1
|
Bhatt RR, Haddad E, Zhu AH, Thompson PM, Gupta A, Mayer EA, Jahanshad N. Mapping Brain Structure Variability in Chronic Pain: The Role of Widespreadness and Pain Type and Its Mediating Relationship With Suicide Attempt. Biol Psychiatry 2024; 95:473-481. [PMID: 37543299 PMCID: PMC10838358 DOI: 10.1016/j.biopsych.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Chronic pain affects nearly 20% of the U.S. POPULATION It is a leading cause of disability globally and is associated with a heightened risk for suicide. The role of the central nervous system in the perception and maintenance of chronic pain has recently been accepted, but specific brain circuitries involved have yet to be mapped across pain types in a large-scale study. METHODS We used data from the UK Biobank (N = 21,968) to investigate brain structural alterations in individuals reporting chronic pain compared with pain-free control participants and their mediating effect on history of suicide attempt. RESULTS Chronic pain and, more notably, chronic multisite pain was associated with, on average, lower surface area throughout the cortex after adjusting for demographic, clinical, and neuropsychiatric confounds. Only participants with abdominal pain showed lower subcortical volumes, including the amygdala and brainstem, and lower cerebellum volumes. Participants with chronic headaches showed a widespread thicker cortex compared with control participants. Mediation analyses revealed that precuneus thickness mediated the relationship of chronic multisite pain and history of suicide attempt. Mediating effects were also identified specific to localized pain, with the strongest effect being amygdala volume in individuals with chronic abdominal pain. CONCLUSIONS Results support a widespread effect of chronic pain on brain structure and distinct brain structures underlying chronic musculoskeletal pain, visceral pain, and headaches. Mediation effects of regions in the extended ventromedial prefrontal cortex subsystem suggest that exacerbated negative internal states, negative self-referencing, and impairments in future planning may underlie suicidal behaviors in individuals with chronic pain.
Collapse
Affiliation(s)
- Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
| | - Elizabeth Haddad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Arpana Gupta
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
| |
Collapse
|
2
|
Woodbury A, Krishnamurthy LC, Bohsali A, Krishnamurthy V, Smith JL, Gebre M, Tyler K, Vernon M, Crosson B, Kalangara JP, Napadow V, Allen JW, Harper D. Percutaneous electric nerve field stimulation alters cortical thickness in a pilot study of veterans with fibromyalgia. Neurobiol Pain 2022; 12:100093. [PMID: 35733704 PMCID: PMC9207563 DOI: 10.1016/j.ynpai.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Objective To evaluate changes in cortical thickness and right posterior insula (r-pIns) gamma-aminobutyric acid (GABA) concentrations in veterans with fibromyalgia treated with auricular percutaneous electric nerve field stimulation (PENFS). Materials & methods This was a randomized, controlled, open label investigation conducted in a government hospital. Twenty-one veterans with fibromyalgia were randomized to receive either standard therapy (ST; i.e., 4 weekly visits with a pain practitioner) or ST with auricular PENFS (ST + PENFS). Neuroimaging data was collected at baseline (i.e. before the first treatment session) and again within 2 weeks post-treatment. Clinical pain and physical function were also assessed at these timepoints. Single-voxel magnetic resonance spectroscopy was carried out in r-pIns to assess changes in r-pIns GABA concentrations and high-resolution T1-weighted images were collected to assess changes in regional gray matter volume using cortical thickness. Results Both the ST + PENFS and ST groups reported a decrease in pain with treatment. Volumetric: Cortical thickness significantly decreased in the left middle posterior cingulate (p = 0.018) and increased in the left cuneus (p = 0.014) following ST + PENFS treatment. These findings were significant following FDR correction for multiple comparisons. ST group right hemisphere insula cortical thickness increased post-treatment and was significantly (p = 0.02) inversely correlated with pain scores. ST + PENFS group right hemisphere posterior dorsal cingulate size significantly (p = 0.044) positively correlated with pain scores. GABA: There were no significant correlations with GABA, though a trend was noted towards increased GABA following treatment in both groups (p = 0.083) using a linear mixed effects model. Conclusions Results suggest a novel effect of PENFS reflected by differential volumetric changes compared to ST. The changes in GABA that occur in both groups are more likely related to ST. Insular GABA and cortical thickness in key regions of interest may be developed as potential biomarkers for evaluating chronic pain pathology and treatment outcomes.
Collapse
Affiliation(s)
- Anna Woodbury
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Lisa C. Krishnamurthy
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
- Georgia State University, Atlanta, GA, USA
| | | | - Venkatagiri Krishnamurthy
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | | | - Melat Gebre
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kari Tyler
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Mark Vernon
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Bruce Crosson
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Jerry P. Kalangara
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Vitaly Napadow
- Spaulding Rehabilitation Network, Harvard Medical School, Charlestown, MA, USA
| | | | - Daniel Harper
- Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
3
|
Tu Y, Wang J, Xiong F, Gao F. Cortical abnormalities in patients with fibromyalgia: a pilot study of surface-based morphometry analysis. Pain Med 2022; 23:1939-1946. [PMID: 35881694 DOI: 10.1093/pm/pnac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although neuroanatomical studies correlated to fibromyalgia (FM) are gaining increasing interest, the cortical morphology of patients are largely unknown, and data on cortical gyrification are scarce. The objective of the present study is to assess the cortical morphology in female patients with FM compared with healthy controls (HC) using surface-based morphometry (SBM) analysis of magnetic resonance imaging (MRI). METHODS T1-MRIs and clinical data of 20 FM patients and 20 HC subjects were obtained from a public databset via OpenNeuro. For each subject, surface parameters including cortical thickness, local gyrification index (LGI), sulcal depth, and fractal dimensionality were estimated using SBM analysis. These data were compared between two groups controlled by age. The correlations between regional SBM parameters showing group differences and clinical profiles were analyzed. RESULTS Compared with HC subjects, FM patients showed reduced cortical thickness in right primary motor cortex, lower LGI in right rostral anterior cingulate and higher sulcal depth in right precuneus (p < 0.05 cluster level family- wise error corrected). In FM patients, correlation analysis showed that the cortical thickness in right primary motor cortex were inversely correlated with scores of pain catastrophizing scale (r = -0.498, p = 0.030) and pain self-perception scale (r = -0.527, p = 0.020), and disease duration (r = -0.488, p = 0.034), respectively. CONCLUSIONS Our findings provide evidence of neuroanatomical aberrations in FM patients, which may provide insight into the neuropathology of FM.
Collapse
Affiliation(s)
- Ye Tu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Xiong
- Department of Radiology, PLA Central Theater General Hospital, Wuhan, China
| | - Feng Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Martín-Brufau R, Gómez MN, Sanchez-Sanchez-Rojas L, Nombela C. Fibromyalgia Detection Based on EEG Connectivity Patterns. J Clin Med 2021; 10:jcm10153277. [PMID: 34362061 PMCID: PMC8348913 DOI: 10.3390/jcm10153277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: The identification of a complementary test to confirm the diagnosis of FM. The diagnosis of fibromyalgia (FM) is based on clinical features, but there is still no consensus, so patients and clinicians might benefit from such a test. Recent findings showed that pain lies in neuronal bases (pain matrices) and, in the long term, chronic pain modifies the activity and dynamics of brain structures. Our hypothesis is that patients with FM present lower levels of brain activity and therefore less connectivity than controls. Methods: We registered the resting state EEG of 23 patients with FM and compared them with 23 control subjects’ resting state recordings from the PhysioBank database. We measured frequency, amplitude, and functional connectivity, and conducted source localization (sLORETA). ROC analysis was performed on the resulting data. Results: We found significant differences in brain bioelectrical activity at rest in all analyzed bands between patients and controls, except for Delta. Subsequent source analysis provided connectivity values that depicted a distinct profile, with high discriminative capacity (between 91.3–100%) between the two groups. Conclusions: Patients with FM show a distinct neurophysiological pattern that fits with the clinical features of the disease.
Collapse
Affiliation(s)
- Ramón Martín-Brufau
- Unidad de Corta Estancia, Hospital Psiquiátrico Román Alberca, National Service of Health, 30120 Murcia, Spain;
| | | | - Leyre Sanchez-Sanchez-Rojas
- Regenerative Medicine and Advanced Therapies Lab., Instituto de Investigación Sanitaria San Carlos (IdIISC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Cristina Nombela
- Biological and Health Psychology, Autonomous University of Madrid (UAM), 28049 Madrid, Spain
- Correspondence: ; Tel.: +34-4975921
| |
Collapse
|
5
|
Lawson K, Singh A, Kantsedikas I, Jenner CA, Austen DK. Flupirtine as a Potential Treatment for Fibromyalgia. Journal of Exploratory Research in Pharmacology 2021; 000:000-000. [DOI: 10.14218/jerp.2020.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
6
|
Woodbury A, Krishnamurthy V, Gebre M, Napadow V, Bicknese C, Liu M, Lukemire J, Kalangara J, Cui X, Guo Y, Sniecinski R, Crosson B. Feasibility of Auricular Field Stimulation in Fibromyalgia: Evaluation by Functional Magnetic Resonance Imaging, Randomized Trial. Pain Med 2021; 22:715-726. [PMID: 33164085 PMCID: PMC7971465 DOI: 10.1093/pm/pnaa317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the feasibility of recruitment, preliminary efficacy, and acceptability of auricular percutaneous electrical nerve field stimulation (PENFS) for the treatment of fibromyalgia in veterans, using neuroimaging as an outcome measure and a biomarker of treatment response. DESIGN Randomized, controlled, single-blind. SETTING Government hospital. SUBJECTS Twenty-one veterans with fibromyalgia were randomized to standard therapy (ST) control or ST with auricular PENFS treatment. METHODS Participants received weekly visits with a pain practitioner over 4 weeks. The PENFS group received reapplication of PENFS at each weekly visit. Resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) data were collected within 2 weeks prior to initiating treatment and 2 weeks following the final treatment. Analysis of rs-fcMRI used a right posterior insula seed. Pain and function were assessed at baseline and at 2, 6, and 12 weeks post-treatment. RESULTS At 12 weeks post-treatment, there was a nonsignificant trend toward improved pain scores and significant improvements in pain interference with sleep among the PENFS treatment group as compared with the ST controls. Neuroimaging data displayed increased connectivity to areas of the cerebellum and executive control networks in the PENFS group as compared with the ST control group following treatment. CONCLUSIONS There was a trend toward improved pain and function among veterans with fibromyalgia in the ST + PENFS group as compared with the ST control group. Pain and functional outcomes correlated with altered rs-fcMRI network connectivity. Neuroimaging results differed between groups, suggesting an alternative underlying mechanism for PENFS analgesia.
Collapse
Affiliation(s)
- Anna Woodbury
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Venkatagiri Krishnamurthy
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Melat Gebre
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mofei Liu
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Joshua Lukemire
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jerry Kalangara
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Xiangqin Cui
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ying Guo
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Bruce Crosson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
Collapse
Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
| |
Collapse
|
8
|
Sundermann B, Dehghan Nayyeri M, Pfleiderer B, Stahlberg K, Jünke L, Baie L, Dieckmann R, Liem D, Happe T, Burgmer M. Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease-specific effects. Eur J Neurosci 2019; 50:3958-3967. [PMID: 31448468 DOI: 10.1111/ejn.14558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel-based morphometry and additional ROI-analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS-specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS-specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.
Collapse
Affiliation(s)
- Benedikt Sundermann
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Mahboobeh Dehghan Nayyeri
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Kim Stahlberg
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Leonie Jünke
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Lara Baie
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | - Dennis Liem
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | | | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| |
Collapse
|
9
|
Kaplan CM, Schrepf A, Vatansever D, Larkin TE, Mawla I, Ichesco E, Kochlefl L, Harte SE, Clauw DJ, Mashour GA, Harris RE. Functional and neurochemical disruptions of brain hub topology in chronic pain. Pain 2019; 160:973-83. [PMID: 30763287 DOI: 10.1097/j.pain.0000000000001480] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is Available in the Text. Hub topology is altered in fibromyalgia, and disruption of the excitatory tone within the insula influences hub status and is associated with clinical pain intensity. A critical component of brain network architecture is a robust hub structure, wherein hub regions facilitate efficient information integration by occupying highly connected and functionally central roles in the network. Across a wide range of neurological disorders, hub brain regions seem to be disrupted, and the character of this disruption can yield insights into the pathophysiology of these disorders. We applied a brain network–based approach to examine hub topology in fibromyalgia, a chronic pain condition with prominent central nervous system involvement. Resting state functional magnetic resonance imaging data from 40 fibromyalgia patients and 46 healthy volunteers, and a small validation cohort of 11 fibromyalgia patients, were analyzed using graph theoretical techniques to model connections between 264 brain regions. In fibromyalgia, the anterior insulae functioned as hubs and were members of the rich club, a highly interconnected nexus of hubs. In fibromyalgia, rich-club membership varied with the intensity of clinical pain: the posterior insula, primary somatosensory, and motor cortices belonged to the rich club only in patients with the highest pain intensity. Furthermore, the eigenvector centrality (a measure of how connected a region is to other highly connected regions) of the posterior insula positively correlated with clinical pain and mediated the relationship between glutamate + glutamine (assessed by proton magnetic resonance spectroscopy) within this structure and the patient's clinical pain report. Together, these findings reveal altered hub topology in fibromyalgia and demonstrate, for the first time to our knowledge, a neurochemical basis for altered hub strength and its relationship to the perception of pain.
Collapse
|
10
|
Letzen JE, Seminowicz DA, Campbell CM, Finan PH. Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. Neurosci Biobehav Rev 2019; 98:10-7. [PMID: 30543904 DOI: 10.1016/j.neubiorev.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/28/2022]
Abstract
Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.
Collapse
|
11
|
Hwang RJ, Chen HJ, Guo ZX, Lee YS, Liu TY. Effects of aerobic exercise on sad emotion regulation in young women: an electroencephalograph study. Cogn Neurodyn 2018; 13:33-43. [PMID: 30728869 DOI: 10.1007/s11571-018-9511-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022] Open
Abstract
The effects of exercise on cognitive abilities have been studied. However, evidence regarding the neural substrates of sad emotion regulation is limited. Women have higher rates for affective disorders than men, but insufficient outcomes assess how aerobic exercises modulate central frontal activation in sad emotion inhibition and resilience among healthy women. This study investigated the effects of aerobic exercise-related brain activity on sad emotion inhibition processing in young women. Sad facial Go/No-Go and neutral Go/No-Go trials were conducted among 30 healthy young women to examine the changes in the N2 component, which reflects frontal inhibition responses, between pre-exercise and post-exercise periods. The first test was performed before aerobic exercise (baseline; 1st) and the second test was performed during an absolute rest period of 90 min after exercise. The sad No-Go stimuli that evoked N200 (N2) event-related potential were recorded and analyzed. The results showed that in the sad No-Go trials, N2 activation at the central-prefrontal cortex was significantly attenuated after exercise compared to the baseline N2 activation. Exercise-modulated N2 activation was not observed in the neutral No-Go trials. The behavioral error rates of sad No-Go trials did not differ between the two experiments. A reduced engagement of central-frontal activation to sad No-Go stimuli was shown after exercise. However, behavioral performance was consistent between the two measurements. The findings scope the benefits of the aerobic exercise on the neural efficiency in responding to sad emotion-eliciting cues as well as adaptive transitions reinstatement for regulatory capabilities in healthy young women.
Collapse
Affiliation(s)
- Ren-Jen Hwang
- Department of Nursing, Chang Gung University of Science and Technology (CGUST), 261 Wei-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, Taiwan, ROC.,Nursing Department, Chang Gung Memorial Hospital, Linkou, Taiwan.,3Center of Clinical Competency Center, Chang Gung University of Science and Technology (CGUST), Tao-Yuan, Taiwan
| | - Hsin-Ju Chen
- Department of Nursing, Chang Gung University of Science and Technology (CGUST), 261 Wei-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Zhan-Xian Guo
- Department of Nursing, Chang Gung University of Science and Technology (CGUST), 261 Wei-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Yu-Sheun Lee
- Department of Nursing, Chang Gung University of Science and Technology (CGUST), 261 Wei-Hwa 1st Rd, Kwei-Shan, Tao-Yuan, Taiwan, ROC.,4China Medical University Hospital, Taichung City, Taiwan
| | - Tai-Ying Liu
- 5Science and Technology Policy Research and Information Center, National Applied Research Laboratories, 15F, No. 106, Sec. 2, Heping E. Rd, Taipei, 10636 Taiwan, ROC
| |
Collapse
|
12
|
Borsook D, Youssef AM, Barakat N, Sieberg CB, Elman I. Subliminal (latent) processing of pain and its evolution to conscious awareness. Neurosci Biobehav Rev 2018; 88:1-15. [PMID: 29476771 DOI: 10.1016/j.neubiorev.2018.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 12/18/2022]
Abstract
By unconscious or covert processing of pain we refer to nascent interactions that affect the eventual deliverance of pain awareness. Thus, internal processes (viz., repeated nociceptive events, inflammatory kindling, reorganization of brain networks, genetic) or external processes (viz., environment, socioeconomic levels, modulation of epigenetic status) contribute to enhancing or inhibiting the presentation of pain awareness. Here we put forward the notion that for many patients, ongoing sub-conscious changes in brain function are significant players in the eventual manifestation of chronic pain. In this review, we provide clinical examples of nascent or what we term pre-pain processes and the neurobiological mechanisms of how these changes may contribute to pain, but also potential opportunities to define the process for early therapeutic interventions.
Collapse
Affiliation(s)
- David Borsook
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States.
| | - Andrew M Youssef
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Nadia Barakat
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Christine B Sieberg
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Igor Elman
- Dayton Veterans Affairs Medical Center 4100 West Third Street Dayton, OH, 45428, United States
| |
Collapse
|
13
|
Littlejohn G, Guymer E. Modulation of NMDA Receptor Activity in Fibromyalgia. Biomedicines 2017; 5:biomedicines5020015. [PMID: 28536358 PMCID: PMC5489801 DOI: 10.3390/biomedicines5020015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 01/15/2023] Open
Abstract
Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer–term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia.
Collapse
Affiliation(s)
- Geoffrey Littlejohn
- Departments of Medicine, Monash University and Rheumatology, MonashHealth, Melbourne 3168, Australia.
| | - Emma Guymer
- Departments of Medicine, Monash University and Rheumatology, MonashHealth, Melbourne 3168, Australia.
| |
Collapse
|
14
|
Lawson K. Emerging pharmacological strategies for the treatment of fibromyalgia. World J Pharmacol 2017; 6:1-10. [DOI: 10.5497/wjp.v6.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/06/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Fibromyalgia (FM) has been described as a chronic clinical condition related to multisensory hypersensitivity presenting with a complex of symptoms dominated by chronic widespread pain associated with the existence of a range of co-morbidities, such as fatigue, sleep disturbance, cognitive impairment, anxiety and depression. Current treatments include drugs that target serotonin and noradrenaline levels within the central nervous system, e.g., tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, and voltage-gated calcium channel subunit ligands, e.g., gabapentin and pregabalin. Investigation of a range of novel targets, such as melatoninergic, cannabinoid, dopamine, NMDA, angiotensin, orexin and opioid receptors, and ion channels, in addition revisiting bioamine modulation and subunits has provided efficacy outcomes that improve the health status of patients with FM. Nevertheless, modest and limited efficacy is often observed reflecting the heterogeneity of FM with existence of subpopulations of patients, the contribution of peripheral and central components to the pathophysiology, and the extensive range of accompanying co-morbidities. The complexity and multidimensional nature of FM is emphasized by the diversity of pharmacological targets gaining interest. Clues to underlying mechanisms which offer themselves as novel and potential targets for new medications are being provided by advances in the understanding of the pathophysiology of FM.
Collapse
|
15
|
Affiliation(s)
- Don L Goldenberg
- Department of Medicine & Nursing, Tufts University School of Medicine, Oregon Health Sciences, 2865 SW Fairview Blvd, Portland, OR 97205, USA
| |
Collapse
|