Augmented pain-evoked primary sensorimotor cortex activation in adolescent girls with juvenile fibromyalgia

Sex, Neural Networks, and Behavioral Symptoms Among Adolescents With Multisite Pain

Importance

Multisite pain disproportionately affects females starting in adolescence and is associated with central nervous system dysregulation. Understanding the heterogeneity of underlying neural networks and behavioral symptoms is essential.

Objective

To characterize sex-related resting-state neural networks and co-occurring symptoms, including sleep and behavioral problems, in youth with multisite pain.

Design, Setting, and Participants

This cross-sectional analysis leverages the 2-year follow-up data from the Adolescent Brain and Cognitive Development Study. A total of 684 youth aged 11 to 12 years with multisite pain were compared with 1368 youth with no pain or with regional pain, matched by pubertal status, handedness, and race and ethnicity. Data were collected from July 2018 to February 2021 and released October 2021. Data were analyzed from June 2023 to July 2024.

Exposure

Youth-reported number of painful regions during the last month classified into multisite (≥3), regional (1-2), and no pain groups.

Main Outcomes and Measures

Sex-stratified group iterative multiple model estimation was used for sparse network estimation of regions from the salience network (SLN), sensorimotor network (SMN), and default mode network (DMN). Individual within-network and between-network densities were calculated. Symptoms were behavioral problems and sleep disturbances. Sex-stratified differences in network densities and symptoms were examined between groups. Associations between brain networks and co-occurring symptoms were explored.

Results

Of 2052 participants (1044 [50.88%] female), mean (SD) pubertal status was 2.23 (0.65) and mean (SD) age was 12.02 (0.66) years; 25 (1.22%) were Asian, 149 (7.26%) were Black, 361 (17.59%) were Hispanic, 1307 (63.69%) were White, and 210 (10.23%) were other race or ethnicity. A total of 1646 participants (80.21%) were right-handed, 100 (4.87%) were left-handed, and 306 (14.91%) were ambidextrous. Multisite pain was associated with lower within-SMN connectivity in male (F2,1005 = 61.40; η2 = 0.11; false discovery rate [FDR] P < .001) and female (F2,1041 = 13.38; η2 = 0.03; FDR P < .001) participants and was associated with greater behavioral problems in male (F2,918 = 28.12; η2 = 0.04; FDR P < .001) and female (F2,945 = 9.12; η2 = 0.02; FDR P < .001) participants compared with the subgroup with no pain. Male participants with multisite pain had heightened DMN-SMN connectivity (F2,1005 = 3.55; η2 = 0.007; FDR P = .04). Female participants with multisite pain had heightened sleep disturbances (F2,1039 = 10.64; η2 = 0.02; FDR P = .002), partially explained by reduced within-SMN connectivity (indirect effect estimate, 0.15; 95% CI, 0.03-0.34).

Conclusions and Relevance

In this cross-sectional study of 2052 adolescents, sex-related neurophysiological mechanisms were associated with multisite pain. Brain connectivity partially explained the sleep-pain association in female participants only. On replication and evidence of persistence, these findings suggest that female adolescents with pain may especially benefit from interventions targeting sleep disturbances.

Localized electrocortical activity as a function of single-leg squat phases and its relationship to knee frontal plane stability

This study investigated differences in electroencephalography (EEG) activity within motor-related brain areas during three phases of a single-leg squat (SLS)-i.e., descending, holding, and ascending phases. Specifically, utilizing advanced magnetic resonance imaging guided EEG source localization techniques and markerless motion capture technology, we explored the interplay between concurrently recorded lower-extremity biomechanics and brain activity. Among the phases of a nondominant leg SLS, differences in contralateral brain activity (right hemisphere) were found in the activity of the precentral gyrus, the postcentral gyrus, and the sensory motor area. Alternatively, during the dominant SLS leg, differences among the three SLS phases in contralateral brain activity were fewer. Hemispheric dependent brain activity also significantly correlated with participants' knee valgus angle range of motion (right hemisphere) and peak knee valgus angles (left hemisphere). In addition to the novel brain and biomechanical findings, this study sheds light on the technical feasibility of recording EEG during complex multi-joint movements and its potential applications in understanding sensorimotor behavior.

Changes in brain structure and function during early aging in patients with chronic low back pain

Objective

To explore the structural and functional changes in cognition-related brain regions in patients with chronic low back pain (CLBP) at earlier ages, and explore the impact of the interaction between CLBP and age on the brain.

Methods

Seventy-six patients with CLBP were recruited and divided into "younger" age group (20-29 years, YA), "middle" age group (30-39 years, MA), and "older" age group (40-49 years, OA). All patients underwent functional magnetic resonance imaging (fMRI) as well as clinical psychological and pain-related symptoms assessments.

Results

Structural analysis showed that patients in OA group had lower gray matter (GM) volumes in the orbitofrontal cortex (OFC) bilaterally and the right superior frontal gyrus (SFG) compared to YA group. The resting-state brain activity analysis showed that amplitude of low-frequency fluctuation (ALFF) values in the bilateral postcentral gyrus and left ventral medial prefrontal cortex (mPFC) were significantly different in the OA group. The functional connectivity (FC) in the right ventral dorsolateral prefrontal cortex (DLPFC) and the right insula was significantly decreased in the OA group compared to the YA and MA groups. Likewise, the FC in the left caudal parahippocampal gyrus (PHG) and left inferior parietal lobule (IPL) were significantly lower in the MA and OA groups compared to the YA group. In addition, both the structural properties and the FC values of these brain regions were significantly correlated with age.

Conclusion

This preliminary study concludes that CLBP affects the aging process. The synergistic effects of CLBP and aging accelerate the functional and structural decline of certain areas of the brain, which not only affects pain processing, but are also may be associated with cognitive declines.

Reduced Cortico-Cortical Resting-State Connectivity in Sensory Systems Related to Bodily Pain in Juvenile Fibromyalgia

OBJECTIVE

Juvenile-onset fibromyalgia (JFM) is a paradigmatic chronic pain condition for which the underlying neurobiological substrates are poorly understood. This study examined, for the first time, data-driven resting-state functional connectivity (rsFC) alterations in 37 female adolescents with JFM compared with 43 healthy female adolescents and identified associations with bodily pain.

METHODS

Whole-brain voxel-wise rsFC alterations were assessed using the intrinsic connectivity contrast, a measure of node centrality at each voxel, and seed-based analyses for interpretability. We studied the relationship between rsFC alterations in somatosensory systems and the location and extension of bodily pain.

RESULTS

Adolescents with JFM had voxel-wise rsFC reductions in the paracentral lobule (PCL)/primary somatosensory cortex (S1) (T = 4.89, family-wise error corrected p-value (pFWE) < 0.001) and left midcingulate cortex (T = 4.67, pFWE = 0.043). Post hoc analyses revealed reduced rsFC spanning major cortical sensory hubs (T > 4.4, pFWE < 0.030). Cortico-cortical rsFC reductions within PCL/S1 in JFM occurred in locations innervated by bodily areas where the pain was most frequent (F = 3.15; positive false discovery rate = 0.029) and predicted widespread pain (T > 4.4, pFWE < 0.045). Conversely, adolescents with JFM had increases in PCL/S1-thalamus (T = 4.75, pFWE = 0.046) and PCL/S1-anterior insula rsFC (T = 5.13, pFWE = 0.039).

CONCLUSION

Reduced cortico-cortical sensory integration involving PCL/S1 and spanning the sensory systems may underly critical pain sensory features in youth with JFM. Reduced sensory integration is paralleled by augmented cross-talk between sensory and affective/salience-processing regions, potentially indicating a shift toward more affectively colored sensory experiences to the detriment of specific sensory discrimination.