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Delsart A, Castel A, Dumas G, Otis C, Lachance M, Barbeau-Grégoire M, Lussier B, Péron F, Hébert M, Lapointe N, Moreau M, Martel-Pelletier J, Pelletier JP, Troncy E. Non-invasive electroencephalography in awake cats: Feasibility and application to sensory processing in chronic pain. J Neurosci Methods 2024; 411:110254. [PMID: 39173717 DOI: 10.1016/j.jneumeth.2024.110254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/06/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Feline osteoarthritis (OA) leads to chronic pain and somatosensory sensitisation. In humans, sensory exposure can modulate chronic pain. Recently, electroencephalography (EEG) revealed a specific brain signature to human OA. However, EEG pain characterisation or its modulation does not exist in OA cats, and all EEG were conducted in sedated cats, using intradermal electrodes, which could alter sensory (pain) perception. NEW METHOD Cats (n=11) affected by OA were assessed using ten gold-plated surface electrodes. Sensory stimuli were presented in random orders: response to mechanical temporal summation, grapefruit scent and mono-chromatic wavelengths (500 nm-blue, 525 nm-green and 627 nm-red light). The recorded EEG was processed to identify event-related potentials (ERP) and to perform spectral analysis (z-score). RESULTS The procedure was well-tolerated. The ERPs were reported for both mechanical (F3, C3, Cz, P3, Pz) and olfactory stimuli (Cz, Pz). The main limitation was motion artifacts. Spectral analysis revealed a significant interaction between the power of EEG frequency bands and light wavelengths (p<0.001). All wavelengths considered, alpha band proportion was higher than that of delta and gamma bands (p<0.044), while the latter was lower than the beta band (p<0.016). Compared to green and red, exposure to blue light elicited distinct changes in EEG power over time (p<0.001). COMPARISON WITH EXISTING METHOD This is the first demonstration of EEG feasibility in conscious cats with surface electrodes recording brain activity while exposing them to sensory stimulations. CONCLUSION The identification of ERPs and spectral patterns opens new avenues for investigating feline chronic pain and its potential modulation through sensory interventions.
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Affiliation(s)
- Aliénor Delsart
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada
| | - Aude Castel
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Department of clinical sciences, Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.
| | - Guillaume Dumas
- Department of psychiatry and addictology, Faculté de médecine, Université de Montréal, Québec, Canada; Research center of the Sainte-Justine mother and child university hospital center (CHU Sainte-Justine), Québec, Canada
| | - Colombe Otis
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada
| | - Mathieu Lachance
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada
| | - Maude Barbeau-Grégoire
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada
| | - Bertrand Lussier
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Department of clinical sciences, Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada; Osteoarthritis research unit, University of Montreal hospital research center (CRCHUM), Québec, Canada
| | | | - Marc Hébert
- Department of ophthalmology and otorhinolaryngology - Head and neck surgery, Faculté de médecine, Université Laval, Québec, Canada; CERVO Brain Research Center, Québec, Canada
| | | | - Maxim Moreau
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Osteoarthritis research unit, University of Montreal hospital research center (CRCHUM), Québec, Canada
| | - Johanne Martel-Pelletier
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Osteoarthritis research unit, University of Montreal hospital research center (CRCHUM), Québec, Canada
| | - Jean-Pierre Pelletier
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Osteoarthritis research unit, University of Montreal hospital research center (CRCHUM), Québec, Canada
| | - Eric Troncy
- Groupe de recherche en pharmacologie animale du Québec (GREPAQ), Université de Montréal, Québec, Canada; Osteoarthritis research unit, University of Montreal hospital research center (CRCHUM), Québec, Canada
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Aspbury M, Mansfield RC, Baxter L, Bhatt A, Cobo MM, Fitzgibbon SP, Hartley C, Hauck A, Marchant S, Monk V, Pillay K, Poorun R, van der Vaart M, Slater R. Establishing a standardised approach for the measurement of neonatal noxious-evoked brain activity in response to an acute somatic nociceptive heel lance stimulus. Cortex 2024; 179:215-234. [PMID: 39197410 DOI: 10.1016/j.cortex.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/10/2024] [Accepted: 05/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Electroencephalography (EEG) can be used in neonates to measure brain activity changes that are evoked by noxious events, such as clinically required immunisations, cannulation and heel lancing for blood tests. EEG provides an alternative approach to infer pain experience in infants compared with more commonly used behavioural and physiological pain assessments. Establishing the generalisability and construct validity of these measures will help corroborate the use of brain-derived outcomes to evaluate the efficacy of new or existing pharmacological and non-pharmacological methods to treat neonatal pain. This study aimed to test whether a measure of noxious-evoked EEG activity called the noxious neurodynamic response function (n-NRF), that was originally derived in a sample of term-aged infants at the Oxford John Radcliffe Hospital, UK, in 2017, can reliably distinguish noxious from non-noxious events in two independent datasets collected at University College London Hospital and at Royal Devon & Exeter Hospital. We aimed to reproduce three published results that use this measure to quantify noxious-evoked changes in brain activity. We used the n-NRF to quantify noxious-evoked brain activity to test (i) whether significantly larger noxious-evoked activity is recorded in response to a clinical heel lance compared to a non-noxious control heel lance procedure; (ii) whether the magnitude of the activity evoked by a noxious heel lance is equivalent in independent cohorts of infants; and (iii) whether the magnitude of the noxious-evoked brain activity increases with postmenstrual age (PMA) in premature infants up to 37 weeks PMA. Positive replication of these studies will build confidence in the use of the n-NRF as a valid and reliable pain-related outcome which could be used to evaluate analgesic efficacy in neonates. The protocol for this study was published following peer review (https://doi.org/10.17605/OSF.IO/ZY9MS). RESULTS The n-NRF magnitude to a noxious heel lance stimulus was significantly greater than to a non-noxious control heel lance stimulus in both the UCL dataset (n = 60; mean difference .88; 95% confidence interval (CI) .64-1.13; p < .0001) and the Exeter dataset (n = 31; mean difference .31; 95% CI .02-.61; p = .02). The mean magnitude and 90% bootstrap confidence interval of the n-NRF evoked by the heel lance did not meet our pre-defined equivalence bounds of 1.0 ± .2 in either the UCL dataset (n = 72; mean magnitude 1.33; 90% bootstrapped CI 1.18-1.52) or the Exeter dataset (n = 35; mean magnitude .92, 90% bootstrapped CI .74-1.22). The magnitude of the n-NRF to the noxious stimulus was significantly positively correlated with PMA in infants up to 37 weeks PMA (n = 65; one-sided Pearson's R, adjusted for site: .24; 95% CI .06-1.00; p = .03). CONCLUSIONS We have reproduced in independent datasets the findings that the n-NRF response to a noxious stimulus is significantly greater than to a non-noxious stimulus, and that the noxious-evoked EEG response increases with PMA. The pre-defined equivalence bounds for the mean magnitude of the EEG response were not met, though this might be due to either inter-site differences such as the lack of calibration of devices between sites (a true negative) or underpowering (a false negative). This reproducibility study provides robust evidence that supports the use of the n-NRF as an objective outcome for clinical trials assessing acute nociception in neonates. Use of the n-NRF in this way has the potential to transform the way analgesic efficacy studies are performed.
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Affiliation(s)
| | - Roshni C Mansfield
- Department of Paediatrics, University of Oxford, Oxford, UK; Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maria M Cobo
- Department of Paediatrics, University of Oxford, Oxford, UK; Universidad San Francisco de Quito USFQ, Colegio de Ciencias Biologicas y Ambientales, Quito, Ecuador
| | - Sean P Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | | | - Annalisa Hauck
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Simon Marchant
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Vaneesha Monk
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Kirubin Pillay
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ravi Poorun
- Children's Services, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK; College of Medicine & Health, University of Exeter, Exeter, UK
| | | | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Sevivas C, Ibáñez R, Fontalvo M, Couce ML, Camprubí-Camprubí M. Pain and heart rate variability in neonates receiving dexmedetomidine. J Perinatol 2024:10.1038/s41372-024-02053-8. [PMID: 39033232 DOI: 10.1038/s41372-024-02053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Neonates in a NICU experience pain. Based on the cardiovascular and nociceptive systems link, a Newborn Infant Parasympathetic Evaluation (NIPE) monitor was designed to assess pain. The use of α2-agonists as analgesic-sedative drugs has increased in neonates. Given their effect on the autonomic system, we hypothesized that their use may alter NIPE's measurement capacity. METHODS Data were prospectively collected. The included patients were evaluated using combined pain assessment systems. RESULTS Sixteen newborns requiring sedoanalgesia underwent a total of 84 pain assessments. A good correlation was found between the NIPE-index and the COMFORT-neo and the crSO2 (cerebral regional oxygen saturation). No correlation was found in premature infants. By sedation group, the correlation remained in those receiving α2-agonist. CONCLUSION NIPE is a reliable tool for pain assessment. Further studies in premature infants are needed. The use of α2-agonist does not alter the measuring capacity of NIPE. The correlation between NIPE-index and crSO2 was also demonstrated.
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Affiliation(s)
- Catarina Sevivas
- Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain.
- Neonatology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), RICORS, Santiago de Compostela, Spain.
| | - Ruth Ibáñez
- Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Melissa Fontalvo
- Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - María Luz Couce
- Neonatology, Clinical University Hospital of Santiago de Compostela, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), RICORS, MetabERN: European Reference Network for Rare Hereditary Metabolic Disorders, Santiago de Compostela, Spain
| | - Marta Camprubí-Camprubí
- Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
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Amornjiraporn I, Rugsapol S, Thanasarnpaiboon P, Paes B, Kitsommart R. A comparison of the effect of procedural pain on cerebral oxygen saturation between late preterm and term infants. J Perinatol 2024:10.1038/s41372-024-01978-4. [PMID: 38789794 DOI: 10.1038/s41372-024-01978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants. METHODS Near-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed. RESULTS Thirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted. CONCLUSION LPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age.
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Affiliation(s)
- Ittichote Amornjiraporn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supranee Rugsapol
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawit Thanasarnpaiboon
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Schulthess S, Friedl S, Narula G, Brandi G, Willms JF, Keller E, Bicciato G. Low frequency oscillations reflect neurovascular coupling and disappear after cerebral death. Sci Rep 2024; 14:11287. [PMID: 38760449 PMCID: PMC11101423 DOI: 10.1038/s41598-024-61819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
Spectrum power analysis in the low frequency oscillations (LFO) region of functional near infrared spectroscopy (fNIRS) is a promising method to deliver information about brain activation and therefore might be used for prognostication in patients with disorders of consciousness in the neurocritical care unit alongside with established methods. In this study, we measure the cortical hemodynamic response measured by fNIRS in the LFO region following auditory and somatosensory stimulation in healthy subjects. The significant hemodynamic reaction in the contralateral hemisphere correlation with the physiologic electric response suggests neurovascular coupling. In addition, we investigate power spectrum changes in steady state measurements of cerebral death patients and healthy subjects in the LFO region, the frequency of the heartbeat and respiration. The spectral power within the LFO region was lower in the patients with cerebral death compared to the healthy subjects, whereas there were no differences in spectral power for physiological activities such as heartbeat and respiration rate. This finding indicates the cerebral origin of our low frequency measurements. Therefore, LFO measurements are a potential method to detect brain activation in patients with disorders of consciousness and cerebral death. However, further studies in patients are needed to investigate its potential clinical use.
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Affiliation(s)
- Sven Schulthess
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland.
| | - Susanne Friedl
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Gagan Narula
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Jan Folkard Willms
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery, Institute of Intensive Care Medicine, University Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland
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Zhang H, Hu Y, Li Y, Li D, Liu H, Li X, Song Y, Zhao C. Neurovascular coupling in the attention during visual working memory processes. iScience 2024; 27:109368. [PMID: 38510112 PMCID: PMC10951642 DOI: 10.1016/j.isci.2024.109368] [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: 11/06/2023] [Revised: 11/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Focusing attention in visual working memory (vWM) depends on the ability to filter distractors and expand the scope of targets. Although many properties of attention processes in vWM have been well documented, it remains unclear how the mechanisms of neurovascular coupling (NVC) function during attention processes in vWM. Here, we show simultaneous multimodal data that reveal the similar temporal and spatial features of attention processes during vWM. These similarities lead to common NVC outcomes across individuals. When filtering out distractors, the electroencephalography (EEG)-informed NVC displayed broader engagement across the frontoparietal network. A negative correlation may exist between behavioral metrics and EEG-informed NVC strength related to attention control. On a dynamic basis, NVC features exhibited higher discriminatory power in predicting behavior than other features alone. These results underscore how multimodal approaches can advance our understanding of the role of attention in vWM, and how NVC fluctuations are associated with actual behavior.
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Affiliation(s)
- Hao Zhang
- School of Systems Science, Beijing Normal University, Beijing 100875, China
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China
- International Academic Center of Complex Systems, Advanced Institute of Natural Sciences, Beijing Normal University, Zhuhai, China
| | - Yiqing Hu
- Chinese Institute for Brain Research, Beijing 102206, China
| | - Yang Li
- Chinese Institute for Brain Research, Beijing 102206, China
| | - Dongwei Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Department of Applied Psychology, School of Arts and Sciences, Beijing Normal University, Zhuhai, China
| | - Hanli Liu
- Department of Bioengineering, the University of Texas at Arlington, Arlington, TX, USA
| | - Xiaoli Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yan Song
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Chenguang Zhao
- School of Systems Science, Beijing Normal University, Beijing 100875, China
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China
- Chinese Institute for Brain Research, Beijing 102206, China
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Bardol M, Pan S, Walker SM, Standing JF, Dawes JM. Pharmacokinetic pharmacodynamic modeling of analgesics and sedatives in children. Paediatr Anaesth 2023; 33:781-792. [PMID: 37341161 PMCID: PMC10947261 DOI: 10.1111/pan.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
Pharmacokinetic pharmacodynamic modeling is an important tool which uses statistical methodology to provide a better understanding of the relationship between concentration and effect of drugs such as analgesics and sedatives. Pharmacokinetic pharmacodynamic models also describe between-subject variability that allows identification of subgroups and dose adjustment for optimal pain management in individual patients. This approach is particularly useful in the pediatric population, where most drugs have received limited evaluation and dosing is extrapolated from adult practice. In children, the covariates of weight and age are used to describe size- and maturation-related changes in pharmacokinetics. It is important to consider both size and maturation in order to develop an accurate model and determine the optimal dose for different age groups. An adequate assessment of analgesic and sedative effect using pain scales or brain activity measures is essential to build reliable pharmacokinetic pharmacodynamic models. This is often challenging in children due to the multidimensional nature of pain and the limited sensitivity and specificity of some measurement tools. This review provides a summary of the pharmacokinetic and pharmacodynamic methodology used to describe the dose-concentration-effect relationship of analgesics and sedation in children, with a focus on the different pharmacodynamic endpoints and the challenges of pharmacodynamic modeling.
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Affiliation(s)
- Maddlie Bardol
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Shan Pan
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Suellen M. Walker
- Department of Anaesthesia and Pain MedicineGreat Ormond St Hospital NHS Foundation TrustLondonUK
- Developmental Neurosciences Program, UCL Great Ormond St Institute of Child HealthUniversity College LondonLondonUK
| | - Joseph F. Standing
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PharmacyGreat Ormond St Hospital NHS Foundation TrustLondonUK
| | - Joy M. Dawes
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of Anaesthesia and Pain MedicineGreat Ormond St Hospital NHS Foundation TrustLondonUK
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Agyeman K, McCarty T, Multani H, Mattingly K, Koziar K, Chu J, Liu C, Kokkoni E, Christopoulos V. Task-based functional neuroimaging in infants: a systematic review. Front Neurosci 2023; 17:1233990. [PMID: 37655006 PMCID: PMC10466897 DOI: 10.3389/fnins.2023.1233990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Infancy is characterized by rapid neurological transformations leading to consolidation of lifelong function capabilities. Studying the infant brain is crucial for understanding how these mechanisms develop during this sensitive period. We review the neuroimaging modalities used with infants in stimulus-induced activity paradigms specifically, for the unique opportunity the latter provide for assessment of brain function. Methods Conducted a systematic review of literature published between 1977-2021, via a comprehensive search of four major databases. Standardized appraisal tools and inclusion/exclusion criteria were set according to the PRISMA guidelines. Results Two-hundred and thirteen papers met the criteria of the review process. The results show clear evidence of overall cumulative growth in the number of infant functional neuroimaging studies, with electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) to be the most utilized and fastest growing modalities with behaving infants. However, there is a high level of exclusion rates associated with technical limitations, leading to limited motor control studies (about 6 % ) in this population. Conclusion Although the use of functional neuroimaging modalities with infants increases, there are impediments to effective adoption of existing technologies with this population. Developing new imaging modalities and experimental designs to monitor brain activity in awake and behaving infants is vital.
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Affiliation(s)
- Kofi Agyeman
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Tristan McCarty
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Harpreet Multani
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Kamryn Mattingly
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
| | - Katherine Koziar
- Orbach Science Library, University of California, Riverside, Riverside, CA, United States
| | - Jason Chu
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Charles Liu
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Elena Kokkoni
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Vassilios Christopoulos
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
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9
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Rupawala M, Bucsea O, Laudiano-Dray MP, Whitehead K, Meek J, Fitzgerald M, Olhede S, Jones L, Fabrizi L. A developmental shift in habituation to pain in human neonates. Curr Biol 2023; 33:1397-1406.e5. [PMID: 36931271 DOI: 10.1016/j.cub.2023.02.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/22/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
Habituation to recurrent non-threatening or unavoidable noxious stimuli is an important aspect of adaptation to pain. Neonates, especially if preterm, are exposed to repeated noxious procedures during their clinical care. They can mount strong behavioral, autonomic, spinal, and cortical responses to a single noxious stimulus; however, it is not known whether the developing nervous system can adapt to the recurrence of these inputs. Here, we used electroencephalography to investigate changes in cortical microstates (representing the complex sequential processing of noxious inputs) following two consecutive clinically required heel lances in term and preterm infants. We show that stimulus repetition dampens the engagement of initial microstates and associated behavioral and autonomic responses in term infants, while preterm infants do not show signs of habituation. Nevertheless, both groups engage different longer-latency cortical microstates to each lance, which is likely to reflect changes in higher-level stimulus processing with repeated stimulation. These data suggest that while both age groups are capable of encoding contextual differences in pain, the preterm brain does not regulate the initial cortical, behavioral, and autonomic responses to repeated noxious stimuli. Habituation mechanisms to pain are already in place at term age but mature over the equivalent of the last trimester of gestation and are not fully functional in preterm neonates.
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Affiliation(s)
- Mohammed Rupawala
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK
| | - Oana Bucsea
- Faculty of Health, Department of Psychology, York University, Toronto, ON M3J 1P3, Canada
| | | | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London WC1E 6DB, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK
| | - Sofia Olhede
- Department of Statistical Science, University College London, London WC1E 6BT, UK; Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne 1015, Switzerland
| | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK.
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10
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Jotwani ML, Wu Z, Lunde CE, Sieberg CB. The missing mechanistic link: Improving behavioral treatment efficacy for pediatric chronic pain. FRONTIERS IN PAIN RESEARCH 2022; 3:1022699. [PMID: 36313218 PMCID: PMC9614027 DOI: 10.3389/fpain.2022.1022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Pediatric chronic pain is a significant global issue, with biopsychosocial factors contributing to the complexity of the condition. Studies have explored behavioral treatments for pediatric chronic pain, but these treatments have mixed efficacy for improving functional and psychological outcomes. Furthermore, the literature lacks an understanding of the biobehavioral mechanisms contributing to pediatric chronic pain treatment response. In this mini review, we focus on how neuroimaging has been used to identify biobehavioral mechanisms of different conditions and how this modality can be used in mechanistic clinical trials to identify markers of treatment response for pediatric chronic pain. We propose that mechanistic clinical trials, utilizing neuroimaging, are warranted to investigate how to optimize the efficacy of behavioral treatments for pediatric chronic pain patients across pain types and ages.
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Affiliation(s)
- Maya L. Jotwani
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Ziyan Wu
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B. Sieberg
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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11
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Early life inflammation is associated with spinal cord excitability and nociceptive sensitivity in human infants. Nat Commun 2022; 13:3943. [PMID: 35803920 PMCID: PMC9270448 DOI: 10.1038/s41467-022-31505-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Abstract
Immune function and sensitivity to pain are closely related, but the association between early life inflammation and sensory nervous system development is poorly understood-especially in humans. Here, in term-born infants, we measure brain activity and reflex withdrawal activity (using EEG and EMG) and behavioural and physiological activity (using the PIPP-R score) to assess the impact of suspected early-onset neonatal infection on tactile- and noxious-evoked responses. We present evidence that neonatal inflammation (assessed by measuring C-reactive protein levels) is associated with increased spinal cord excitability and evoked brain activity following both tactile and noxious stimulation. There are early indications that this hyperalgesia could be maintained post-inflammation, supporting pre-clinical reports of early-life immune dysfunction influencing pain sensitivity in adults.
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12
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Jones L, Verriotis M, Cooper RJ, Laudiano-Dray MP, Rupawala M, Meek J, Fabrizi L, Fitzgerald M. Widespread nociceptive maps in the human neonatal somatosensory cortex. eLife 2022; 11:71655. [PMID: 35451960 PMCID: PMC9090328 DOI: 10.7554/elife.71655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Topographic cortical maps are essential for spatial localisation of sensory stimulation and generation of appropriate task-related motor responses. Somatosensation and nociception are finely mapped and aligned in the adult somatosensory (S1) cortex, but in infancy, when pain behaviour is disorganised and poorly directed, nociceptive maps may be less refined. We compared the topographic pattern of S1 activation following noxious (clinically required heel lance) and innocuous (touch) mechanical stimulation of the same skin region in newborn infants (n = 32) using multioptode functional near-infrared spectroscopy (fNIRS). Within S1 cortex, touch and lance of the heel elicit localised, partially overlapping increases in oxygenated haemoglobin concentration (Δ[HbO]), but while touch activation was restricted to the heel area, lance activation extended into cortical hand regions. The data reveals a widespread cortical nociceptive map in infant S1, consistent with their poorly directed pain behaviour.
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Affiliation(s)
- Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Madeleine Verriotis
- Department of Developmental Neuroscience, University College London, London, United Kingdom
| | - Robert J Cooper
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Mohammed Rupawala
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
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13
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Yeung MK, Chu VW. Viewing neurovascular coupling through the lens of combined EEG-fNIRS: A systematic review of current methods. Psychophysiology 2022; 59:e14054. [PMID: 35357703 DOI: 10.1111/psyp.14054] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022]
Abstract
Neurovascular coupling is a key physiological mechanism that occurs in the healthy human brain, and understanding this process has implications for understanding the aging and neuropsychiatric populations. Combined electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) has emerged as a promising, noninvasive tool for probing neurovascular interactions in humans. However, the utility of this approach critically depends on the methodological quality used for multimodal integration. Despite a growing number of combined EEG-fNIRS applications reported in recent years, the methodological rigor of past studies remains unclear, limiting the accurate interpretation of reported findings and hindering the translational application of this multimodal approach. To fill this knowledge gap, we critically evaluated various methodological aspects of previous combined EEG-fNIRS studies performed in healthy individuals. A literature search was conducted using PubMed and PsycINFO on June 28, 2021. Studies involving concurrent EEG and fNIRS measurements in awake and healthy individuals were selected. After screening and eligibility assessment, 96 studies were included in the methodological evaluation. Specifically, we critically reviewed various aspects of participant sampling, experimental design, signal acquisition, data preprocessing, outcome selection, data analysis, and results presentation reported in these studies. Altogether, we identified several notable strengths and limitations of the existing EEG-fNIRS literature. In light of these limitations and the features of combined EEG-fNIRS, recommendations are made to improve and standardize research practices to facilitate the use of combined EEG-fNIRS when studying healthy neurovascular coupling processes and alterations in neurovascular coupling among various populations.
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Affiliation(s)
- Michael K Yeung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Vivian W Chu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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14
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Yuan I, Nelson O, Barr GA, Zhang B, Topjian AA, DiMaggio TJ, Lang SS, Christ LA, Izzetoglu K, Greco CC, Kurth CD, Ganesh A. Functional near-infrared spectroscopy to assess pain in neonatal circumcisions. Paediatr Anaesth 2022; 32:404-412. [PMID: 34747096 DOI: 10.1111/pan.14326] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near-infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy-(HbO) and total-hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale. METHODS In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1-Prep before local anesthetic injection; 2-Local anesthetic injection; 3-Prep before incision; 4-Oral sucrose; 5-Incision; 6-Gomco (hemostatic device) attached; 7-Gomco twisted on; and 8-Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed-rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient. RESULTS In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1], p < .001; HbT: 2.3 [0.2, 7.6], p < .001), Gomco attached (HbO: 0.7 [0.1, 1.7], p = .002; HbT: 0.7 [-0.2, 2.9], p = .02), and Gomco twisted on (HbO: 0.5 [-0.2, 1.7], p = .03; HbT: 0.8 [-0.1, 3.3], p = .02). fNIRS decreased with non-noxious event: Prep before incision (HbO: -0.6 [-1.2, -0.2] p < .001; HbT: -1 [-1.8, -0.4], p < .001). Local anesthetic attenuated fNIRS increases to subsequent sharp stimuli. NIPS increased with subsequent sharp stimuli despite local anesthetic. Although fNIRS and NIPS changed in the same direction, there was not a strong correlation between them. CONCLUSIONS During neonatal circumcision, changes in fNIRS differed between different types of painful stimuli, which was not the case for NIPS, suggesting that fNIRS may complement NIPS to assess the quality of pain.
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Affiliation(s)
- Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bingqing Zhang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theresa J DiMaggio
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Division of Neurosurgery, Department of Neurosurgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori A Christ
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christine C Greco
- Department of Neonatology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles D Kurth
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arjunan Ganesh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Goel S, Choudhary S, Saxena A, Sonkar M. The myth and half-truths of fetal pain decrypted: A metaverse. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Shiroshita Y, Kirimoto H, Watanabe T, Yunoki K, Sobue I. Event-related potentials evoked by skin puncture reflect activation of Aβ fibers: comparison with intraepidermal and transcutaneous electrical stimulations. PeerJ 2021; 9:e12250. [PMID: 34707936 PMCID: PMC8504465 DOI: 10.7717/peerj.12250] [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: 02/26/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background Recently, event-related potentials (ERPs) evoked by skin puncture, commonly used for blood sampling, have received attention as a pain assessment tool in neonates. However, their latency appears to be far shorter than the latency of ERPs evoked by intraepidermal electrical stimulation (IES), which selectively activates nociceptive Aδ and C fibers. To clarify this important issue, we examined whether ERPs evoked by skin puncture appropriately reflect central nociceptive processing, as is the case with IES. Methods In Experiment 1, we recorded evoked potentials to the click sound produced by a lance device (click-only), lance stimulation with the click sound (click+lance), or lance stimulation with white noise (WN+lance) in eight healthy adults to investigate the effect of the click sound on the ERP evoked by skin puncture. In Experiment 2, we tested 18 heathy adults and recorded evoked potentials to shallow lance stimulation (SL) with a blade that did not reach the dermis (0.1 mm insertion depth); normal lance stimulation (CL) (1 mm depth); transcutaneous electrical stimulation (ES), which mainly activates Aβ fibers; and IES, which selectively activates Aδ fibers when low stimulation current intensities are applied. White noise was continuously presented during the experiments. The stimulations were applied to the hand dorsum. In the SL, the lance device did not touch the skin and the blade was inserted to a depth of 0.1 mm into the epidermis, where the free nerve endings of Aδ fibers are located, which minimized the tactile sensation caused by the device touching the skin and the activation of Aβ fibers by the blade reaching the dermis. In the CL, as in clinical use, the lance device touched the skin and the blade reached a depth of 1 mm from the skin surface, i.e., the depth of the dermis at which the Aβ fibers are located. Results The ERP N2 latencies for click-only (122 ± 2.9 ms) and click+lance (121 ± 6.5 ms) were significantly shorter than that for WN+lance (154 ± 7.1 ms). The ERP P2 latency for click-only (191 ± 11.3 ms) was significantly shorter than those for click+lance (249 ± 18.6 ms) and WN+lance (253 ± 11.2 ms). This suggests that the click sound shortens the N2 latency of the ERP evoked by skin puncture. The ERP N2 latencies for SL, CL, ES, and IES were 146 ± 8.3, 149 ± 9.9, 148 ± 13.1, and 197 ± 21.2 ms, respectively. The ERP P2 latencies were 250 ± 18.2, 251 ± 14.1, 237 ± 26.3, and 294 ± 30.0 ms, respectively. The ERP latency for SL was significantly shorter than that for IES and was similar to that for ES. This suggests that the penetration force generated by the blade of the lance device activates the Aβ fibers, consequently shortening the ERP latency. Conclusions Lance ERP may reflect the activation of Aβ fibers rather than Aδ fibers. A pain index that correctly and reliably reflects nociceptive processing must be developed to improve pain assessment and management in neonates.
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Affiliation(s)
- Yui Shiroshita
- Department of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hikari Kirimoto
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsunori Watanabe
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Yunoki
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuko Sobue
- Department of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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17
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Nishino T, Ito N, Tomori S, Shimada S, Kodera M, Morita K, Takahashi K, Mimaki M. Effects of Temperature and Position Change on Neonatal Brain Regional Oxygen Saturation in Tub Bathing: A Prospective Study. Pain Ther 2021; 10:1269-1282. [PMID: 34263424 PMCID: PMC8279383 DOI: 10.1007/s40122-021-00290-9] [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: 05/15/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION A major goal in neonatal medicine is to reduce stress as much as possible in routine care. Bathing is one of the important routine cares for neonates, but it makes a big environmental change for them. We aimed to examine whether water temperature, room temperature, and position changes in tub bathing serve as noxious stimuli to neonates. METHODS This prospective trial was performed in full-term and non-low-birth-weight neonates admitted to the hospital between July 2020 and March 2021. Those with underlying diseases, fetal distress, infection, and other medical conditions were excluded. Measurements were taken during the neonates' first tub bath since birth, which was performed by a trained nurse. Changes in regional oxygen saturation (rSO2), determined using near-infrared spectroscopy, and water and room temperature, were examined at five different time points: upon entering the bath, head washing, position change, exiting the bath, and during the 3 min after bathing. RESULTS In total, 17 neonates were analyzed. No changes in rSO2 due to head washing or position change were observed; however, rSO2 significantly decreased upon entering (78.5 ± 4.1% vs. 75.7 ± 4.1%, p < 0.001) and exiting the bath (75.8 ± 5.7% vs. 74.4 ± 5.4%, p < 0.04). The rate change in rSO2 upon entering the bath showed a significant inverse correlation with water temperature (r = - 0.53, p < 0.03), and there were no significant correlations between rSO2 and water or room temperature upon exiting the bath. There was no change in body skin temperature before and after bathing, but rSO2 gradually decreased during the 3 min after bathing. CONCLUSIONS Neonates may perceive certain temperatures during bathing as noxious stimuli. Therefore, methods to minimize stress associated with bathing should be implemented to reduce the difference between water temperature and room temperature during bathing. TRIAL REGISTRATION This trial has been registered at UMIN repository with the trial number UMIN000041045 ( https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046500 ). The date of the final dataset was April 01, 2021.
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Affiliation(s)
- Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Naoki Ito
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Shinya Tomori
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Satoshi Shimada
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Misaki Kodera
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kiyoko Morita
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Does Repeated Painful Stimuli Change Cerebral Near-Infrared Spectroscopy Response in Healthy, Term, Large for Gestational Age Newborns? Clin J Pain 2021; 36:110-116. [PMID: 31651426 DOI: 10.1097/ajp.0000000000000774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of repeated painful stimuli on short-term pain response in healthy, term, large for gestational age newborns by measuring the regional cerebral oxygen saturation (rScO2), and behavioral and physiological responses. METHODS We compared term large for gestational age infants who received repeated painful stimuli (study group) with term, appropriate for gestational age infants (control group). A pulse oximeter and a near-infrared spectroscopy probe were connected to babies during the study period, and the responses of the babies were recorded by video, from which the crying time and the Neonatal Infant Pain Scale were obtained. The heart rate, peripheral oxygen saturation (SpO2), and rScO2 data were sampled every 1 second and exported to a personal computer via digital output during the study period. The maximum heart rate, the minimum SpO2, and peak, baseline, and mean rScO2 measurements following skin puncture were recorded. Data were compared within 1 group and between the 2 groups. RESULTS After the heel prick, crying time (P<0.001) and Neonatal Infant Pain Scale scores (P=0.024) increased, and SpO2 levels decreased significantly (P=0.012) in the study group versus the control group. Although mean rScO2 increased significantly within 1 group (P<0.001), it was not significant between the 2 groups. The percent change in rScO2 was greater in the study group (5.2 [2.5 to 9.3]) compared with the control group (2.8 [1.1 to 8.2], P=0.037). CONCLUSION We showed that rScO2 values changed significantly within the first few days of life in babies who received more painful stimuli compared with the control group, similar to behavioral and physiological responses.
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19
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Baxter L, Moultrie F, Fitzgibbon S, Aspbury M, Mansfield R, Bastiani M, Rogers R, Jbabdi S, Duff E, Slater R. Functional and diffusion MRI reveal the neurophysiological basis of neonates' noxious-stimulus evoked brain activity. Nat Commun 2021; 12:2744. [PMID: 33980860 PMCID: PMC8115252 DOI: 10.1038/s41467-021-22960-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
Understanding the neurophysiology underlying neonatal responses to noxious stimulation is central to improving early life pain management. In this neonatal multimodal MRI study, we use resting-state and diffusion MRI to investigate inter-individual variability in noxious-stimulus evoked brain activity. We observe that cerebral haemodynamic responses to experimental noxious stimulation can be predicted from separately acquired resting-state brain activity (n = 18). Applying this prediction model to independent Developing Human Connectome Project data (n = 215), we identify negative associations between predicted noxious-stimulus evoked responses and white matter mean diffusivity. These associations are subsequently confirmed in the original noxious stimulation paradigm dataset, validating the prediction model. Here, we observe that noxious-stimulus evoked brain activity in healthy neonates is coupled to resting-state activity and white matter microstructure, that neural features can be used to predict responses to noxious stimulation, and that the dHCP dataset could be utilised for future exploratory research of early life pain system neurophysiology.
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Affiliation(s)
- Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sean Fitzgibbon
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | | | - Matteo Bastiani
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Richard Rogers
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - Saad Jbabdi
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Eugene Duff
- Department of Paediatrics, University of Oxford, Oxford, UK
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK.
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20
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Cobo MM, Hartley C, Gursul D, Andritsou F, van der Vaart M, Schmidt Mellado G, Baxter L, Duff EP, Buckle M, Evans Fry R, Green G, Hoskin A, Rogers R, Adams E, Moultrie F, Slater R. Quantifying noxious-evoked baseline sensitivity in neonates to optimise analgesic trials. eLife 2021; 10:e65266. [PMID: 33847561 PMCID: PMC8087440 DOI: 10.7554/elife.65266] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/17/2021] [Indexed: 01/18/2023] Open
Abstract
Despite the high burden of pain experienced by hospitalised neonates, there are few analgesics with proven efficacy. Testing analgesics in neonates is experimentally and ethically challenging and minimising the number of neonates required to demonstrate efficacy is essential. EEG (electroencephalography)-derived measures of noxious-evoked brain activity can be used to assess analgesic efficacy; however, as variability exists in neonate's responses to painful procedures, large sample sizes are often required. Here, we present an experimental paradigm to account for individual differences in noxious-evoked baseline sensitivity which can be used to improve the design of analgesic trials in neonates. The paradigm is developed and tested across four observational studies using clinical, experimental, and simulated data (92 neonates). We provide evidence of the efficacy of gentle brushing and paracetamol, substantiating the need for randomised controlled trials of these interventions. This work provides an important step towards safe, cost-effective clinical trials of analgesics in neonates.
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Affiliation(s)
- Maria M Cobo
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias Biologicas y AmbientalesQuitoEcuador
| | - Caroline Hartley
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Deniz Gursul
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | | | | | | | - Luke Baxter
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Eugene P Duff
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of OxfordOxfordUnited Kingdom
| | - Miranda Buckle
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Ria Evans Fry
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Gabrielle Green
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Amy Hoskin
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Richard Rogers
- Department of Anaesthetics, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Eleri Adams
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Fiona Moultrie
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of OxfordOxfordUnited Kingdom
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Shiroshita Y, Kirimoto H, Ozawa M, Watanabe T, Uematsu H, Yunoki K, Sobue I. Can Event-Related Potentials Evoked by Heel Lance Assess Pain Processing in Neonates? A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:58. [PMID: 33498331 PMCID: PMC7909417 DOI: 10.3390/children8020058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 01/04/2023]
Abstract
To clarify the possibility of event-related potential (ERP) evoked by heel lance in neonates as an index of pain assessment, knowledge acquired by and problems of the methods used in studies on ERP evoked by heel lance in neonates were systematically reviewed, including knowledge about Aδ and C fibers responding to noxious stimuli and Aβ fibers responding to non-noxious stimuli. Of the 863 reports searched, 19 were selected for the final analysis. The following points were identified as problems for ERP evoked by heel lance in neonates to serve as a pain assessment index: (1) It is possible that the ERP evoked by heel lance reflected the activation of Aβ fibers responding to non-noxious stimuli and not the activation of Aδ or C fibers responding to noxious stimulation; (2) Sample size calculation was presented in few studies, and the number of stimulation trials to obtain an averaged ERP was small. Accordingly, to establish ERP evoked by heel lance as a pain assessment in neonates, it is necessary to perform a study to clarify ERP evoked by Aδ- and C-fiber stimulations accompanied by heel lance in neonates.
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Affiliation(s)
- Yui Shiroshita
- Division of Nursing Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (I.S.)
| | - Hikari Kirimoto
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (H.K.); (T.W.); (K.Y.)
| | - Mio Ozawa
- Division of Nursing Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (I.S.)
| | - Tatsunori Watanabe
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (H.K.); (T.W.); (K.Y.)
| | - Hiroko Uematsu
- School of Nursing, University of Human Environments, Aichi 474-0035, Japan;
| | - Keisuke Yunoki
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (H.K.); (T.W.); (K.Y.)
| | - Ikuko Sobue
- Division of Nursing Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (I.S.)
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22
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Ranger M, Albert A, MacLean K, Holsti L. Cerebral hemodynamic response to a therapeutic bed for procedural pain management in preterm infants in the NICU: a randomized controlled trial. Pain Rep 2021; 6:e890. [PMID: 33490850 PMCID: PMC7808560 DOI: 10.1097/pr9.0000000000000890] [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: 09/13/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We developed a novel device, Calmer, that mimics key components of skin-to-skin holding to reduce stress in preterm infants. Our feasibility trial showed that Calmer worked 50% better than no treatment and no differently from our standard of care, facilitated tucking (FT), for reducing pain scores during a heel lance in preterm infants in the neonatal intensive care unit. OBJECTIVE We compared the effects of Calmer on regional cerebral hemodynamic activity during a noxious stimulation to FT. METHODS During a clinically required heel lance, we measured frontal cortex tissue oxygenation in a subsample of 29 preterm infants (27-33 weeks gestational age) from our larger randomized controlled trial. Infants were randomized to either FT (n = 16) or Calmer treatment (n = 12). The outcome measure, obtained using near-infrared spectroscopy, was a change in the tissue oxygenation index (TSI) across study phases (Baseline, Heel Lance, Recovery; median duration 517 seconds [421-906 seconds]). RESULTS No statistically significant differences were found between groups in the median TSI during any of the study phases. In response to the heel lance, 7 infants (27.6%) had a TSI that dipped below the 60% threshold (3 in the Calmer group 25% and 4 in the FT group 25%); none below 50%. CONCLUSIONS Infants on Calmer maintained normal regional cerebral oxygen levels (55%-85%) no differently from infants receiving a human touch intervention during blood collection. Parental skin-to-skin holding is one of the most effective strategies to relieve procedural pain in preterm infants. When parents or FT are not available, Calmer shows potential for filling this gap in care.
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Affiliation(s)
- Manon Ranger
- School of Nursing, Faculty Applied Science, University of British Columbia, Vancouver, BC, Canada
- B.C. Children's Hospital Research Institute, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hosptial & Health Center, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hosptial & Health Center, Vancouver, BC, Canada
| | - Karon MacLean
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Liisa Holsti
- B.C. Children's Hospital Research Institute, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hosptial & Health Center, Vancouver, BC, Canada
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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23
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Stephan F, Saalbach H, Rossi S. Inner versus Overt Speech Production: Does This Make a Difference in the Developing Brain? Brain Sci 2020; 10:E939. [PMID: 33291489 PMCID: PMC7762104 DOI: 10.3390/brainsci10120939] [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: 11/02/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
Studies in adults showed differential neural processing between overt and inner speech. So far, it is unclear whether inner and overt speech are processed differentially in children. The present study examines the pre-activation of the speech network in order to disentangle domain-general executive control from linguistic control of inner and overt speech production in 6- to 7-year-olds by simultaneously applying electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). Children underwent a picture-naming task in which the pure preparation of a subsequent speech production and the actual execution of speech can be differentiated. The preparation phase does not represent speech per se but it resembles the setting up of the language production network. Only the fNIRS revealed a larger activation for overt, compared to inner, speech over bilateral prefrontal to parietal regions during the preparation phase. Findings suggest that the children's brain can prepare the subsequent speech production. The preparation for overt and inner speech requires different domain-general executive control. In contrast to adults, the children´s brain did not show differences between inner and overt speech when a concrete linguistic content occurs and a concrete execution is required. This might indicate that domain-specific executive control processes are still under development.
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Affiliation(s)
- Franziska Stephan
- Department of Educational Psychology, Faculty of Education, University Leipzig, 04109 Leipzig, Germany;
- Leipzig Research Center for Early Child Development, 04109 Leipzig, Germany
- ICONE, Innsbruck Cognitive Neuroscience, Department for Hearing, Speech, and Voice Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Henrik Saalbach
- Department of Educational Psychology, Faculty of Education, University Leipzig, 04109 Leipzig, Germany;
- Leipzig Research Center for Early Child Development, 04109 Leipzig, Germany
| | - Sonja Rossi
- ICONE, Innsbruck Cognitive Neuroscience, Department for Hearing, Speech, and Voice Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
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24
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Karunakaran KD, Peng K, Berry D, Green S, Labadie R, Kussman B, Borsook D. NIRS measures in pain and analgesia: Fundamentals, features, and function. Neurosci Biobehav Rev 2020; 120:335-353. [PMID: 33159918 DOI: 10.1016/j.neubiorev.2020.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/28/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Current pain assessment techniques based only on clinical evaluation and self-reports are not objective and may lead to inadequate treatment. Having a functional biomarker will add to the clinical fidelity, diagnosis, and perhaps improve treatment efficacy in patients. While many approaches have been deployed in pain biomarker discovery, functional near-infrared spectroscopy (fNIRS) is a technology that allows for non-invasive measurement of cortical hemodynamics. The utility of fNIRS is especially attractive given its ability to detect specific changes in the somatosensory and high-order cortices as well as its ability to measure (1) brain function similar to functional magnetic resonance imaging, (2) graded responses to noxious and innocuous stimuli, (3) analgesia, and (4) nociception under anesthesia. In this review, we evaluate the utility of fNIRS in nociception/pain with particular focus on its sensitivity and specificity, methodological advantages and limitations, and the current and potential applications in various pain conditions. Everything considered, fNIRS technology could enhance our ability to evaluate evoked and persistent pain across different age groups and clinical populations.
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Affiliation(s)
- Keerthana Deepti Karunakaran
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
| | - Ke Peng
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States; Département en Neuroscience, Centre de Recherche du CHUM, l'Université de Montréal Montreal, QC, Canada
| | - Delany Berry
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Stephen Green
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Robert Labadie
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Barry Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, United States.
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25
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Frijia EM, Billing A, Lloyd-Fox S, Vidal Rosas E, Collins-Jones L, Crespo-Llado MM, Amadó MP, Austin T, Edwards A, Dunne L, Smith G, Nixon-Hill R, Powell S, Everdell NL, Cooper RJ. Functional imaging of the developing brain with wearable high-density diffuse optical tomography: A new benchmark for infant neuroimaging outside the scanner environment. Neuroimage 2020; 225:117490. [PMID: 33157266 DOI: 10.1016/j.neuroimage.2020.117490] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023] Open
Abstract
Studies of cortical function in the awake infant are extremely challenging to undertake with traditional neuroimaging approaches. Partly in response to this challenge, functional near-infrared spectroscopy (fNIRS) has become increasingly common in developmental neuroscience, but has significant limitations including resolution, spatial specificity and ergonomics. In adults, high-density arrays of near-infrared sources and detectors have recently been shown to yield dramatic improvements in spatial resolution and specificity when compared to typical fNIRS approaches. However, most existing fNIRS devices only permit the acquisition of ~20-100 sparsely distributed fNIRS channels, and increasing the number of optodes presents significant mechanical challenges, particularly for infant applications. A new generation of wearable, modular, high-density diffuse optical tomography (HD-DOT) technologies has recently emerged that overcomes many of the limitations of traditional, fibre-based and low-density fNIRS measurements. Driven by the development of this new technology, we have undertaken the first study of the infant brain using wearable HD-DOT. Using a well-established social stimulus paradigm, and combining this new imaging technology with advances in cap design and spatial registration, we show that it is now possible to obtain high-quality, functional images of the infant brain with minimal constraints on either the environment or on the infant participants. Our results are consistent with prior low-density fNIRS measures based on similar paradigms, but demonstrate superior spatial localization, improved depth specificity, higher SNR and a dramatic improvement in the consistency of the responses across participants. Our data retention rates also demonstrate that this new generation of wearable technology is well tolerated by the infant population.
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Affiliation(s)
- Elisabetta Maria Frijia
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom; neoLAB, Cambridge University NHS Foundation Trust, Cambridge CB2 OQQ, United Kingdom.
| | - Addison Billing
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom; Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, United Kingdom
| | - Sarah Lloyd-Fox
- Cambridge Babylab, Department of Psychology, University of Cambridge, Cambridge, CB2 3ER, United Kingdom; Centre for Brain and Cognitive Development, Birkbeck, University of London, London WC1E 7HX, United Kingdom
| | - Ernesto Vidal Rosas
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Liam Collins-Jones
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom; neoLAB, Cambridge University NHS Foundation Trust, Cambridge CB2 OQQ, United Kingdom
| | - Maria Magdalena Crespo-Llado
- Cambridge Babylab, Department of Psychology, University of Cambridge, Cambridge, CB2 3ER, United Kingdom; Centre for Brain and Cognitive Development, Birkbeck, University of London, London WC1E 7HX, United Kingdom
| | - Marta Perapoch Amadó
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London WC1E 7HX, United Kingdom; Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Topun Austin
- neoLAB, Cambridge University NHS Foundation Trust, Cambridge CB2 OQQ, United Kingdom
| | - Andrea Edwards
- neoLAB, Cambridge University NHS Foundation Trust, Cambridge CB2 OQQ, United Kingdom
| | - Luke Dunne
- Gowerlabs Ltd., Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Greg Smith
- Gowerlabs Ltd., Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Reuben Nixon-Hill
- Gowerlabs Ltd., Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Samuel Powell
- Gowerlabs Ltd., Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Nicholas L Everdell
- Gowerlabs Ltd., Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Robert J Cooper
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom; neoLAB, Cambridge University NHS Foundation Trust, Cambridge CB2 OQQ, United Kingdom
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26
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Collins-Jones LH, Arichi T, Poppe T, Billing A, Xiao J, Fabrizi L, Brigadoi S, Hebden JC, Elwell CE, Cooper RJ. Construction and validation of a database of head models for functional imaging of the neonatal brain. Hum Brain Mapp 2020; 42:567-586. [PMID: 33068482 PMCID: PMC7814762 DOI: 10.1002/hbm.25242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open
Abstract
The neonatal brain undergoes dramatic structural and functional changes over the last trimester of gestation. The accuracy of source localisation of brain activity recorded from the scalp therefore relies on accurate age-specific head models. Although an age-appropriate population-level atlas could be used, detail is lost in the construction of such atlases, in particular with regard to the smoothing of the cortical surface, and so such a model is not representative of anatomy at an individual level. In this work, we describe the construction of a database of individual structural priors of the neonatal head using 215 individual-level datasets at ages 29-44 weeks postmenstrual age from the Developing Human Connectome Project. We have validated a method to segment the extra-cerebral tissue against manual segmentation. We have also conducted a leave-one-out analysis to quantify the expected spatial error incurred with regard to localising functional activation when using a best-matching individual from the database in place of a subject-specific model; the median error was calculated to be 8.3 mm (median absolute deviation 3.8 mm). The database can be applied for any functional neuroimaging modality which requires structural data whereby the physical parameters associated with that modality vary with tissue type and is freely available at www.ucl.ac.uk/dot-hub.
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Affiliation(s)
- Liam H Collins-Jones
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Biomedical Optics Research Laboratory, Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Department of Bioengineering, Imperial College of Science, Technology, and Medicine, London, UK
| | - Tanya Poppe
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Addison Billing
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Institute for Cognitive Neuroscience, University College London, London, UK
| | - Jiaxin Xiao
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Sabrina Brigadoi
- Department of Information Engineering, University of Padova, Padova, Italy.,Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Jeremy C Hebden
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Biomedical Optics Research Laboratory, Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Clare E Elwell
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Robert J Cooper
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Biomedical Optics Research Laboratory, Medical Physics and Biomedical Engineering, University College London, London, UK
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27
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Dix LML, Shepherd K, Polglase GR, Miller SL, Sehgal A, Wong FY. The Cerebral Hemodynamic Response to Pain in Preterm Infants With Fetal Growth Restriction. Front Pediatr 2020; 8:268. [PMID: 32537447 PMCID: PMC7267032 DOI: 10.3389/fped.2020.00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Preterm infants undergoing intensive care often experience painful procedures such as heel lance for blood sampling. Knowledge of the cerebral hemodynamic response to painful stimuli contributes to understanding of cortical pain processing and the neurovascular network in the preterm brain. Previous research has demonstrated cerebral hemodynamic responses using near-infrared spectroscopy (NIRS) after noxious stimuli in infants appropriately grown for age (AGA). But this has not been studied in infants born small for gestational age after fetal growth restriction (FGR). FGR infants differ in brain development due to utero-placental insufficiency leading to the intrauterine growth restriction, and cerebral response to pain may be altered. Objectives: We aimed to compare the cerebral hemodynamic response to painful stimuli (heel lance) in FGR and AGA infants. Methods: Preterm FGR infants (n = 20) and AGA infants (n = 15) born at 28-32 weeks' gestation were studied at mean ± SD postnatal age of 11.5 ± 2.4 and 10.5 ± 2.4 days, respectively. Infants had baseline echocardiographic assessment of ductus arteriosus and stroke volume. They were monitored with NIRS for changes in tissue oxygenation index (TOI, %), and oxygenated, deoxygenated, and total hemoglobin (ΔO2Hb, ΔHHb, and ΔTHb) in contralateral and ipsilateral cerebral hemispheres, during a heel lance. Results: At baseline, FGR infants had significantly lower TOI, higher heart rate, and lower stroke volume compared to AGA infants. Most infants in both groups showed increase in each of the NIRS parameters in the contralateral hemisphere following heel lance. However, more AGA infants (6/15) showed decreased ΔTHb compared to FGR infants (1/20) (p = 0.016). The magnitude of cerebral hemodynamic response and time to response did not differ between FGR and AGA infants. FGR infants showed larger ΔO2Hb in the contralateral compared to ipsilateral cortex (p = 0.05). Conclusion: Preterm FGR infants have reduced stroke volume and lower cerebral oxygenation compared to AGA infants in the second to third week of life. FGR infants show similar cerebral hemodynamic responses to noxious stimuli compared to AGA infants. However, FGR infants are less likely to have a cerebral vasoconstrictive response, possibly due to cerebrovascular changes following placental insufficiency and brain sparing in-utero.
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Affiliation(s)
- Laura M L Dix
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia.,Neonatology, Wilhelmina Children's Hospital, Utrecht Medical Centre, Utrecht, Netherlands
| | - Kelsee Shepherd
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Graeme R Polglase
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Suzanne L Miller
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Arvind Sehgal
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
| | - Flora Y Wong
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
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28
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Abstract
Preterm and term neonate pain assessment in neonatal intensive care units is vitally important because of the prevalence of procedural and postoperative pain. Of the 40 plus tools available, a few should be chosen for different populations and contexts (2 have been validated in premature infants). Preterm neonates do not display pain behaviors and physiologic indicators as reliably and specifically as full-term infants, and are vulnerable to long-term sequelae of painful experiences. Brain-oriented approaches may become available in the future; meanwhile, neonatal pain assessment tools must be taught, implemented, and their use optimized for consistent, reproducible, safe, and effective treatment.
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Affiliation(s)
- Lynne G Maxwell
- Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Wood 6021, Philadelphia, PA 19104, USA.
| | - María V Fraga
- Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Carrie P Malavolta
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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29
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Segelcke D, Reichl S, Neuffer S, Zapp S, Rüther T, Evers D, Zahn PK, Pogatzki-Zahn EM. The role of the spinal cyclooxygenase (COX) for incisional pain in rats at different developmental stages. Eur J Pain 2019; 24:312-324. [PMID: 31566273 DOI: 10.1002/ejp.1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cyclooxygenase enzymes (COX)-1 and COX-2 are important targets for pain relief after surgery, but the spinal contribution of both isoforms is still unclear, e.g., from a developmental point of view. Here, we studied changes of spinal COX-1 and COX-2 expression and their functional relevance in rats of different ages for pain-related behaviour after incision. METHODS Mechanical paw withdrawal thresholds (PWT) were assessed before and after incision and after intrathecal administration (IT) of SC-560 (COX-1 inhibitor) or NS-398 (COX-2 inhibitor) in rats aged 5, 14 and 28 days (P5, P14, P28). Furthermore, spinal expressions of COX m-RNA and proteins were investigated. RESULTS In P5 rats, only IT-administered NS-398 but not SC-560 significantly reversed the decreased PWT after incision. In P14 rats, none of the substance modified PWT, and in P28 rats, only SC-560 increased PWT. Spinal COX-2 mRNA and protein were increased in P5 but not in P14 and P28 rats after incision. Whereas COX-2 is located in spinal neurons, COX-1 is mainly found in spinal microglia cells. CONCLUSION Our results demonstrate a possible developmental transition from COX-2 to COX-1 activation. Whereas in adult rats spinal COX-1 but not COX-2 is involved in pain-related behaviour after incision, it seems opposite in P5 rats. Interestingly, in P14, neither COX-1 nor COX-2 seems to play a role. This switch may relate to altered neuronal/microglia activation. Our findings indicate specific mechanisms to pain after incision that are age-dependent and may guide further research improving paediatric pain management. SIGNIFICANCE Postoperative pain in pediatric patients after surgery is still poorly controlled; this might contribute to long-lasting alteration in the nociceptive system and prolonged chronic pain. Here we show a possible developmental switch in the COX-dependent pathway for nociceptive spinal transmission that may explain why pain management in young children needs to be related to age-dependent mechanisms.
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Affiliation(s)
- Daniel Segelcke
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Sylvia Reichl
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Simon Neuffer
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Sebastian Zapp
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Theresa Rüther
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Dagmar Evers
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University, BG-Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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30
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Abstract
Measuring brain activity in infants provides an objective surrogate approach with which to infer pain perception following noxious events. Here we discuss different approaches which can be used to measure noxious-evoked brain activity, and discuss how these measures can be used to assess the analgesic efficacy of pharmacological and non-pharmacological interventions. We review factors that can modulate noxious-evoked brain activity, which may impact infant pain experience, including gestational age, sex, prior pain, stress, and illness.
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Affiliation(s)
- Deniz Gursul
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom.
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31
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Hendrikx D, Smits A, Lavanga M, De Wel O, Thewissen L, Jansen K, Caicedo A, Van Huffel S, Naulaers G. Measurement of Neurovascular Coupling in Neonates. Front Physiol 2019; 10:65. [PMID: 30833901 PMCID: PMC6387909 DOI: 10.3389/fphys.2019.00065] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/21/2019] [Indexed: 01/01/2023] Open
Abstract
Neurovascular coupling refers to the mechanism that links the transient neural activity to the subsequent change in cerebral blood flow, which is regulated by both chemical signals and mechanical effects. Recent studies suggest that neurovascular coupling in neonates and preterm born infants is different compared to adults. The hemodynamic response after a stimulus is later and less pronounced and the stimulus might even result in a negative (hypoxic) signal. In addition, studies both in animals and neonates confirm the presence of a short hypoxic period after a stimulus in preterm infants. In clinical practice, different methodologies exist to study neurovascular coupling. The combination of functional magnetic resonance imaging or functional near-infrared spectroscopy (brain hemodynamics) with EEG (brain function) is most commonly used in neonates. Especially near-infrared spectroscopy is of interest, since it is a non-invasive method that can be integrated easily in clinical care and is able to provide results concerning longer periods of time. Therefore, near-infrared spectroscopy can be used to develop a continuous non-invasive measurement system, that could be used to study neonates in different clinical settings, or neonates with different pathologies. The main challenge for the development of a continuous marker for neurovascular coupling is how the coupling between the signals can be described. In practice, a wide range of signal interaction measures exist. Moreover, biomedical signals often operate on different time scales. In a more general setting, other variables also have to be taken into account, such as oxygen saturation, carbon dioxide and blood pressure in order to describe neurovascular coupling in a concise manner. Recently, new mathematical techniques were developed to give an answer to these questions. This review discusses these recent developments.
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Affiliation(s)
- Dries Hendrikx
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Mario Lavanga
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Ofelie De Wel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Liesbeth Thewissen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Sabine Van Huffel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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32
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Green G, Hartley C, Hoskin A, Duff E, Shriver A, Wilkinson D, Adams E, Rogers R, Moultrie F, Slater R. Behavioural discrimination of noxious stimuli in infants is dependent on brain maturation. Pain 2019; 160:493-500. [PMID: 30422872 PMCID: PMC6343955 DOI: 10.1097/j.pain.0000000000001425] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
Changes in facial expression are an essential form of social communication and in nonverbal infants are often used to alert care providers to pain-related distress. However, studies of early human brain development suggest that premature infants aged less than 34 weeks' gestation do not display discriminative brain activity patterns to equally salient noxious and innocuous events. Here we examine the development of facial expression in 105 infants, aged between 28 and 42 weeks' gestation. We show that the presence of facial expression change after noxious and innocuous stimulation is age-dependent and that discriminative facial expressions emerge from approximately 33 weeks' gestation. In a subset of 49 infants, we also recorded EEG brain activity and demonstrated that the temporal emergence of facial discrimination mirrors the developmental profile of the brain's ability to generate discriminative responses. Furthermore, within individual infants, the ability to display discriminative facial expressions is significantly related to brain response maturity. These data demonstrate that the emergence of behavioural discrimination in early human life corresponds to our brain's ability to discriminate noxious and innocuous events and raises fundamental questions as to how best to interpret infant behaviours when measuring and treating pain in premature infants.
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Affiliation(s)
- Gabrielle Green
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Amy Hoskin
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Eugene Duff
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Adam Shriver
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | - Dominic Wilkinson
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Richard Rogers
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, United Kingdom
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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33
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Relland LM, Gehred A, Maitre NL. Behavioral and Physiological Signs for Pain Assessment in Preterm and Term Neonates During a Nociception-Specific Response: A Systematic Review. Pediatr Neurol 2019; 90:13-23. [PMID: 30449602 DOI: 10.1016/j.pediatrneurol.2018.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND/GOAL Assessment and treatment of neonatal pain is difficult because current scales are rarely validated against brain-based evidence. We sought to systematically evaluate published evidence to extract validation of the most promising markers of neonatal pain. METHODS We searched four databases using germane MeSH terms. We focused on assessments of pain and/or nociception that had at least two measures among behavioral, physiological, or cortical components in preterm and/or term neonates. We evaluated studies for quality of evidence and strength of recommendations using standardized tools. RESULTS Fifteen articles met our inclusion criteria. Among the behavioral components uncovered in this review, the withdrawal reflex and changes in facial expression are the most strongly associated with nociception-specific brain activity. These associations may be influenced by gestational age and change over time. Physiological signs, such heart rate and oxygen saturation, have little to no association with this type of response. CONCLUSIONS Current assessments of neonatal pain include behavioral components that are associated with nociceptive processing, but also other less valid components, while omitting newer measures based on neuroscientific research.
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Affiliation(s)
- Lance M Relland
- Center for Clinical and Translational Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Alison Gehred
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nathalie L Maitre
- Center for Perinatal Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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34
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EEG, behavioural and physiological recordings following a painful procedure in human neonates. Sci Data 2018; 5:180248. [PMID: 30422128 PMCID: PMC6233256 DOI: 10.1038/sdata.2018.248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023] Open
Abstract
We present a dataset of cortical, behavioural, and physiological responses following a single, clinically required noxious stimulus in a neonatal sample. Cortical activity was recorded from 112 neonates (29–47 weeks gestational age at study) using a 20-channel electroencephalogram (EEG), which was time-locked to a heel lance. This data is linked to pain-related behaviour (facial expression), physiology (heart rate, oxygenation) and a composite clinical score (Premature Infant Pain Profile, PIPP). The dataset includes responses to non-noxious sham and auditory controls. The infants’ relevant medical and pain history was collected up to the day of the study and recorded in an extensive database of variables including clinical condition at birth, diagnoses, medications, previous painful procedures, injuries, and selected maternal information. This dataset can be used to investigate the cortical, physiological, and behavioural pain-related processing in human infants and to evaluate the impact of medical conditions and experiences upon the infant response to noxious stimuli. Furthermore, it provides information on the formation of individual pain phenotypes.
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35
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Miguel HO, Gonçalves ÓF, Cruz S, Sampaio A. Infant brain response to affective and discriminative touch: A longitudinal study using fNIRS. Soc Neurosci 2018; 14:571-582. [DOI: 10.1080/17470919.2018.1536000] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Helga O. Miguel
- Division of Imaging, Behavior, and Genetic Integrity, Section on Analytical and Functional, National Institute of Child and Human Development, NIH, Bethesda, MD, USA
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Óscar F. Gonçalves
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown MA, USA
| | - Sara Cruz
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Adriana Sampaio
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Roué JM, Rioualen S, Gendras J, Misery L, Gouillou M, Sizun J. Multi-modal pain assessment: are near-infrared spectroscopy, skin conductance, salivary cortisol, physiologic parameters, and Neonatal Facial Coding System interrelated during venepuncture in healthy, term neonates? J Pain Res 2018; 11:2257-2267. [PMID: 30349352 PMCID: PMC6188070 DOI: 10.2147/jpr.s165810] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Improving pain and stress assessments in neonates remains important in preventing the short- and long-term consequences. We aimed to identify the relationships between different pain assessment parameters by simultaneously measuring changes in cortical, autonomic, hormonal, physiological, and behavioral evoked responses to venepuncture in healthy, full-term neonates. Methods This observational, prospective study (ancillary to the ACTISUCROSE trial) included 113 healthy, 3-day old, full-term neonates who underwent venepuncture for systematic neonatal screening, from July to October 2013, in a tertiary-level maternity ward of a university hospital. During venepuncture, we simultaneously measured the cortical single-channel near-infrared spectroscopy (NIRS) signals, foot skin conductance, salivary cortisol, physiological responses, and behavioral (Neonatal Facial Coding System [NFCS]) evoked responses. Results Regarding the NIRS analysis, the highest correlation was between the NFCS at venepuncture and the change in NIRS integrated values of total hemoglobin (r=0.41, P<0.001) or oxygenated hemoglobin (r=0.27, P<0.001). The NFCS at venepuncture was moderately positively correlated with changes in salivary cortisol (r=0.42, P<0.001) and skin conductance (r=0.29, P<0.001). Salivary cortisol and skin conductance changes were not correlated; the latter parameters were not correlated with heart rate, respiratory rate, or SpO2. Conclusion During venepuncture, NFCS was mildly or moderately correlated with salivary cortisol, skin conductance, and cortical NIRS changes.
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Affiliation(s)
- Jean-Michel Roué
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Stéphane Rioualen
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Julie Gendras
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Laurent Misery
- Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Maëlenn Gouillou
- Inserm CIC 1412, Centre for Clinical Investigation, Brest University Hospital, Brest, France
| | - Jacques Sizun
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
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37
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de Roever I, Bale G, Mitra S, Meek J, Robertson NJ, Tachtsidis I. Investigation of the Pattern of the Hemodynamic Response as Measured by Functional Near-Infrared Spectroscopy (fNIRS) Studies in Newborns, Less Than a Month Old: A Systematic Review. Front Hum Neurosci 2018; 12:371. [PMID: 30333736 PMCID: PMC6176492 DOI: 10.3389/fnhum.2018.00371] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/29/2018] [Indexed: 01/03/2023] Open
Abstract
It has been 20 years since functional near-infrared spectroscopy (fNIRS) was first used to investigate the evoked hemodynamic response to a stimulus in newborns. The hemodynamic response to functional activation is well-established in adults, with an observed increase in concentration change of oxygenated hemoglobin (Δ[HbO2]) and decrease in deoxygenated hemoglobin (Δ[HHb]). However, functional studies in newborns have revealed a mixed response, particularly with Δ[HHb] where an inconsistent change in direction is observed. The reason for this heterogeneity is unknown, with potential explanations arising from differing physiology in the developing brain, or differences in instrumentation or methodology. The aim of this review is to collate the findings from studies that have employed fNIRS to monitor cerebral hemodynamics in term newborn infants aged 1 day-1 month. A total of 46 eligible studies were identified; some studies investigated more than one stimulus type, resulting in a total of 51 reported results. The NIRS parameters reported varied across studies with 50/51 cases reporting Δ[HbO2], 39/51 reporting Δ[HHb], and 13/51 reporting total hemoglobin concentration Δ[HbT] (Δ[HbO2] + Δ[HHb]). However, of the 39 cases reporting Δ[HHb] in graphs or tables, only 24 studies explicitly discussed the response (i.e., direction of change) of this variable. In the studies where the fNIRS responses were discussed, 46/51 cases observed an increase in Δ[HbO2], 7/51 observed an increase or varied Δ[HHb], and 2/51 reported a varied or negative Δ[HbT]. An increase in Δ[HbO2] and decrease or no change in Δ[HHb] was observed in 15 studies. By reviewing this body of literature, we have identified that the majority of research articles reported an increase in Δ[HbO2] across various functional tasks and did not report the response of Δ[HHb]. Confirming the normal, healthy hemodynamic response in newborns will allow identification of unhealthy patterns and their association to normal neurodevelopment.
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Affiliation(s)
- Isabel de Roever
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Gemma Bale
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Subhabrata Mitra
- Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Judith Meek
- Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Nicola J. Robertson
- Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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38
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Verriotis M, Jones L, Whitehead K, Laudiano-Dray M, Panayotidis I, Patel H, Meek J, Fabrizi L, Fitzgerald M. The distribution of pain activity across the human neonatal brain is sex dependent. Neuroimage 2018; 178:69-77. [PMID: 29763673 PMCID: PMC6062722 DOI: 10.1016/j.neuroimage.2018.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022] Open
Abstract
In adults, there are differences between male and female structural and functional brain connectivity, specifically for those regions involved in pain processing. This may partly explain the observed sex differences in pain sensitivity, tolerance, and inhibitory control, and in the development of chronic pain. However, it is not known if these differences exist from birth. Cortical activity in response to a painful stimulus can be observed in the human neonatal brain, but this nociceptive activity continues to develop in the postnatal period and is qualitatively different from that of adults, partly due to the considerable cortical maturation during this time. This research aimed to investigate the effects of sex and prematurity on the magnitude and spatial distribution pattern of the long-latency nociceptive event-related potential (nERP) using electroencephalography (EEG). We measured the cortical response time-locked to a clinically required heel lance in 81 neonates born between 29 and 42 weeks gestational age (median postnatal age 4 days). The results show that heel lance results in a spatially widespread nERP response in the majority of newborns. Importantly, a widespread pattern is significantly more likely to occur in females, irrespective of gestational age at birth. This effect is not observed for the short latency somatosensory waveform in the same infants, indicating that it is selective for the nociceptive component of the response. These results suggest the early onset of a greater anatomical and functional connectivity reported in the adult female brain, and indicate the presence of pain-related sex differences from birth.
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Affiliation(s)
- Madeleine Verriotis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Laura Jones
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Maria Laudiano-Dray
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Ismini Panayotidis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Hemani Patel
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London, WC1E6DB, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom.
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Paquette T, Jeffrey-Gauthier R, Leblond H, PichÉ M. Functional Neuroimaging of Nociceptive and Pain-Related Activity in the Spinal Cord and Brain: Insights From Neurovascular Coupling Studies. Anat Rec (Hoboken) 2018; 301:1585-1595. [PMID: 29752872 DOI: 10.1002/ar.23854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/22/2018] [Accepted: 03/31/2018] [Indexed: 12/12/2022]
Abstract
Spinal cord and brain processes underlie pain perception, which produces systemic cardiovascular changes. In turn, the autonomic nervous system regulates vascular function in the spinal cord and brain in order to adapt to these systemic changes, while neuronal activity induces local vascular changes. Thus, autonomic regulation and pain processes in the brain and spinal cord are tightly linked and interrelated. The objective of this topical review is to discuss work on neurovascular coupling during nociceptive processing in order to highlight supporting evidence and limitations for the use of cerebral and spinal fMRI to investigate pain mechanisms and spinal nociceptive processes. Work on functional neuroimaging of pain is presented and discussed in relation to available neurovascular coupling studies and related issues. Perspectives on future work are also discussed with an emphasis on differences between the brain and the spinal cord and on different approaches that may be useful to improve current methods, data analyses and interpretation. In summary, this review highlights the lack of data on neurovascular coupling during nociceptive stimulation and indicates that hemodynamic and BOLD responses measured with fMRI may be biased by nonspecific vascular changes. Future neuroimaging studies on nociceptive and pain-related processes would gain further understanding of neurovascular coupling in the brain and spinal cord and should take into account the effects of systemic vascular changes that may affect hemodynamic responses. Anat Rec, 301:1585-1595, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Thierry Paquette
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Renaud Jeffrey-Gauthier
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Hugues Leblond
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mathieu PichÉ
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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40
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Maria A, Shekhar S, Nissilä I, Kotilahti K, Huotilainen M, Karlsson L, Karlsson H, Tuulari JJ. Emotional Processing in the First 2 Years of Life: A Review of Near-Infrared Spectroscopy Studies. J Neuroimaging 2018; 28:441-454. [PMID: 29883005 PMCID: PMC6175097 DOI: 10.1111/jon.12529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 12/16/2022] Open
Abstract
Emotional stimuli processing during childhood helps us to detect salient cues in our environment and prepares us for our social life. In early childhood, the emotional valences of auditory and visual input are salient and relevant cues of social aspects of the environment, and it is of special interest to understand how exactly the processing of emotional stimuli develops. Near‐infrared spectroscopy (NIRS) is a noninvasive neuroimaging tool that has proven valuable in studying emotional processing in children. After conducting a systematic search of PubMed, Web of Science, and Embase databases, we examined 50 NIRS studies performed to study emotional stimuli processing in children in the first 2 years of age. We found that the majority of these studies are done in infants and the most commonly used stimuli are visual and auditory. Many of the reviewed studies suggest the involvement of bilateral temporal areas in emotional processing of visual and auditory stimuli. It is unclear which neural activation patterns reflect maturation and at what age the emotional encoding reaches those typically seen in adults. Our review provides an overview of the database on emotional processing in children up to 2 years of age. Furthermore, it demonstrates the need to include the less‐studied age range of 1 to 2 years, and suggests the use of combined audio‐visual stimuli and longitudinal studies for future research on emotional processing in children. Thus, NIRS might be a vital tool to study the associations between the early pattern of neural responses and socioemotional development later in life.
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Affiliation(s)
- Ambika Maria
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Shashank Shekhar
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Neurology, University of Mississippi Medical Center, Jackson, MS
| | - Ilkka Nissilä
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Kalle Kotilahti
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Minna Huotilainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Cognitive Brain Research Unit and Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
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Abstract
Purpose of review Pain management presents a major challenge in neonatal care. Newborn infants who require medical treatment can undergo frequent invasive procedures during a critical period of neurodevelopment. However, adequate analgesic provision is infrequently and inconsistently provided for acute noxious procedures because of limited and conflicting evidence regarding analgesic efficacy and safety of most commonly used pharmacological agents. Here, we review recent advances in the measurement of infant pain and discuss clinical trials that assess the efficacy of pharmacological analgesia in infants. Recent findings Recently developed measures of noxious-evoked brain activity are sensitive to analgesic modulation, providing an objective quantitative outcome measure that can be used in clinical trials of analgesics. Summary Noxious stimulation evokes changes in activity across all levels of the infant nervous system, including reflex activity, altered brain activity and behaviour, and long-lasting changes in infant physiological stability. A multimodal approach is needed if we are to identify efficacious and well tolerated analgesic treatments. Well designed clinical trials are urgently required to improve analgesic provision in the infant population.
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Jones L, Fabrizi L, Laudiano-Dray M, Whitehead K, Meek J, Verriotis M, Fitzgerald M. Nociceptive Cortical Activity Is Dissociated from Nociceptive Behavior in Newborn Human Infants under Stress. Curr Biol 2017; 27:3846-3851.e3. [PMID: 29199079 PMCID: PMC5742634 DOI: 10.1016/j.cub.2017.10.063] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022]
Abstract
Newborn infants display strong nociceptive behavior in response to tissue damaging stimuli, and this is accompanied by nociceptive activity generated in subcortical and cortical areas of the brain [1, 2]. In the absence of verbal report, these nociceptive responses are used as measures of pain sensation in newborn humans, as they are in animals [3, 4]. However, many infants are raised in a physiologically stressful environment, and little is known about the effect of background levels of stress upon their pain responses. In adults, acute physiological stress causes hyperalgesia [5, 6, 7], and increased background stress increases pain [8, 9, 10], but these data cannot necessarily be extrapolated to infants. Here we have simultaneously measured nociceptive behavior, brain activity, and levels of physiological stress in a sample of 56 newborn human infants aged 36–42 weeks. Salivary cortisol (hypothalamic pituitary axis), heart rate variability (sympathetic adrenal medullary system), EEG event-related potentials (nociceptive cortical activity), and facial expression (behavior) were acquired in individual infants following a clinically required heel lance. We show that infants with higher levels of stress exhibit larger amplitude cortical nociceptive responses, but this is not reflected in their behavior. Furthermore, while nociceptive behavior and cortical activity are normally correlated, this relationship is disrupted in infants with high levels of physiological stress. Brain activity evoked by noxious stimulation is therefore enhanced by stress, but this cannot be deduced from observation of pain behavior. This may be important in the prevention of adverse effects of early repetitive pain on brain development. Infant pain behavior and nociceptive brain activity are generally correlated Stress disrupts the relationship between infant pain brain activity and behavior Stress is associated with increased nociceptive brain activity, but not behavior Stress is an important factor when assessing infant pain experience
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Affiliation(s)
- Laura Jones
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Maria Laudiano-Dray
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London WC1E6DB, UK
| | - Madeleine Verriotis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK.
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Miguel HO, Lisboa IC, Gonçalves ÓF, Sampaio A. Brain mechanisms for processing discriminative and affective touch in 7-month-old infants. Dev Cogn Neurosci 2017; 35:20-27. [PMID: 29108882 PMCID: PMC6968955 DOI: 10.1016/j.dcn.2017.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 10/13/2017] [Accepted: 10/20/2017] [Indexed: 12/20/2022] Open
Abstract
Affective touch has been associated with affiliative behavior during early stages of infant development; however, its underlying brain mechanisms are still poorly understood. This study used fNIRS (functional near-infrared spectroscopy) to examine both affective and discriminative touch in 7- month-old infants (n=35). Infants were provided affective stimuli on the forearm for 10 sec followed by a 20 sec rest period. The protocol was repeated for discriminative touch, and both affective and discriminative stimuli were given in a counterbalanced order. Brain activation (oxy-hemoglobin and deoxy-hemoglobin levels) in the somatosensory and temporal regions was registered during administration of the stimuli. There was an increase in oxy-hemoglobin and decrease in deoxy-hemoglobin only in the somatosensory region in response to both affective and discriminative touch. No other activations were found. Seven-month-old infants’ brain activation in the somatosensory cortex was similar for both discriminative and affective touch, but the stimuli did not elicit any activation in the temporal region/ pSTS. Our study is the first to suggest that 7-month-old infants do not yet recruit socio-emotional brain areas in response to affective touch.
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Affiliation(s)
- Helga O Miguel
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Isabel C Lisboa
- Human Cognition Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Óscar F Gonçalves
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown campus: 79/96 13th Street, Charlestown, MA, 02129, USA.
| | - Adriana Sampaio
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
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Chiarelli AM, Zappasodi F, Di Pompeo F, Merla A. Simultaneous functional near-infrared spectroscopy and electroencephalography for monitoring of human brain activity and oxygenation: a review. NEUROPHOTONICS 2017; 4:041411. [PMID: 28840162 PMCID: PMC5566595 DOI: 10.1117/1.nph.4.4.041411] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 05/24/2023]
Abstract
Multimodal monitoring has become particularly common in the study of human brain function. In this context, combined, synchronous measurements of functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) are getting increased interest. Because of the absence of electro-optical interference, it is quite simple to integrate these two noninvasive recording procedures of brain activity. fNIRS and EEG are both scalp-located procedures. fNIRS estimates brain hemodynamic fluctuations relying on spectroscopic measurements, whereas EEG captures the macroscopic temporal dynamics of brain electrical activity through passive voltages evaluations. The "orthogonal" neurophysiological information provided by the two technologies and the increasing interest in the neurovascular coupling phenomenon further encourage their integration. This review provides, together with an introduction regarding the principles and future directions of the two technologies, an evaluation of major clinical and nonclinical applications of this flexible, low-cost combination of neuroimaging modalities. fNIRS-EEG systems exploit the ability of the two technologies to be conducted in an environment or experimental setting and/or on subjects that are generally not suited for other neuroimaging modalities, such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography. fNIRS-EEG brain monitoring settles itself as a useful multimodal tool for brain electrical and hemodynamic activity investigation.
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Affiliation(s)
- Antonio M. Chiarelli
- University of Illinois at Urbana Champaign, Beckman Institute, Urbana, Illinois, United States
| | - Filippo Zappasodi
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Francesco Di Pompeo
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Arcangelo Merla
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
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Anand KJS. Defining pain in newborns: need for a uniform taxonomy? Acta Paediatr 2017; 106:1438-1444. [PMID: 28556311 PMCID: PMC5601230 DOI: 10.1111/apa.13936] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022]
Abstract
A framework for defining pain terms such as acute, persistent, prolonged or chronic pain to newborns was derived from the scientific literature on neonatal pain assessments, previous attempts to define chronic pain and the clinical and neurophysiological features of neonatal pain. This novel framework incorporates the temporal features, localising characteristics, and secondary effects of the pain experienced, as well as the behavioural and physiological response patterns of newborns. CONCLUSION Although not evidence-based, this framework provides an initial starting point for defining commonly used neonatal pain terms. It will require future revision/refinement based on the accumulating evidence for non-acute pain.
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Anand KJS, Eriksson M, Boyle EM, Avila-Alvarez A, Andersen RD, Sarafidis K, Polkki T, Matos C, Lago P, Papadouri T, Attard-Montalto S, Ilmoja ML, Simons S, Tameliene R, van Overmeire B, Berger A, Dobrzanska A, Schroth M, Bergqvist L, Courtois E, Rousseau J, Carbajal R. Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr 2017; 106:1248-1259. [PMID: 28257153 DOI: 10.1111/apa.13810] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 12/25/2022]
Abstract
AIM Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. METHODS A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission. RESULTS Only 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p < 0.001). Daily assessments for continuous pain occurred in only 10.4% of all neonates (TrV: 14.0%, NiV: 10.7%, NoV: 7.6%; p < 0.001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions and surgical admissions (all p < 0.01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anaesthetics (O-SH-GA) (all p < 0.001), or surgery (p = 0.028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1.60, p < 0.001) and NiV groups (OR:1.40, p < 0.001). CONCLUSION Assessments of continuous pain occurred in less than one-third of NICU admissions and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.
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Affiliation(s)
- Kanwaljeet J. S. Anand
- Departments of Pediatrics, Anesthesiology, Perioperative & Pain Medicine; Stanford University School of Medicine; Stanford CA USA
| | - Mats Eriksson
- School of Health Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - Elaine M. Boyle
- Department of Health Sciences; University of Leicester; Leicester UK
| | | | | | - Kosmas Sarafidis
- 1st Department of Neonatology; ‘Hippokrateion’ General Hospital; Aristotle University of Thessaloniki; Thessalokiki Greece
| | - Tarja Polkki
- Children and Women Department; Oulu University Hospital; Oulu Finland
| | | | - Paola Lago
- Department of Woman's and Child's Health; University of Padua; Padua Italy
| | - Thalia Papadouri
- Department of Paediatrics; Arch. Makarios III Hospital; Nicosia Cyprus
| | | | - Mari-Liis Ilmoja
- Department of Paediatrics; Tallinn Children's Hospital; Tallinn Estonia
| | - Sinno Simons
- Department of Pediatrics; Erasmus MC-Sophia Kinderziekenhuis; Rotterdam The Netherlands
| | - Rasa Tameliene
- Department of Neonatology; Kaunas Perinatal Center; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Bart van Overmeire
- Cliniques Universitaires de Bruxelles; Erasme Hospital; Bruxelles Belgium
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine; Medical University Vienna; Vienna Austria
| | - Anna Dobrzanska
- Department of Neonatology; Children's Memorial Health Institute Warsaw; Warszawa Poland
| | - Michael Schroth
- Department of Paediatrics; Cnopf'sche Kinderklinik; Nürnberg Children's Hospital; Nürenberg Germany
| | - Lena Bergqvist
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Solna Sweden
| | - Emilie Courtois
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
| | - Jessica Rousseau
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
| | - Ricardo Carbajal
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
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Verriotis M, Chang P, Fitzgerald M, Fabrizi L. The development of the nociceptive brain. Neuroscience 2016; 338:207-219. [DOI: 10.1016/j.neuroscience.2016.07.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 12/20/2022]
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Chang P, Fabrizi L, Olhede S, Fitzgerald M. The Development of Nociceptive Network Activity in the Somatosensory Cortex of Freely Moving Rat Pups. Cereb Cortex 2016; 26:4513-4523. [PMID: 27797835 PMCID: PMC5193146 DOI: 10.1093/cercor/bhw330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/02/2016] [Indexed: 12/13/2022] Open
Abstract
Cortical perception of noxious stimulation is an essential component of pain experience but it is not known how cortical nociceptive activity emerges during brain development. Here we use continuous telemetric electrocorticogram (ECoG) recording from the primary somatosensory cortex (S1) of awake active rat pups to map functional nociceptive processing in the developing brain over the first 4 weeks of life. Cross-sectional and longitudinal recordings show that baseline S1 ECoG energy increases steadily with age, with a distinctive beta component replaced by a distinctive theta component in week 3. Event-related potentials were evoked by brief noxious hindpaw skin stimulation at all ages tested, confirming the presence of functional nociceptive spinothalamic inputs in S1. However, hindpaw incision, which increases pain sensitivity at all ages, did not increase S1 ECoG energy until week 3. A significant increase in gamma (20–50 Hz) energy occurred in the presence of skin incision at week 3 accompanied by a longer-lasting increase in theta (4–8 Hz) energy at week 4. Continuous ECoG recording demonstrates specific postnatal functional stages in the maturation of S1 cortical nociception. Somatosensory cortical coding of an ongoing pain “state” in awake rat pups becomes apparent between 2 and 4 weeks of age.
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Affiliation(s)
- P Chang
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK.,Current address: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK
| | - L Fabrizi
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK
| | - S Olhede
- Department of Statistical Science, University College London, London WC1E6BT, UK
| | - M Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK
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