - Brian J. Mickey
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Katherine T. Martucci
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, Northwell Health, John T. Mather Memorial Hospital, Port Jefferson, NY, United States
| | - Tiffany M. Love
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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11
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López-Solà M, Pujol J, Monfort J, Deus J, Blanco-Hinojo L, Harrison BJ, Wager TD. The neurologic pain signature responds to nonsteroidal anti-inflammatory treatment vs placebo in knee osteoarthritis. Pain Rep 2022; 7:e986. [PMID: 35187380 PMCID: PMC8853614 DOI: 10.1097/pr9.0000000000000986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. fMRI-based measures, validated for nociceptive pain, respond to acute osteoarthritis pain, are not sensitive to placebo, and are mild-to-moderately sensitive to naproxen. Introduction: Many drug trials for chronic pain fail because of high placebo response rates in primary endpoints. Neurophysiological measures can help identify pain-linked pathophysiology and treatment mechanisms. They can also help guide early stop/go decisions, particularly if they respond to verum treatment but not placebo. The neurologic pain signature (NPS), an fMRI-based measure that tracks evoked pain in 40 published samples and is insensitive to placebo in healthy adults, provides a potentially useful neurophysiological measure linked to nociceptive pain. Objectives: This study aims to validate the NPS in knee osteoarthritis (OA) patients and test the effects of naproxen on this signature. Methods: In 2 studies (50 patients, 64.6 years, 75% females), we (1) test the NPS and other control signatures related to negative emotion in knee OA pain patients; (2) test the effect of placebo treatments; and (3) test the effect of naproxen, a routinely prescribed nonsteroidal anti-inflammatory drug in OA. Results: The NPS was activated during knee pain in OA (d = 1.51, P < 0.001) and did not respond to placebo (d = 0.12, P = 0.23). A single dose of naproxen reduced NPS responses (vs placebo, NPS d = 0.34, P = 0.03 and pronociceptive NPS component d = 0.38, P = 0.02). Naproxen effects were specific for the NPS and did not appear in other control signatures. Conclusion: This study provides preliminary evidence that fMRI-based measures, validated for nociceptive pain, respond to acute OA pain, do not appear sensitive to placebo, and are mild-to-moderately sensitive to naproxen.
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Affiliation(s)
- Marina López-Solà
- Department of Medicine, School of Medicine and Health Sciences, Serra Hunter Faculty Program, University of Barcelona, Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Jordi Monfort
- Rheumatology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Ben J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Dartmouth, MA, USA
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12
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Martucci KT, Weber KA, Mackey SC. Spinal Cord Resting State Activity in Individuals With Fibromyalgia Who Take Opioids. Front Neurol 2021; 12:694271. [PMID: 34421798 PMCID: PMC8371264 DOI: 10.3389/fneur.2021.694271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic pain coincides with myriad functional alterations throughout the brain and spinal cord. While spinal cord mechanisms of chronic pain have been extensively characterized in animal models and in vitro, to date, research in patients with chronic pain has focused only very minimally on the spinal cord. Previously, spinal cord functional magnetic resonance imaging (fMRI) identified regional alterations in spinal cord activity in patients (who were not taking opioids) with fibromyalgia, a chronic pain condition. Here, in patients with fibromyalgia who take opioids (N = 15), we compared spinal cord resting-state fMRI data vs. patients with fibromyalgia not taking opioids (N = 15) and healthy controls (N = 14). We hypothesized that the opioid (vs. non-opioid) patient group would show greater regional alterations in spinal cord activity (i.e., the amplitude of low frequency fluctuations or ALFF, a measure of regional spinal cord activity). However, we found that regional spinal cord activity in the opioid group was more similar to healthy controls, while regional spinal cord activity in the non-opioid group showed more pronounced differences (i.e., ventral increases and dorsal decreases in regional ALFF) vs. healthy controls. Across patient groups, self-reported fatigue correlated with regional differences in spinal cord activity. Additionally, spinal cord functional connectivity and graph metrics did not differ among groups. Our findings suggest that, contrary to our main hypothesis, patients with fibromyalgia who take opioids do not have greater alterations in regional spinal cord activity. Thus, regional spinal cord activity may be less imbalanced in patients taking opioids compared to patients not taking opioids.
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Affiliation(s)
- Katherine T. Martucci
- Human Affect and Pain Neuroscience Laboratory, Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Kenneth A. Weber
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Sean C. Mackey
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
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13
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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14
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Murray K, Lin Y, Makary MM, Whang PG, Geha P. Brain Structure and Function of Chronic Low Back Pain Patients on Long-Term Opioid Analgesic Treatment: A Preliminary Study. Mol Pain 2021; 17:1744806921990938. [PMID: 33567986 PMCID: PMC7883154 DOI: 10.1177/1744806921990938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic low back pain (CLBP) is often treated with opioid analgesics (OA), a class of medications associated with a significant risk of misuse. However, little is known about how treatment with OA affect the brain in chronic pain patients. Gaining this knowledge is a necessary first step towards understanding OA associated analgesia and elucidating long-term risk of OA misuse. Here we study CLBP patients chronically medicated with opioids without any evidence of misuse and compare them to CLBP patients not on opioids and to healthy controls using structural and functional brain imaging. CLBP patients medicated with OA showed loss of volume in the nucleus accumbens and thalamus, and an overall significant decrease in signal to noise ratio in their sub-cortical areas. Power spectral density analysis (PSD) of frequency content in the accumbens’ resting state activity revealed that both medicated and unmedicated patients showed loss of PSD within the slow-5 frequency band (0.01–0.027 Hz) while only CLBP patients on OA showed additional density loss within the slow-4 frequency band (0.027–0.073 Hz). We conclude that chronic treatment with OA is associated with altered brain structure and function within sensory limbic areas.
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Affiliation(s)
- Kyle Murray
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | - Yezhe Lin
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Meena M Makary
- The John B. Pierce Laboratory, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, Egypt
| | - Peter G Whang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Paul Geha
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.,The John B. Pierce Laboratory, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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