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Nichols SJ, Yanes JA, Reid MA, Robinson JL. 7 T characterization of excitatory and inhibitory systems of acute pain in healthy female participants. NMR IN BIOMEDICINE 2024; 37:e5088. [PMID: 38140895 DOI: 10.1002/nbm.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Current understanding of the physiological underpinnings of normative pain processing is incomplete. Enhanced knowledge of these systems is necessary to advance our understanding of pain processes as well as to develop effective therapeutic interventions. Previous neuroimaging research suggests a network of interrelated brain regions that seem to be implicated in the processing and experience of pain. Among these, the dorsal anterior cingulate cortex (dACC) plays an important role in the affective aspects of pain signals. The current study leveraged functional MRS to investigate the underlying dynamic shifts in the neurometabolic signature of the human dACC at rest and during acute pain. Results provide support for increased glutamate levels following acute pain administration. Specifically, a 4.6% increase in glutamate was observed during moderate pressure pain compared with baseline. Exploratory analysis also revealed meaningful changes in dACC gamma aminobutyric acid in response to pain stimulation. These data contribute toward the characterization of neurometabolic shifts, which lend insight into the role of the dACC in the pain network. Further research in this area with larger sample sizes could contribute to the development of novel therapeutics or other advances in pain-related outcomes.
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Affiliation(s)
- Steven J Nichols
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Julio A Yanes
- Exponent Inc., Washington, District of Columbia, USA
| | - Meredith A Reid
- Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama, USA
| | - Jennifer L Robinson
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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2
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Zhang LB, Lu XJ, Huang G, Zhang HJ, Tu YH, Kong YZ, Hu L. Selective and replicable neuroimaging-based indicators of pain discriminability. Cell Rep Med 2022; 3:100846. [PMID: 36473465 PMCID: PMC9798031 DOI: 10.1016/j.xcrm.2022.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/18/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Neural indicators of pain discriminability have far-reaching theoretical and clinical implications but have been largely overlooked previously. Here, to directly identify the neural basis of pain discriminability, we apply signal detection theory to three EEG (Datasets 1-3, total N = 366) and two fMRI (Datasets 4-5, total N = 399) datasets where participants receive transient stimuli of four sensory modalities (pain, touch, audition, and vision) and two intensities (high and low) and report perceptual ratings. Datasets 1 and 4 are used for exploration and others for validation. We find that most pain-evoked EEG and fMRI brain responses robustly encode pain discriminability, which is well replicated in validation datasets. The neural indicators are also pain selective since they cannot track tactile, auditory, or visual discriminability, even though perceptual ratings and sensory discriminability are well matched between modalities. Overall, we provide compelling evidence that pain-evoked brain responses can serve as replicable and selective neural indicators of pain discriminability.
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Affiliation(s)
- Li-Bo Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xue-Jing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Gan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen 518060, China
| | - Hui-Juan Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yi-Heng Tu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ya-Zhuo Kong
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China,CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China,Corresponding author
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3
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Zhou YP, Sun Y, Takahashi K, Belov V, Andrews N, Woolf CJ, Brugarolas P. Development of a PET radioligand for α2δ-1 subunit of calcium channels for imaging neuropathic pain. Eur J Med Chem 2022; 242:114688. [PMID: 36031695 PMCID: PMC9623503 DOI: 10.1016/j.ejmech.2022.114688] [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: 04/28/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
Neuropathic pain affects 7-10% of the adult population. Being able to accurately monitor biological changes underlying neuropathic pain will improve our understanding of neuropathic pain mechanisms and facilitate the development of novel therapeutics. Positron emission tomography (PET) is a noninvasive molecular imaging technique that can provide quantitative information of biochemical changes at the whole-body level by using radiolabeled ligands. One important biological change underlying the development of neuropathic pain is the overexpression of α2δ-1 subunit of voltage-dependent calcium channels (the target of gabapentin). Thus, we hypothesized that a radiolabeled form of gabapentin may allow imaging changes in α2δ-1 for monitoring the underlying pathophysiology of neuropathic pain. Here, we report the development of two 18F-labeled derivatives of gabapentin (trans-4-[18F]fluorogabapentin and cis-4-[18F]fluorogabapentin) and their evaluation in healthy rats and a rat model of neuropathic pain (spinal nerve ligation model). Both isomers were found to selectively bind to the α2δ-1 receptor with trans-4-[18F]fluorogabapentin having higher affinity. Both tracers displayed around 1.5- to 2-fold increased uptake in injured nerves over the contralateral uninjured nerves when measured by gamma counting ex vivo. Although the small size of the nerves and the signal from surrounding muscle prevented visualizing these changes using PET, this work demonstrates that fluorinated derivatives of gabapentin retain binding to α2δ-1 and that their radiolabeled forms can be used to detect pathological changes in vitro and ex vivo. Furthermore, this work confirms that α2δ-1 is a promising target for imaging specific features of neuropathic pain.
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Affiliation(s)
- Yu-Peng Zhou
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yang Sun
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kazue Takahashi
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vasily Belov
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nick Andrews
- F.M. Kirby Neurobiology Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Clifford J Woolf
- F.M. Kirby Neurobiology Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedro Brugarolas
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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4
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Abstract
Pain is an unpleasant sensory and emotional experience. Understanding the neural mechanisms of acute and chronic pain and the brain changes affecting pain factors is important for finding pain treatment methods. The emergence and progress of non-invasive neuroimaging technology can help us better understand pain at the neural level. Recent developments in identifying brain-based biomarkers of pain through advances in advanced imaging can provide some foundations for predicting and detecting pain. For example, a neurologic pain signature (involving brain regions that receive nociceptive afferents) and a stimulus intensity-independent pain signature (involving brain regions that do not show increased activity in proportion to noxious stimulus intensity) were developed based on multivariate modeling to identify processes related to the pain experience. However, an accurate and comprehensive review of common neuroimaging techniques for evaluating pain is lacking. This paper reviews the mechanism, clinical application, reliability, strengths, and limitations of common neuroimaging techniques for assessing pain to promote our further understanding of pain.
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Affiliation(s)
- Jing Luo
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hui-Qi Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Bo Gou
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China.
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
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5
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Bertels Z, Mangutov E, Conway C, Siegersma K, Asif S, Shah P, Huck N, Tawfik VL, Pradhan AA. Migraine and peripheral pain models show differential alterations in neuronal complexity. Headache 2022; 62:780-791. [PMID: 35676889 PMCID: PMC9543775 DOI: 10.1111/head.14352] [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: 05/12/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
Objective Our laboratory has recently shown that there is a decrease in neuronal complexity in head pain processing regions in mouse models of chronic migraine‐associated pain and aura. Importantly, restoration of this neuronal complexity corresponds with anti‐migraine effects of known and experimental pharmacotherapies. The objective of the current study was to expand this work and examine other brain regions involved with pain or emotional processing. We also investigated the generalizability of our findings by analyzing neuronal cytoarchitectural changes in a model of complex regional pain syndrome (CRPS), a peripheral pain disorder. Methods We used the nitroglycerin (NTG) model of chronic migraine‐associated pain in which mice receive 10 mg/kg NTG every other day for 9 days. Cortical spreading depression (CSD), a physiological corelate of migraine aura, was evoked in anesthetized mice using KCl. CRPS was induced by tibial fracture followed by casting. Neuronal cytoarchitecture was visualized with Golgi stain and analyzed with Simple Neurite Tracer. Results In the NTG model, we previously showed decreased neuronal complexity in the trigeminal nucleus caudalis (TNC) and periaqueductal gray (PAG). In contrast, we found increased neuronal complexity in the thalamus and no change in the amygdala or caudate putamen in this study. Following CSD, we observed decreased neuronal complexity in the PAG, in line with decreases in the somatosensory cortex and TNC reported with this model previously. In the CRPS model there was decreased neuronal complexity in the hippocampus, as reported by others; increased complexity in the PAG; and no change within the somatosensory cortex. Conclusions Collectively these results demonstrate that alterations in neuronal complexity are a feature of both chronic migraine and chronic CRPS. However, each type of pain presents a unique cytoarchitectural signature, which may provide insight on how these pain states differentially transition from acute to chronic conditions.
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Affiliation(s)
- Zachariah Bertels
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Elizaveta Mangutov
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Catherine Conway
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Kendra Siegersma
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Sarah Asif
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Pal Shah
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
| | - Nolan Huck
- Department of Anesthesiology, Perioperative & Pain Medicine Stanford University Stanford California USA
| | - Vivianne L. Tawfik
- Department of Anesthesiology, Perioperative & Pain Medicine Stanford University Stanford California USA
| | - Amynah A. Pradhan
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois USA
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6
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Gui SG, Chen RB, Zhong YL, Huang X. Machine Learning Analysis Reveals Abnormal Static and Dynamic Low-Frequency Oscillations Indicative of Long-Term Menstrual Pain in Primary Dysmenorrhea Patients. J Pain Res 2021; 14:3377-3386. [PMID: 34737632 PMCID: PMC8558045 DOI: 10.2147/jpr.s332224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous neuroimaging studies demonstrated that patients with primary dysmenorrhea (PD) exhibited dysfunctional resting-state brain activity. However, alterations of dynamic brain activity in PD patients have not been fully characterized. PURPOSE Our study aimed to assess the effect of long-term menstrual pain on changes in static and dynamic neural activity in PD patients. MATERIAL AND METHODS Twenty-eight PD patients and 28 healthy controls (HCs) underwent resting-state magnetic resonance imaging scans. The amplitude of low-frequency fluctuations (ALFF) and dynamic ALFF was used as classification features in a machine learning approach involving a support vector machine (SVM) classifier. RESULTS Compared with the HC group, PD patients showed significantly increased ALFF values in the right cerebellum_crus2, right rectus, left supplementary motor area, right superior frontal gyrus, right supplementary motor area, and left superior frontal medial gyrus. Additionally, PD patients showed significantly decreased ALFF values in the right middle temporal gyrus and left thalamus. PD patients also showed significantly increased dALFF values in the right fusiform, Vermis_10, right middle temporal gyrus, right putamen, right insula, left thalamus, right precentral gyrus, and right postcentral gyrus. Based on ALFF and dALFF values, the SVM classifier achieved respective overall accuracies of 96.36% and 85.45% and respective areas under the curve of 1.0 and 0.95. CONCLUSION PD patients demonstrated abnormal static and dynamic brain activities that involved the default mode network, sensorimotor network, and pain-related subcortical nuclei. Moreover, ALFF and dALFF may offer sensitive biomarkers for distinguishing patients with PD from HCs.
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Affiliation(s)
- Shao-Gao Gui
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
- Department of Radiology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Ri-Bo Chen
- Department of Radiology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Yu-Lin Zhong
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
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7
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Role of the Anterior Cingulate Cortex in Translational Pain Research. Neurosci Bull 2021; 37:405-422. [PMID: 33566301 DOI: 10.1007/s12264-020-00615-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
As the most common symptomatic reason to seek medical consultation, pain is a complex experience that has been classified into different categories and stages. In pain processing, noxious stimuli may activate the anterior cingulate cortex (ACC). But the function of ACC in the different pain conditions is not well discussed. In this review, we elaborate the commonalities and differences from accumulated evidence by a variety of pain assays for physiological pain and pathological pain including inflammatory pain, neuropathic pain, and cancer pain in the ACC, and discuss the cellular receptors and signaling molecules from animal studies. We further summarize the ACC as a new central neuromodulation target for invasive and non-invasive stimulation techniques in clinical pain management. The comprehensive understanding of pain processing in the ACC may lead to bridging the gap in translational research between basic and clinical studies and to develop new therapies.
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8
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Hua K, Wang P, Lan Z, Li M, Zhao W, Wang T, Li S, Ma X, Li C, Fu S, Yin Y, Liu P, Fang J, Li T, Jiang G. Increased Left Putamen Volume Correlates With Pain in Ankylosing Spondylitis Patients. Front Neurol 2020; 11:607646. [PMID: 33329370 PMCID: PMC7734309 DOI: 10.3389/fneur.2020.607646] [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: 09/17/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
Ankylosing spondylitis (AS) mainly affects the axial skeleton and is an important factor leading to chronic lower back pain in young individuals. However, few studies have explored alterations of brain gray matter volume in AS patients. The purpose of the present study was to describe brain gray matter abnormalities associated with AS pain. A total of 61 AS patients and 52 healthy controls (HCs) were included in this study. Using voxel-based morphometrics, we detected abnormal gray matter volume in AS patients. Based on the voxel-wise analysis, the gray matter volume in the left putamen of the AS group was increased significantly compared with that of the HC group. In addition, we found that the gray matter volume of the left putamen was positively correlated with the duration of AS and total back pain scores, whereas it was not significantly correlated with Bath Ankylosing Spondylitis Disease Activity Index scores, C-reactive protein, or erythrocyte sedimentation rate in AS patients. Taken together, our findings improve our understanding of the neural substrates of pain in AS and provide evidence of AS-related neurological impairment. Hence, further investigation of the pathophysiology of the left putamen in AS is warranted.
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Affiliation(s)
- Kelei Hua
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Peijun Wang
- Department of Medical Imaging, Traditional Chinese Medicine-Integrated Hospital of Southern Medical University, Guangzhou, China
| | - Zhihong Lan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenkai Zhao
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shumei Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaofen Ma
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chao Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jin Fang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianwang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
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9
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Archibald J, MacMillan EL, Graf C, Kozlowski P, Laule C, Kramer JLK. Metabolite activity in the anterior cingulate cortex during a painful stimulus using functional MRS. Sci Rep 2020; 10:19218. [PMID: 33154474 PMCID: PMC7645766 DOI: 10.1038/s41598-020-76263-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
To understand neurochemical brain responses to pain, proton magnetic resonance spectroscopy (1H-MRS) is used in humans in vivo to examine various metabolites. Recent MRS investigations have adopted a functional approach, where acquisitions of MRS are performed over time to track task-related changes. Previous studies suggest glutamate is of primary interest, as it may play a role during cortical processing of noxious stimuli. The objective of this study was to examine the metabolic effect (i.e., glutamate) in the anterior cingulate cortex during noxious stimulation using fMRS. The analysis addressed changes in glutamate and glutamate + glutamine (Glx) associated with the onset of pain, and the degree by which fluctuations in metabolites corresponded with continuous pain outcomes. Results suggest healthy participants undergoing tonic noxious stimulation demonstrated increased concentrations of glutamate and Glx at the onset of pain. Subsequent reports of pain were not accompanied by corresponding changes in glutamate of Glx concentrations. An exploratory analysis on sex revealed large effect size changes in glutamate at pain onset in female participants, compared with medium-sized effects in male participants. We propose a role for glutamate in the ACC related to the detection of a noxious stimulus.
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Affiliation(s)
- J Archibald
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada.
| | - E L MacMillan
- Department of Radiology, University of British Columbia, Vancouver, Canada
- ImageTech Lab, Simon Fraser University, Surrey, Canada
- Philips Healthcare Canada, Markham, Canada
| | - C Graf
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - P Kozlowski
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Hughill Center, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - C Laule
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Hughill Center, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - J L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Center for Brain Health (DMCH), Vancouver, Canada
- Hughill Center, Vancouver, Canada
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10
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Wan L, Li Z, Liu T, Chen X, Xu Q, Yao W, Zhang C, Zhang Y. Epoxyeicosatrienoic acids: Emerging therapeutic agents for central post-stroke pain. Pharmacol Res 2020; 159:104923. [PMID: 32461186 DOI: 10.1016/j.phrs.2020.104923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 01/23/2023]
Abstract
Central post-stroke pain (CPSP) is chronic neuropathic pain due to a lesion or dysfunction of the central nervous system following cerebrovascular insult. This syndrome is characterized by chronic somatosensory abnormalities including spontaneous pain, hyperalgesia and allodynia, which localize to body areas corresponding to the injured brain region. However, despite its potential to impair activities of daily life and cause mood disorders after stroke, it is probably the least recognized complication of stroke. All currently approved treatments for CPSP have limited efficacy but troublesome side effects. The detailed mechanism underlying CPSP is still under investigation; however, its diverse clinical features indicate excessive central neuronal excitability, which is attributed to loss of inhibition and excessive neuroinflammation. Recently, exogenous epoxyeicosatrienoic acids (EETs) have been used to attenuate the mechanical allodynia in CPSP rats and proven to provide a quicker onset and superior pain relief compared to the current first line drug gabapentin. This anti-nociceptive effect is mediated by reserving the normal thalamic inhibition state through neurosteroid-GABA signaling. Moreover, mounting evidence has revealed that EETs exert anti-inflammatory effects by inhibiting the expression of vascular adhesion molecules, activating NFκB, inflammatory cytokines secretion and COX-2 gene induction. The present review focuses on the extensive evidence supporting the potential of EETs to be a multi-functional therapeutic approach for CPSP. Additionally, the role of EETs in the crosstalk between anti-CPSP and the comorbid mood disorder is reviewed herein.
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Affiliation(s)
- Li Wan
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zuofan Li
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tongtong Liu
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xuhui Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qiaoqiao Xu
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenlong Yao
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chuanhan Zhang
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Zhang
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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11
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Rousseaux F, Bicego A, Ledoux D, Massion P, Nyssen AS, Faymonville ME, Laureys S, Vanhaudenhuyse A. Hypnosis Associated with 3D Immersive Virtual Reality Technology in the Management of Pain: A Review of the Literature. J Pain Res 2020; 13:1129-1138. [PMID: 32547176 PMCID: PMC7247604 DOI: 10.2147/jpr.s231737] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypnosis is well documented in the literature in the management of acute and chronic pain. Virtual reality (VR) is currently gaining credibility in the same fields as hypnosis for medical applications. Lately, the combination of hypnosis and VR was considered. The aim of this scoping review is to understand the current studied contexts and effects of virtual reality hypnosis (VRH) for the management of pain. We searched on PubMed, Taylor & Francis Online, and ProQuest databases with the following terms: “virtual reality,” “3D,” “hypnosis,” and “pain”. We included 8 studies that combined hypnosis and VR. All articles are in English. Two included healthy volunteers and six are clinical studies. Short-term results indicated significant decreases in pain intensity, pain unpleasantness, time spent thinking about pain, anxiety, and levels of opioids. However, results are not consistent for all patients all the days. VR alone seems to reduce pain independently of the hypnotizability level. One study claimed that VR and hypnosis could alter each other’s effects and another argued that VR did not inhibit the hypnotic process and may even facilitate it by employing visual imagery. We cannot affirm that VR added value to hypnosis when they are combined. These trials and case series gave us indications about the possible applications of VRH in different contexts. Additional randomized clinical trials on VRH in the future will have to test this technique in clinical practice and help define guidelines for VRH utilization in pain management.
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Affiliation(s)
- Floriane Rousseaux
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Aminata Bicego
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Didier Ledoux
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Paul Massion
- Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Anne-Sophie Nyssen
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | | | | | - Audrey Vanhaudenhuyse
- Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
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12
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Najafi P, Carré JL, Ben Salem D, Brenaut E, Misery L, Dufor O. Central mechanisms of itch: A systematic literature review and meta-analysis. J Neuroradiol 2019; 47:450-457. [PMID: 31809769 DOI: 10.1016/j.neurad.2019.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
In recent years, studying the central mechanism of itch has gained momentum. However, a proper meta-analysis has not been conducted in this domain. In this study, we tried to respond to this need. A systematic search and a meta-analysis were carried out to estimate the central mechanism of itch. The itch matrix comprises the thalamus and the parietal, secondary somatosensory, insular and cingulate cortices. We have shown that the basal ganglia (BG) play an important role in itch reduction. Finally, we explored itch processing in AD patients and observed that the itch matrix in these patients was different. In conclusion, this is the first meta-analysis on the central mechanisms of itch perception and processing. Our study demonstrated that different modalities of itch induction can produce a common pattern of activity in the brain and provided further insights into understanding the underlying nature of itch central perception.
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Affiliation(s)
| | - Jean-Luc Carré
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Douraied Ben Salem
- LaTIM, Inserm UMR 1101, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Emilie Brenaut
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France
| | - Laurent Misery
- LIEN, université Brest, 29200 Brest, France; University Hospital of Brest, 29200 Brest, France.
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13
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Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 2019; 101:1029-1041. [PMID: 30897355 DOI: 10.1016/j.neuron.2019.01.055] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 12/18/2022]
Abstract
Since noxious stimulation usually leads to the perception of pain, pain has traditionally been considered sensory nociception. But its variability and sensitivity to a broad array of cognitive and motivational factors have meant it is commonly viewed as inherently imprecise and intangibly subjective. However, the core function of pain is motivational-to direct both short- and long-term behavior away from harm. Here, we illustrate that a reinforcement learning model of pain offers a mechanistic understanding of how the brain supports this, illustrating the underlying computational architecture of the pain system. Importantly, it explains why pain is tuned by multiple factors and necessarily supported by a distributed network of brain regions, recasting pain as a precise and objectifiable control signal.
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Affiliation(s)
- Ben Seymour
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, 1-4 Yamadaoka, Suita, Osaka 565-0871, Japan; Computational and Biological Learning Lab, Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK.
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14
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De Vloo P, Milosevic L, Gramer RM, Aguirre-Padilla DH, Dallapiazza RF, Lee DJ, Hutchison WD, Fasano A, Lozano AM. Complete resolution of postherpetic neuralgia following pallidotomy: case report. J Neurosurg 2019; 133:1229-1234. [PMID: 31561224 DOI: 10.3171/2019.7.jns191050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/08/2019] [Indexed: 11/06/2022]
Abstract
The authors report on a female patient with left-dominant Parkinson's disease with motor fluctuations and levodopa-induced dyskinesias and comorbid postherpetic neuralgia (PHN), who underwent a right-sided pallidotomy. Besides a substantial improvement in her Parkinson's symptoms, she reported an immediate and complete disappearance of PHN. This neuralgia had been long-standing, pharmacologically refractory, and severe (preoperative Brief Pain Inventory [BPI] pain severity score of 8.0, BPI pain interference score of 7.3, short-form McGill Pain Questionnaire sensory pain rating index of 7 and affective pain rating index of 10, Present Pain Intensity rank value of 4, and visual analog scale score of 81 mm; all postoperative scores were 0). She continued to be pain free at 16 months postoperatively.This peculiar finding adds substantially to the largely unrecognized evidence for the role of the pallidum in pain processing, based on previous electrophysiological, metabolic, anatomical, pharmacological, and clinical observations. Therefore, the potential of the pallidum as a neurosurgical target for neuropathic pain warrants further investigation.
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Affiliation(s)
- Philippe De Vloo
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- 2Department of Neurosurgery, University Hospitals Leuven, Vlaams-Brabant, Belgium
| | - Luka Milosevic
- 3Department of Physiology, Toronto Western Hospital and University of Toronto, Ontario, Canada
- 4Krembil Research Institute, University of Toronto, Ontario, Canada; and
| | - Robert M Gramer
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- 4Krembil Research Institute, University of Toronto, Ontario, Canada; and
| | | | - Robert F Dallapiazza
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Darrin J Lee
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - William D Hutchison
- 3Department of Physiology, Toronto Western Hospital and University of Toronto, Ontario, Canada
- 4Krembil Research Institute, University of Toronto, Ontario, Canada; and
| | - Alfonso Fasano
- 4Krembil Research Institute, University of Toronto, Ontario, Canada; and
- 5Division of Neurology, The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network Toronto, Ontario, Canada
| | - Andres M Lozano
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- 4Krembil Research Institute, University of Toronto, Ontario, Canada; and
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15
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Peyron R, Fauchon C. The posterior insular-opercular cortex: An access to the brain networks of thermosensory and nociceptive processes? Neurosci Lett 2019; 702:34-39. [DOI: 10.1016/j.neulet.2018.11.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Abstract
Anterior midcingulate cortex (aMCC) has been shown to be involved in most of the functional imaging studies investigating acute pain. For 10-15 years, it has even been a main focus of interest for pain studies, considering that neurons in the aMCC could encode for pain intensity. This latter function is now presumed to occur in secondary somatosensory (SII) area and/or insular cortices, while anterior cingulate cortex (ACC) is supposed to sustain other functions such as pain-related attention, arousal, motor withdrawal reflex, pain modulations, and engagement of endogenous pain control system. The quantitative imaging studies have shown a rich density of opioid receptors in the ACC. Thus, the perigenual subdivision has been suggested to participate in top-down controls of pain, (including the placebo effects known to be opioid mediated), mainly (but not exclusively) through the connection between the orbitofrontal/subgenual ACC and the periaqueductal gray (PAG). From this rationale, this area may lead to neurosurgical targeting including electrical stimulation for intractable pain in the future. A number of imaging studies have also reported activity changes in the posterior cingulate cortex during pain and proposed its speculative involvement to modulate the conscious experience of pain according to elements from the context and awareness of the self and others.
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17
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Peyron R, Fauchon C. Functional imaging of pain. Rev Neurol (Paris) 2018; 175:38-45. [PMID: 30318262 DOI: 10.1016/j.neurol.2018.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
Brain functional imaging has been applied to the study of pain since 1991. Then, a plethora of studies around the world looking at pain sensations and their brain correlates was published. Four kinds of studies can be distinguished: i) A first set investigated brain responses to noxious heat stimulations (above the pain threshold) relative to an equivalent warm innocuous stimulation (below the pain threshold). The aim of these studies was to identify the pattern of brain regions involved in the nociceptive processes and they may be considered as descriptive studies rather than explanative studies. Their value was to list for the first time every brain structure that might be playing a role. ii) Secondly, several experimental investigations have explored brain activations when subjects are confronted with unpleasant situations such as seeing or imagining other people in pain (e.g. empathy for pain). Obviously, feeling pain and representing others suffering share a common brain network, indicating that a large part of the regions showing intensity changes are not specific to nociception. iii) The third set of imaging studies is aimed at investigating the functional and structural brain abnormalities that may account for clinical pain states. Unfortunately, a relatively small number of studies provide clear findings that do not allow drawing convincing and generalized conclusions. iv) The last set of studies focused on the modulation of pain experience in humans. Several research groups conducted projects on different factors known to alter pain perception and their associated brain processes with the objective of identifying one or more key regions capable of controlling the pain sensation. In the same vein, investigations have been performed around pain therapies. From the clinician's point of view, it may be seen as complementary to assess pain and analgesic processes. All these aspects of pain research with functional imaging are considered below, including attempts to understand the functional significance of each of the observed activations. v) A special focus will be dedicated to new sophisticated approaches, vi) applied to neuroimaging (e.g. graph theory). These promising techniques and recent electrophysiological investigations bring additional information to our understanding of pain/analgesic processes, particularly for temporal dynamics and connectivity between brain regions.
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Affiliation(s)
- R Peyron
- Centre stéphanois de la douleur, CHU de Saint-Etienne & INSERM U1028, Université Jean Monnet, CRNL-Lyon, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France.
| | - C Fauchon
- Centre stéphanois de la douleur, CHU de Saint-Etienne & INSERM U1028, Université Jean Monnet, CRNL-Lyon, 10, rue de la Marandière, 42270 Saint-Priest en Jarez, France
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18
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Camilleri JA, Müller VI, Fox P, Laird AR, Hoffstaedter F, Kalenscher T, Eickhoff SB. Definition and characterization of an extended multiple-demand network. Neuroimage 2018; 165:138-147. [PMID: 29030105 PMCID: PMC5732056 DOI: 10.1016/j.neuroimage.2017.10.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
Neuroimaging evidence suggests that executive functions (EF) depend on brain regions that are not closely tied to specific cognitive demands but rather to a wide range of behaviors. A multiple-demand (MD) system has been proposed, consisting of regions showing conjoint activation across multiple demands. Additionally, a number of studies defining networks specific to certain cognitive tasks suggest that the MD system may be composed of a number of sub-networks each subserving specific roles within the system. We here provide a robust definition of an extended MDN (eMDN) based on task-dependent and task-independent functional connectivity analyses seeded from regions previously shown to be convergently recruited across neuroimaging studies probing working memory, attention and inhibition, i.e., the proposed key components of EF. Additionally, we investigated potential sub-networks within the eMDN based on their connectional and functional similarities. We propose an eMDN network consisting of a core whose integrity should be crucial to performance of most operations that are considered higher cognitive or EF. This then recruits additional areas depending on specific demands.
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Affiliation(s)
- J A Camilleri
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1,7), 52425 Jülich, Germany; Institute of Systems Neuroscience, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany.
| | - V I Müller
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1,7), 52425 Jülich, Germany; Institute of Systems Neuroscience, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany
| | - P Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, Texas, United States
| | - A R Laird
- Department of Physics, Florida International University, Miami, United States
| | - F Hoffstaedter
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1,7), 52425 Jülich, Germany; Institute of Systems Neuroscience, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany
| | - T Kalenscher
- Institute of Comparative Psychology, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf Germany
| | - S B Eickhoff
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1,7), 52425 Jülich, Germany; Institute of Systems Neuroscience, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Universitätstraße 1, 40225 Düsseldorf, Germany
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19
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Qiao-Tasserit E, Corradi-Dell'Acqua C, Vuilleumier P. The good, the bad, and the suffering. Transient emotional episodes modulate the neural circuits of pain and empathy. Neuropsychologia 2017; 116:99-116. [PMID: 29258849 DOI: 10.1016/j.neuropsychologia.2017.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/11/2017] [Accepted: 12/14/2017] [Indexed: 01/09/2023]
Abstract
People's sensitivity to first-hand pain is affected by their ongoing emotions, with positive states (joy, amusement) exerting analgesic-like effects, and negative states (sadness, fear) often enhancing the subjective experience. It is however less clear how empathetic responses to others' pain are affected by one's own emotional state. Following embodied accounts that posit a shared representational code between self and others' states, it is plausible that pain empathy might be influenced by emotions in the same way as first-hand pain. Alternatively, other theories in psychology suggest that social resources (including empathetic reactions) might be enhanced by positive states, but inhibited by negative states, as only in the former case, one's mindset is sufficiently broad to take into consideration others' needs. To disambiguate between these opposing predictions, we conducted two experiments in which volunteers observed positive, neutral, or negative video clips, and subsequently either received painful thermal stimuli on their own body (first-hand pain), or observed images of wounded hands (others' pain). We measured subjective pain ratings as well as physiological responses and brain activity using fMRI. We found that, contrary to the case of first-hand pain, others' pain produced weaker galvanic responses and lower neural activity in anterior insula and middle cingulate cortex following negative (relative to neutral and positive) videos. Such inhibition was partially counteracted by personal empathy traits, as individuals with higher scores retained greater sensitivity to others' pain after negative emotion induction, in both behavioral and neural responses in medial prefrontal cortex. Furthermore, multivoxel pattern analysis confirmed similar neural representation for first-hand and others' pain in anterior insula, with representation similarity increasing the more the video preceding the observation of others' suffering was positive. These findings speak against the idea that emotion induction affects first-hand and others' pain in an isomorphic way, but rather supports the idea that contrary to negative emotions, positive emotions favors a broader access to social resources.
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Affiliation(s)
- Emilie Qiao-Tasserit
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences and Clinic of Neurology, University Medical Centre, CH-1211 Geneva, Switzerland; Swiss Centre for Affective Sciences, University of Geneva, CH-1202 Geneva, Switzerland.
| | | | - Patrik Vuilleumier
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences and Clinic of Neurology, University Medical Centre, CH-1211 Geneva, Switzerland; Swiss Centre for Affective Sciences, University of Geneva, CH-1202 Geneva, Switzerland
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20
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Long-Term Results of Deep Brain Stimulation of the Anterior Cingulate Cortex for Neuropathic Pain. World Neurosurg 2017; 106:625-637. [PMID: 28710048 DOI: 10.1016/j.wneu.2017.06.173] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a recent technique that has shown some promising short-term results in patients with chronic refractory neuropathic pain. Three years after the first case series, we assessed its efficacy on a larger cohort, with longer follow-up. METHODS Twenty-four patients (19 males; average age, 49.1 years) with neuropathic pain underwent bilateral ACC DBS. Patient-reported outcome measures were collected before and after surgery, using the Numerical Rating Scale (NRS), Short-Form 36 quality of life (SF-36), McGill Pain Questionnaire (MPQ), and EuroQol 5-domain quality of life (EQ-5D) questionnaire. RESULTS Twenty-two patients after a trial week were fully internalized and 12 had a mean follow-up of 38.9 months. Six months after surgery the mean NRS score decreased from 8.0 to 4.27 (P = 0.004). There was a significant improvement in the MPQ (mean, -36%; P = 0.021) and EQ-5D score significantly decreased (mean, -21%; P = 0.036). The physical functioning domain of SF-36 was significantly improved (mean, +54.2%; P = 0.01). Furthermore, in 83% of these patients, at 6 months, NRS score was improved by 60% (P < 0.001) and MPQ decreased by 47% (P < 0.01). After 1 year, NRS score decreased by 43% (P < 0.01), EQ-5D was significantly reduced (mean, -30.8; P = 0.05) and significant improvements were also observed for different domains of the SF-36. At longer follow-ups, efficacy was sustained up to 42 months in some patients, with an NRS score as low as 3. CONCLUSIONS Follow-up results confirm that ACC DBS alleviates chronic neuropathic pain refractory to pharmacotherapy and improves quality of life in many patients.
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21
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Miyamoto K, Kume K, Ohsawa M. Role of microglia in mechanical allodynia in the anterior cingulate cortex. J Pharmacol Sci 2017; 134:158-165. [PMID: 28669596 DOI: 10.1016/j.jphs.2017.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 01/06/2023] Open
Abstract
Plastic changes that increase nociceptive transmission are observed in several brain regions under conditions of chronic pain. Synaptic plasticity in the anterior cingulate cortex (ACC) is particularly associated with neuropathic pain. Glial cells are considered candidates for the modulation of neural plastic changes in the central nervous system. In this study, we aimed to investigate the role of ACC glial cells in the development of neuropathic pain. First, we examined the expression of glial cells in the ACC of nerve-ligated mice. The expression of astrocytes and microglia was increased in the ACC of nerve-ligated mice, which was reversed by intracerebroventricular (i.c.v) treatment with the microglia inhibitor minocycline. Then, we examined the effect of minocycline on mechanical allodynia in nerve-ligated mice. I.c.v. and intra-ACC treatment with minocycline partially inhibited mechanical allodynia in the nerve-ligated mice. The expression of phosphorylated alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor GluR1 subunit at Ser831, but not at Ser845, was increased in the ACC of the nerve-ligated mice compared to sham-operated mice, which was attenuated by minocycline administration. These results suggest that the activation of microglia in the ACC is involved in the development of hyperalgesia in mice with neuropathic pain.
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Affiliation(s)
- Keisuke Miyamoto
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya 467-8603, Japan
| | - Kazuhiko Kume
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya 467-8603, Japan
| | - Masahiro Ohsawa
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya 467-8603, Japan.
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22
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Córcoles-Parada M, Müller NCJ, Ubero M, Serrano-del-Pueblo VM, Mansilla F, Marcos-Rabal P, Artacho-Pérula E, Dresler M, Insausti R, Fernández G, Muñoz-López M. Anatomical segmentation of the human medial prefrontal cortex. J Comp Neurol 2017; 525:2376-2393. [DOI: 10.1002/cne.24212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 02/26/2017] [Accepted: 03/13/2017] [Indexed: 11/08/2022]
Affiliation(s)
- M. Córcoles-Parada
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - N. C. J. Müller
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Nijmegen The Netherlands
| | - M. Ubero
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - V. M. Serrano-del-Pueblo
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - F. Mansilla
- Radiology Service, Sta. Cristina Clinic and University Hospital of Albacete; Albacete Spain
| | - P. Marcos-Rabal
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - E. Artacho-Pérula
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - M. Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Nijmegen The Netherlands
| | - R. Insausti
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
| | - G. Fernández
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Nijmegen The Netherlands
| | - M. Muñoz-López
- Human Neuroanatomy Laboratory and Regional Centre for Biomedical Research, School of Medicine; University of Castilla-La Mancha; Albacete Spain
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23
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Functional brain mapping using specific sensory-circuit stimulation and a theoretical graph network analysis in mice with neuropathic allodynia. Sci Rep 2016; 6:37802. [PMID: 27898057 PMCID: PMC5127182 DOI: 10.1038/srep37802] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/02/2016] [Indexed: 11/08/2022] Open
Abstract
Allodynia, a form of neuropathic pain, is defined as pain in response to a non-nociceptive stimulus. The brain regions responsible for pain, which are not normally activated, can be activated in allodynic mice by providing a suitable stimulus to Aβ-fibers, which transmit signals from tactile sensory fibers. Functional MRI (fMRI) can be used to objectively observe abnormal brain activation. In the present study, fMRI was conducted to investigate allodynia in mice; allodynia was generated by surgical injury at the L4 spinal nerve root, thus selectively stimulating sensory nerve fibers. In intact mice, only the primary somatosensory cortex (S1) was activated by stimulation of Aβ-fibers. Meanwhile, allodynic mice showed significantly higher BOLD signals in the anterior cingulate area (ACA) and thalamus. Using resting state fMRI, both degree and eigenvector centrality were significantly decreased in the contralateral S1, clustering coefficient and local efficiency were significantly increased in the ACA, and betweenness centrality was significantly higher in the ventral posterolateral nucleus of the thalamus. These results suggest that the observed abnormal BOLD activation is associated with defects in Aβ-fibers when Aβ-fibers in allodynic mice are selectively stimulated. The objective approach enabled by fMRI can improve our understanding of pathophysiological mechanisms and therapeutic efficacy.
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24
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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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25
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Reduced local field potential power in the medial prefrontal cortex by noxious stimuli. Brain Res Bull 2016; 127:92-99. [PMID: 27601092 DOI: 10.1016/j.brainresbull.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022]
Abstract
Nociceptive signals produced by noxious stimuli at the periphery reach the brain through ascending pathways. These signals are processed by various brain areas and lead to activity changes in those areas. The medial prefrontal cortex (mPFC) is involved in higher cognitive functions and emotional processing. It receives projections from brain areas involved in nociception. In this study, we investigated how nociceptive input from the periphery changes the local field potential (LFP) activity in the mPFC. Three different types of noxious stimuli were applied to the hind paw contralateral to the LFP recording site. They were transcutaneous electrical stimulations, mechanical stimuli and a chemical stimulus (formalin injection). High intensity transcutaneous stimulations (10V to 50V) and noxious mechanical stimulus (pinch) significantly reduced the LFP power during the stimulating period (p<0.05), but not the low intensity subcutaneous stimulations (0.1V to 5V) and other innocuous mechanical stimuli (brush and pressure). More frequency bands were inhibited with increased intensity of transcutaneous electrical stimulation, and almost all frequency bands were inhibited by stimulations at or higher than 30v. Pinch significantly reduced the power for beta band and formalin injection significantly reduced the power of alpha and beta band. Our data demonstrated the noxious stimuli-induced reduction of LFP power in the mPFC, which indicates the active processing of nociceptive information by the mPFC.
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26
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Boccard SGJ, Fernandes HM, Jbabdi S, Van Hartevelt TJ, Kringelbach ML, Quaghebeur G, Moir L, Mancebo VP, Pereira EAC, Fitzgerald JJ, Green AL, Stein J, Aziz TZ. Tractography Study of Deep Brain Stimulation of the Anterior Cingulate Cortex in Chronic Pain: Key to Improve the Targeting. World Neurosurg 2015; 86:361-70.e1-3. [PMID: 26344354 DOI: 10.1016/j.wneu.2015.08.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a new treatment for alleviating intractable neuropathic pain. However, it fails to help some patients. The large size of the ACC and the intersubject variability make it difficult to determine the optimal site to position DBS electrodes. The aim of this work was therefore to compare the ACC connectivity of patients with successful versus unsuccessful DBS outcomes to help guide future electrode placement. METHODS Diffusion magnetic resonance imaging (dMRI) and probabilistic tractography were performed preoperatively in 8 chronic pain patients (age 53.4 ± 6.1 years, 2 females) with ACC DBS, of whom 6 had successful (SO) and 2 unsuccessful outcomes (UOs) during a period of trialing. RESULTS The number of patients was too small to demonstrate any statistically significant differences. Nevertheless, we observed differences between patients with successful and unsuccessful outcomes in the fiber tract projections emanating from the volume of activated tissue around the electrodes. A strong connectivity to the precuneus area seems to predict unsuccessful outcomes in our patients (UO: 160n/SO: 27n), with (n), the number of streamlines per nonzero voxel. On the other hand, connectivity to the thalamus and brainstem through the medial forebrain bundle (MFB) was only observed in SO patients. CONCLUSIONS These findings could help improve presurgical planning by optimizing electrode placement, to selectively target the tracts that help to relieve patients' pain and to avoid those leading to unwanted effects.
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Affiliation(s)
- Sandra G J Boccard
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom.
| | - Henrique M Fernandes
- Department of Psychiatry, University of Oxford, United Kingdom; CFIN/MindLab, Aarhus University, Aarhus, Denmark
| | - Saad Jbabdi
- Centre for Functional MRI of the Brain (FMRIB), University of Oxford, United Kingdom
| | - Tim J Van Hartevelt
- Department of Psychiatry, University of Oxford, United Kingdom; CFIN/MindLab, Aarhus University, Aarhus, Denmark
| | - Morten L Kringelbach
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom; Department of Psychiatry, University of Oxford, United Kingdom; CFIN/MindLab, Aarhus University, Aarhus, Denmark
| | | | - Liz Moir
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
| | - Victor Piqueras Mancebo
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
| | - Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
| | - James J Fitzgerald
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
| | - Alexander L Green
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
| | - John Stein
- Department of Physiology, Anatomy, & Genetics, University of Oxford, United Kingdom
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
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Vaseghi B, Zoghi M, Jaberzadeh S. How does anodal transcranial direct current stimulation of the pain neuromatrix affect brain excitability and pain perception? A randomised, double-blind, sham-control study. PLoS One 2015; 10:e0118340. [PMID: 25738603 PMCID: PMC4349802 DOI: 10.1371/journal.pone.0118340] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/12/2015] [Indexed: 12/11/2022] Open
Abstract
Background Integration of information between multiple cortical regions of the pain neuromatrix is thought to underpin pain modulation. Although altered processing in the primary motor (M1) and sensory (S1) cortices is implicated in separate studies, the simultaneous changes in and the relationship between these regions are unknown yet. The primary aim was to assess the effects of anodal transcranial direct current stimulation (a-tDCS) over superficial regions of the pain neuromatrix on M1 and S1 excitability. The secondary aim was to investigate how M1 and S1 excitability changes affect sensory (STh) and pain thresholds (PTh). Methods Twelve healthy participants received 20 min a-tDCS under five different conditions including a-tDCS of M1, a-tDCS of S1, a-tDCS of DLPFC, sham a-tDCS, and no-tDCS. Excitability of dominant M1 and S1 were measured before, immediately, and 30 minutes after intervention respectively. Moreover, STh and PTh to peripheral electrical and mechanical stimulation were evaluated. All outcome measures were assessed at three time-points of measurement by a blind rater. Results A-tDCS of M1 and dorsolateral prefrontal cortex (DLPFC) significantly increased brain excitability in M1 (p < 0.05) for at least 30 min. Following application of a-tDCS over the S1, the amplitude of the N20-P25 component of SEPs increased immediately after the stimulation (p < 0.05), whilst M1 stimulation decreased it. Compared to baseline values, significant STh and PTh increase was observed after a-tDCS of all three stimulated areas. Except in M1 stimulation, there was significant PTh difference between a-tDCS and sham tDCS. Conclusion a-tDCS of M1 is the best spots to enhance brain excitability than a-tDCS of S1 and DLPFC. Surprisingly, a-tDCS of M1 and S1 has diverse effects on S1 and M1 excitability. A-tDCS of M1, S1, and DLPFC increased STh and PTh levels. Given the placebo effects of a-tDCS of M1 in pain perception, our results should be interpreted with caution, particularly with respect to the behavioural aspects of pain modulation. Trial Registration Australian New Zealand Clinical Trials, ACTRN12614000817640, http://www.anzctr.org.au/.
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Affiliation(s)
- Bita Vaseghi
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- * E-mail:
| | - Maryam Zoghi
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Molloy A, Kimmich O, Williams L, Butler JS, Byrne N, Molloy F, Moore H, Healy DG, Lynch T, Edwards MJ, Walsh C, Reilly RB, O'Riordan S, Hutchinson M. An evaluation of the role of environmental factors in the disease penetrance of cervical dystonia. J Neurol Neurosurg Psychiatry 2015; 86:331-5. [PMID: 24963124 DOI: 10.1136/jnnp-2014-307699] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adult onset primary torsion dystonia (AOPTD) is a poorly penetrant autosomal dominant disorder; most gene carriers are non-manifesting despite having reached an adequate age for penetrance. It is hypothesised that genetic, epigenetic and environmental factors may exert protective or deleterious effects on penetrance of AOPTD. By examining environmental exposure history in cervical dystonia patients and their similarly aged unaffected siblings we aimed to determine the role of previous environmental exposures in relation to disease penetrance. METHODS A case-control study of 67 patients with cervical dystonia and 67 of their age-matched unaffected siblings was performed. Past environmental exposures were assessed using a detailed 124-question standardised questionnaire. RESULTS By univariate analysis, cervical dystonia patients, compared to their unaffected siblings, had an increased frequency of a history of car accidents with hospital attendance (OR 10.1, 95% CI 2.1 to 47.4, p=0.004) and surgical episodes (OR 6.5, 95% CI 1.76 to 23.61, p=0.005). Following multivariate analysis, car accidents with hospital attendance (OR 7.3, 95% CI 1.4 to 37.6, p=0.017) and all surgical episodes (OR 4.9, 95% CI 1.24 to 19.31, p=0.023) remained significantly associated with case status. CONCLUSIONS Cervical dystonia patients had a history, prior to symptom onset, of significantly more frequent episodes of surgery and of car accidents with hospital attendance than their age-matched unaffected siblings. Soft tissue trauma appears to increase risk of development of cervical dystonia in genetically predetermined individuals.
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Affiliation(s)
- Anna Molloy
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - Okka Kimmich
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - Laura Williams
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - John S Butler
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | - Niall Byrne
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - Fiona Molloy
- Department of Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Helena Moore
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Daniel G Healy
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Tim Lynch
- Dublin Neurological Institute, Mater Misericordiae Hospital, Dublin, Ireland
| | - Mark J Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Cathal Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | - Sean O'Riordan
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - Michael Hutchinson
- Dept of Neurology, St. Vincent's University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
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Mertens P, Blond S, David R, Rigoard P. Anatomy, physiology and neurobiology of the nociception: a focus on low back pain (part A). Neurochirurgie 2014; 61 Suppl 1:S22-34. [PMID: 25441598 DOI: 10.1016/j.neuchi.2014.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/05/2014] [Accepted: 09/21/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The treatment of Failed Back Surgery Syndrome (FBSS) remains a challenge for pain medicine due to the complexity in the interactions between [1] a residual mechanical pain after surgery and, [2] a progressive transition into chronic pain involving central nervous system plasticity and molecular reorganization. The aim of this paper is to provide a fundamental overview of the pain pathway supporting the nociceptive component of the back pain. METHODS Literature searches included an exhaustive review of 643 references and 74 book chapters updated by searching the major electronic databases from 1930 to August 2013. RESULTS Pain input is gathered by the peripheral fibre from the innervated tissue's environment and relayed by two contiguous central axons to the brain, via the spinal cord. At this level, it is possible to characterize physical pain and emotional pain. These are supported by two different pathways, encoding two dimensions of pain perception: In Neo-spino-thalamic pathway, the wide dynamic range neuron system is able to provide the information needed for mapping the "sensory-discriminative" dimension of pain. The second projection system (Paleo-spino-thalamic pathway) also involves the ventromedial thalamus but projects to the amygdala, the insula and the anterior cingulate cortex. These areas are associated with emotionality and affect. CONCLUSION The mechanical component of FBSS cannot be understood unless the functioning of the pain system is known. But ultimately, the highly variable nature of back pain expression among individuals would require a careful pathophysiological dissection of the potential generators of back pain to guide pain management strategies.
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Affiliation(s)
- P Mertens
- Department of Neurosurgery, Lyon University hospital, 69677 Lyon cedex, France; Laboratory of Anatomy, Faculty of Medicine, 69677 Lyon cedex, France
| | - S Blond
- Department of Neurosurgery, Lille University Hospital, 59037 Lille cedex , France
| | - R David
- Service de neurochirurgie, unité rachis et neurostimulation, Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France; N(3)Lab: Neuromodulation & Neural Networks, Poitiers University Hospital, Poitiers, France
| | - P Rigoard
- Service de neurochirurgie, unité rachis et neurostimulation, Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France; N(3)Lab: Neuromodulation & Neural Networks, Poitiers University Hospital, Poitiers, France; Inserm CIC 802, 86021 Poitiers, France.
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Malheiros JM, Guinsburg R, Covolan L. Cortical modulation of pain: comments on "exacerbation of tonic but not phasic pain by entorhinal cortex lesions". Neurosci Lett 2014; 581:135-6. [PMID: 25128752 DOI: 10.1016/j.neulet.2014.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/05/2014] [Indexed: 01/21/2023]
Affiliation(s)
| | - Ruth Guinsburg
- Department of Pediatrics, Universidade Federal de São Paulo - UNIFESP, São Paulo 04023-062, Brazil
| | - Luciene Covolan
- Departmento of Phyisiology, Universidade Federal de São Paulo - UNIFESP, São Paulo 04023-062, Brazil.
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Abstract
Functional imaging has comprehensively demonstrated that pain involves a number of cortical regions that are often collectively referred to as the pain neuromatrix. This neuromatrix is assumed to be necessary to process the sensory, affective, and cognitive components of pain. Patients who report pain in the apparent absence of injury or disease may experience their symptoms because of dysfunction in one or more components of the pain neuromatrix. Two articles in this edition of Psychosomatic Medicine explore that possibility and provide evidence of altered neural connectivity and activation within components of the pain neuromatrix in patients with low back pain and irritable bowel syndrome. Questions remain as to how best to transition from describing the neural correlates of disease to understanding mechanisms and providing treatments.
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Abstract
In this review, we summarize the contribution of functional imaging to the question of nociception in humans. In the beginning of the 90's, brain areas supposed to be involved in physiological pain processes essentially concerned the primary somatosensory area (SI), thalamus, and anterior cingulate cortex. In spite of these a priori hypotheses, the first imaging studies revealed that the main brain areas and those providing the most consistent activations in pain conditions were the insular and the SII cortices, bilaterally. This has been checked with other techniques such as intracerebral recordings of evoked potentials after nociceptive stimulations with laser showing a consistent response in the operculo-insular area whose amplitude correlates with pain intensity. In spite of electrode implantations in other areas of the brain, only rare and inconsistent responses have been found outside the operculo-insular cortices. With electrical stimulation delivered directly in the brain, it has also been shown that stimulation in this area only - and not in other brain areas - was able to elicit a painful sensation. Thus, over the last 15 years, the operculo-insular cortex has been re-discovered as a main area of pain integration, mainly in its sensory and intensity aspects. In neuropathic pain also, these areas have been demonstrated as being abnormally recruited, bilaterally, in response to innocuous stimuli. These results suggest that plastic changes may occur in brain areas that were pre-defined for generating pain sensations. Conversely, when the brain activations concomitant to pain relief were taken in account, a large number of studies pointed out medial prefrontal and rostral cingulate areas as being associated with pain controls. Interestingly, these activations may correlate with the magnitude of pain relief, with the activation of the peri-acqueductal grey (PAG) and, at least in some instances, with the involvement of endogenous opioids.
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Affiliation(s)
- Roland Peyron
- Département de Neurologie et Centre de la Douleur, CHU, 42055 Saint-Étienne, France - Inserm U879/1028, UCBL Lyon 1, UJM Saint-Étienne, 42023 Saint-Étienne, France - Hôpital Nord, Bâtiment A, Niveau 0, Avenue A. Raimond, 42055 Saint-Étienne Cedex 02, France
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Caeyenberghs K, Leemans A. Hemispheric lateralization of topological organization in structural brain networks. Hum Brain Mapp 2014; 35:4944-57. [PMID: 24706582 DOI: 10.1002/hbm.22524] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/24/2014] [Accepted: 03/24/2014] [Indexed: 11/08/2022] Open
Abstract
The study on structural brain asymmetries in healthy individuals plays an important role in our understanding of the factors that modulate cognitive specialization in the brain. Here, we used fiber tractography to reconstruct the left and right hemispheric networks of a large cohort of 346 healthy participants (20-86 years) and performed a graph theoretical analysis to investigate this brain laterality from a network perspective. Findings revealed that the left hemisphere is significantly more "efficient" than the right hemisphere, whereas the right hemisphere showed higher values of "betweenness centrality" and "small-worldness." In particular, left-hemispheric networks displayed increased nodal efficiency in brain regions related to language and motor actions, whereas the right hemisphere showed an increase in nodal efficiency in brain regions involved in memory and visuospatial attention. In addition, we found that hemispheric networks decrease in efficiency with age. Finally, we observed significant gender differences in measures of global connectivity. By analyzing the structural hemispheric brain networks, we have provided new insights into understanding the neuroanatomical basis of lateralized brain functions.
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Affiliation(s)
- Karen Caeyenberghs
- Department of Physical Therapy and Motor Rehabilitation, Faculty of Medicine and Health sciences, University of Ghent, Ghent, Belgium; Department of Movement and Sports Sciences, University of Ghent, Ghent, Belgium
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Yamashita A, Hamada A, Suhara Y, Kawabe R, Yanase M, Kuzumaki N, Narita M, Matsui R, Okano H, Narita M. Astrocytic activation in the anterior cingulate cortex is critical for sleep disorder under neuropathic pain. Synapse 2014; 68:235-47. [DOI: 10.1002/syn.21733] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/09/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Akira Yamashita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Asami Hamada
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Yuki Suhara
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Rui Kawabe
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Makoto Yanase
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Naoko Kuzumaki
- Department of Physiology; Keio University School of Medicine; 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan
| | - Michiko Narita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
| | - Ryosuke Matsui
- Department of Molecular and Systems Biology; Graduate School of Biostudies, Kyoto University; Yoshida Sakyo-ku Kyoto 606-8501 Japan
| | - Hideyuki Okano
- Department of Physiology; Keio University School of Medicine; 35 Shinanomachi Shinjuku-ku Tokyo 160-8582 Japan
| | - Minoru Narita
- Department of Pharmacology; Hoshi University School of Pharmacy and Pharmaceutical Sciences; 2-4-41 Ebara Shinagawa-ku Tokyo 142-8501 Japan
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Garcia-Larrea L, Peyron R. Pain matrices and neuropathic pain matrices: A review. Pain 2013; 154 Suppl 1:S29-S43. [PMID: 24021862 DOI: 10.1016/j.pain.2013.09.001] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 01/18/2023]
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Markman T, Liu CC, Chien JH, Crone NE, Zhang J, Lenz FA. EEG analysis reveals widespread directed functional interactions related to a painful cutaneous laser stimulus. J Neurophysiol 2013; 110:2440-9. [PMID: 23945784 PMCID: PMC3841864 DOI: 10.1152/jn.00246.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/14/2013] [Indexed: 12/25/2022] Open
Abstract
During attention to a painful cutaneous laser stimulus, event-related causality (ERC) has been detected in recordings from subdural electrodes implanted directly over cortical modules for the treatment of epilepsy. However, these studies afforded limited sampling of modules and did not examine interactions with a nonpainful stimulus as a control. We now sample scalp EEG to test the hypothesis that attention to the laser stimulus is associated with poststimulus ERC interactions that are different from those with attention to a nonpainful stimulus. Subjects attended to (counted) either a painful laser stimulus (laser attention task) or a nonpainful electrical cutaneous stimulus that produced distraction from the laser (laser distraction task). Both of these stimuli were presented in random order in a single train. The intensities of both stimuli were adjusted to produce similar baseline salience and sensations in the same cutaneous territory. The results demonstrated that EEG channels with poststimulus ERC interactions were consistently different during the laser stimulus versus the electric stimulus. Poststimulus ERC interactions for the laser attention task were different from the laser distraction task. Furthermore, scalp EEG frontal channels play a driver role while parietal temporal channels play a receiver role during both tasks, although this does not prove that these channels are connected. Sites at which large numbers of ERC interactions were found for both laser attention and distraction tasks (critical sites) were located at Cz, Pz, and C3. Stimulation leading to disruption of sites of these pain-related interactions may produce analgesia for acute pain.
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Affiliation(s)
- T. Markman
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - C. C. Liu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - J. H. Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - N. E. Crone
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland; and
| | - J. Zhang
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- School of Biological Science and Medical Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - F. A. Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
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Huneke NTM, Brown CA, Burford E, Watson A, Trujillo-Barreto NJ, El-Deredy W, Jones AKP. Experimental placebo analgesia changes resting-state alpha oscillations. PLoS One 2013; 8:e78278. [PMID: 24147129 PMCID: PMC3795660 DOI: 10.1371/journal.pone.0078278] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/12/2013] [Indexed: 12/18/2022] Open
Abstract
The lack of clear understanding of the pathophysiology of chronic pain could explain why we currently have only a few effective treatments. Understanding how pain relief is realised during placebo analgesia could help develop improved treatments for chronic pain. Here, we tested whether experimental placebo analgesia was associated with altered resting-state cortical activity in the alpha frequency band of the electroencephalogram (EEG). Alpha oscillations have been shown to be influenced by top-down processes, which are thought to underpin the placebo response. Seventy-three healthy volunteers, split into placebo or control groups, took part in a well-established experimental placebo procedure involving treatment with a sham analgesic cream. We recorded ongoing (resting) EEG activity before, during, and after the sham treatment. We show that resting alpha activity is modified by placebo analgesia. Post-treatment, alpha activity increased significantly in the placebo group only (p < 0.001). Source analysis suggested that this alpha activity might have been generated in medial components of the pain network, including dorsal anterior cingulate cortex, medial prefrontal cortex, and left insula. These changes are consistent with a cognitive state of pain expectancy, a key driver of the placebo analgesic response. The manipulation of alpha activity may therefore present an exciting avenue for the development of treatments that directly alter endogenous processes to better control pain.
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Affiliation(s)
| | - Christopher A. Brown
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Edward Burford
- School of Medicine, University of Manchester, Manchester, United Kingdom
| | - Alison Watson
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | | | - Wael El-Deredy
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | - Anthony K. P. Jones
- Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
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Wheeler-Kingshott CA, Stroman PW, Schwab JM, Bacon M, Bosma R, Brooks J, Cadotte DW, Carlstedt T, Ciccarelli O, Cohen-Adad J, Curt A, Evangelou N, Fehlings MG, Filippi M, Kelley BJ, Kollias S, Mackay A, Porro CA, Smith S, Strittmatter SM, Summers P, Thompson AJ, Tracey I. The current state-of-the-art of spinal cord imaging: applications. Neuroimage 2013; 84:1082-93. [PMID: 23859923 DOI: 10.1016/j.neuroimage.2013.07.014] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/30/2013] [Accepted: 07/04/2013] [Indexed: 12/14/2022] Open
Abstract
A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small crosssectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research.
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Affiliation(s)
- C A Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, England, UK.
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Differential Localization of Pain-Related and Pain-Unrelated Neural Responses for Acupuncture at BL60 Using BOLD fMRI. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:804696. [PMID: 23853664 PMCID: PMC3703342 DOI: 10.1155/2013/804696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/31/2013] [Indexed: 11/18/2022]
Abstract
The objective of this study was to differentiate between pain-related and pain-unrelated neural responses of acupuncture at BL60 to investigate the specific effects of acupuncture. A total of 19 healthy volunteers were evaluated. fMRI was performed with sham or verum acupuncture stimulation at the left BL60 before and after local anesthesia. To investigate the relative BOLD signal effect for each session, a one-sample t-test was performed for individual contrast maps, and a paired t-test to investigate the differences between the pre- and post-anesthetic signal effects. Regarding verum acupuncture, areas that were more activated before local anesthesia included the superior, middle, and medial frontal gyri, inferior parietal lobule, superior temporal gyrus, thalamus, middle temporal gyrus, cingulate gyrus, culmen, and cerebellar tonsil. The postcentral gyrus was more deactivated before local anesthesia. After local anesthesia, the middle occipital gyrus, inferior temporal gyrus, postcentral gyrus, precuneus, superior parietal lobule, and declive were deactivated. Pre-anesthetic verum acupuncture at BL60 activated areas of vision and pain transmission. Post-anesthetic verum acupuncture deactivated brain areas of visual function, which is considered to be a pain-unrelated acupuncture response. It indicates that specific effects of acupoint BL60 are to control vision sense as used in the clinical setting.
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Jones AKP, Huneke NTM, Lloyd DM, Brown CA, Watson A. Role of functional brain imaging in understanding rheumatic pain. Curr Rheumatol Rep 2013; 14:557-67. [PMID: 22936576 DOI: 10.1007/s11926-012-0287-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rheumatic pain and, in particular, rheumatoid arthritis, osteoarthritis and fibromyalgia, are common and debilitating chronic pain syndromes. Recently, human functional neuroimaging, for example EEG, fMRI, and PET has begun to reveal some of the crucial central nervous system mechanisms underlying these diseases. The purpose of this review is to summarise current knowledge on the brain mechanisms of rheumatic pain revealed by functional neuroimaging techniques. The evidence suggests that two mechanisms may be largely responsible for the clinical pain associated with these rheumatic diseases: abnormalities in the medial pain system and/or central nervous system sensitisation and inhibition. If we can understand how functioning of the central nociceptive system becomes altered, even in the absence of peripheral nociceptive input, by using functional neuroimaging techniques, in the future we may be able to develop improved, more effective treatments for patients with chronic rheumatic pain.
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Affiliation(s)
- Anthony K P Jones
- Human Pain Research Group, School of Translational Medicine, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK.
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Schabrun S, Jones E, Kloster J, Hodges P. Temporal association between changes in primary sensory cortex and corticomotor output during muscle pain. Neuroscience 2013; 235:159-64. [DOI: 10.1016/j.neuroscience.2012.12.072] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/12/2012] [Accepted: 12/21/2012] [Indexed: 11/30/2022]
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Vierck CJ, Whitsel BL, Favorov OV, Brown AW, Tommerdahl M. Role of primary somatosensory cortex in the coding of pain. Pain 2013; 154:334-344. [PMID: 23245864 PMCID: PMC4501501 DOI: 10.1016/j.pain.2012.10.021] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 09/15/2012] [Accepted: 10/29/2012] [Indexed: 02/04/2023]
Abstract
The intensity and submodality of pain are widely attributed to stimulus encoding by peripheral and subcortical spinal/trigeminal portions of the somatosensory nervous system. Consistent with this interpretation are studies of surgically anesthetized animals, demonstrating that relationships between nociceptive stimulation and activation of neurons are similar at subcortical levels of somatosensory projection and within the primary somatosensory cortex (in cytoarchitectural areas 3b and 1 of somatosensory cortex, SI). Such findings have led to characterizations of SI as a network that preserves, rather than transforms, the excitatory drive it receives from subcortical levels. Inconsistent with this perspective are images and neurophysiological recordings of SI neurons in lightly anesthetized primates. These studies demonstrate that an extreme anterior position within SI (area 3a) receives input originating predominantly from unmyelinated nociceptors, distinguishing it from posterior SI (areas 3b and 1), long recognized as receiving input predominantly from myelinated afferents, including nociceptors. Of particular importance, interactions between these subregions during maintained nociceptive stimulation are accompanied by an altered SI response to myelinated and unmyelinated nociceptors. A revised view of pain coding within SI cortex is discussed, and potentially significant clinical implications are emphasized.
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Affiliation(s)
- Charles J Vierck
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL 32610-0244, USA Department of Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA Department of Computer Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA Senior School, Shadyside Academy, Pittsburgh, PA, USA
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Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial. Clin J Pain 2013; 28:581-8. [PMID: 22699130 DOI: 10.1097/ajp.0b013e31823c2bd7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. METHODS Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). RESULTS In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. DISCUSSION We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.
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Bruno MA, Laureys S, Demertzi A. Coma and disorders of consciousness. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:205-13. [PMID: 24182379 DOI: 10.1016/b978-0-444-53501-6.00017-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers' attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients.
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Affiliation(s)
- Marie-Aurélie Bruno
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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Caeyenberghs K, Leemans A, De Decker C, Heitger M, Drijkoningen D, Linden CV, Sunaert S, Swinnen SP. Brain connectivity and postural control in young traumatic brain injury patients: A diffusion MRI based network analysis. NEUROIMAGE-CLINICAL 2012; 1:106-15. [PMID: 24179743 PMCID: PMC3757722 DOI: 10.1016/j.nicl.2012.09.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/15/2012] [Accepted: 09/20/2012] [Indexed: 11/05/2022]
Abstract
Our previous research on traumatic brain injury (TBI) patients has shown a strong relationship between specific white matter (WM) diffusion properties and motor deficits. The potential impact of TBI-related changes in network organization of the associated WM structural network on motor performance, however, remains largely unknown. Here, we used diffusion tensor imaging (DTI) based fiber tractography to reconstruct the human brain WM networks of 12 TBI and 17 control participants, followed by a graph theoretical analysis. A force platform was used to measure changes in body posture under conditions of compromised proprioceptive and/or visual feedback. Findings revealed that compared with controls, TBI patients showed higher betweenness centrality and normalized path length, and lower values of local efficiency, implying altered network organization. These results were not merely a consequence of differences in number of connections. In particular, TBI patients displayed reduced structural connectivity in frontal, parieto-premotor, visual, subcortical, and temporal areas. In addition, the decreased connectivity degree was significantly associated with poorer balance performance. We conclude that analyzing the structural brain networks with a graph theoretical approach provides new insights into motor control deficits following brain injury.
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Affiliation(s)
- K Caeyenberghs
- Motor Control Laboratory, Research Center for Movement Control and Neuroplasticity, KU Leuven, Belgium
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Kobayashi S. Organization of neural systems for aversive information processing: pain, error, and punishment. Front Neurosci 2012; 6:136. [PMID: 23049496 PMCID: PMC3448295 DOI: 10.3389/fnins.2012.00136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/31/2012] [Indexed: 11/30/2022] Open
Abstract
The avoidance of aversive events is critically important for the survival of organisms. It has been proposed that the medial pain system, including the amygdala, periaqueductal gray (PAG), and anterior cingulate cortex (ACC), contains the neural circuitry that signals pain affect and negative value. This system appears to have multiple defense mechanisms, such as rapid stereotyped escape, aversive association learning, and cognitive adaptation. These defense mechanisms vary in speed and flexibility, reflecting different strategies of self-protection. Over the course of evolution, the medial pain system appears to have developed primitive, associative, and cognitive solutions for aversive avoidance. There may be a functional grading along the caudal-rostral axis, such that the amygdala-PAG system underlies automatic and autonomic responses, the amygdala-orbitofrontal system contributes to associative learning, and the ACC controls cognitive processes in cooperation with the lateral prefrontal cortex. A review of behavioral and physiological studies on the aversive system is presented, and a conceptual framework for understanding the neural organization of the aversive avoidance system is proposed.
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Stimulus site and modality dependence of functional activity within the human spinal cord. J Neurosci 2012; 32:6231-9. [PMID: 22553029 DOI: 10.1523/jneurosci.2543-11.2012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic pain is thought to arise because of maladaptive changes occurring within the peripheral nervous system and CNS. The transition from acute to chronic pain is known to involve the spinal cord (Woolf and Salter, 2000). Therefore, to investigate altered human spinal cord function and translate results obtained from other species, a noninvasive neuroimaging technique is desirable. We have investigated the functional response in the cervical spinal cord of 18 healthy human subjects (aged 22-40 years) to noxious thermal and non-noxious tactile stimulation of the left and right forearms. Physiological noise, which is a significant source of signal variability in the spinal cord, was accounted for in the general linear model. Group analysis, performed using a mixed-effects model, revealed distinct regions of activity that were dependent on both the side and the type of stimulation. In particular, thermal stimulation on the medial aspect of the wrist produced activity within the C6/C5 segment ipsilateral to the side of stimulation. Similar to data recorded in animals (Fitzgerald, 1982), painful thermal stimuli produced increased ipsilateral and decreased contralateral blood flow, which may reflect, respectively, excitatory and inhibitory processes. Nonpainful punctate stimulation of the thenar eminence provoked more diffuse activity but was still ipsilateral to the side of stimulation. These results present the first noninvasive evidence for a lateralized response to noxious and non-noxious stimuli in the human spinal cord. The development of these techniques opens the path to understanding, at a subject-specific level, central sensitization processes that contribute to chronic pain states.
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Peyron R, Pomares FB, Faillenot I, Barral FG, Laurent B. Modulations of pain sensations. Neurophysiol Clin 2012; 42:293-8. [PMID: 23040700 DOI: 10.1016/j.neucli.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 12/19/2022] Open
Abstract
Representation of time may affect pain perception. We investigated a group of volunteers looking at different clocks while they were being exposed to the same intensity of pain in two experiments. In one case, they saw the actual time, while in the other, they gazed at a clock that made it seem like the stimulation was shortened, even though it wasn't. These results show that simply believing that time is on your side can make anything more bearable. The results were not influenced by the color of the clock (red or green), or the presence of indexes such as (sad or smiling) smileys. The effects were maximal for high intensities of stimulation (pain threshold +1°C) if the stimulation lasted for at least 25s but were absent if the stimulation was short (15 min). These results suggest that pain modulation by time context is mainly available for long and intense painful stimulations. The right upper and posterior parietal cortex may support this effect. These findings are discussed with regard to previous literature of pain modulations but also with regard to the concept of the "pain matrix", its inputs and the temporal dynamics of its constitutive responses.
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Affiliation(s)
- R Peyron
- U1028 Inserm, Central Integration of Pain, Neuroscience Research Center, Saint-Étienne, France.
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Imaging the neural correlates of neuropathic pain and pleasurable relief associated with inherited erythromelalgia in a single subject with quantitative arterial spin labelling. Pain 2012; 153:1122-1127. [PMID: 22365309 PMCID: PMC3438450 DOI: 10.1016/j.pain.2011.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/05/2011] [Accepted: 12/12/2011] [Indexed: 11/23/2022]
Abstract
We identified a patient with severe inherited erythromelalgia secondary to an L858F mutation in the voltage-gated sodium channel Nav1.7. The patient reported severe ongoing foot pain, which was exquisitely sensitive to limb cooling. We confirmed this heat hypersensitivity using quantitative sensory testing. Additionally, we employed a novel perfusion imaging technique in a simple block design to assess her baseline erythromelalgia pain vs cooling relief. Robust activations of key pain, pain-affect, and reward-related centres were observed. This combined approach allowed us to confirm the presence of a temperature-sensitive channelopathy of peripheral neurons and to investigate the neural correlates of tonic neuropathic pain and relief in a single subject.
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