1
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Stewart BW, Keaser ML, Lee H, Margerison SM, Cormie MA, Moayedi M, Lindquist MA, Chen S, Mathur BN, Seminowicz DA. Pathological claustrum activity drives aberrant cognitive network processing in human chronic pain. Curr Biol 2024:S0960-9822(24)00318-X. [PMID: 38614082 DOI: 10.1016/j.cub.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Abstract
Aberrant cognitive network activity and cognitive deficits are established features of chronic pain. However, the nature of cognitive network alterations associated with chronic pain and their underlying mechanisms require elucidation. Here, we report that the claustrum, a subcortical nucleus implicated in cognitive network modulation, is activated by acute painful stimulation and pain-predictive cues in healthy participants. Moreover, we discover pathological activity of the claustrum and a region near the posterior inferior frontal sulcus of the right dorsolateral prefrontal cortex (piDLPFC) in migraine patients during acute pain and cognitive task performance. Dynamic causal modeling suggests a directional influence of the claustrum on activity in this piDLPFC region, and diffusion weighted imaging verifies their structural connectivity. These findings advance understanding of claustrum function during acute pain and provide evidence of a possible circuit mechanism driving cognitive impairments in chronic pain.
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Affiliation(s)
- Brent W Stewart
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA
| | - Hwiyoung Lee
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Wade Avenue, Catonsville, MD 21228, USA
| | - Sarah M Margerison
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA; Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Penn Street, Baltimore, MD 21201, USA
| | - Matthew A Cormie
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Edward Street, Toronto, ON M5G 1E2, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Edward Street, Toronto, ON M5G 1E2, Canada; Department of Dentistry, Mount Sinai Hospital, University Avenue, Toronto, ON M5G 1X5, Canada; Division of Clinical & Computational Neuroscience, Krembil Brain Institute, University Health Network, Nassau Street, Toronto, ON M5T 1M8, Canada
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, N Wolfe Street, Baltimore, MD 21205, USA
| | - Shuo Chen
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Wade Avenue, Catonsville, MD 21228, USA
| | - Brian N Mathur
- Department of Pharmacology, University of Maryland School of Medicine, W Baltimore Street, Baltimore, MD 21201, USA; Department of Psychiatry, University of Maryland School of Medicine, W Baltimore Street, Baltimore, MD 21201, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, W Baltimore Street, Baltimore, MD 21201, USA; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, Richmond Street, London, ON N6A 5C1, Canada.
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2
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Da Silva JT, Hernandez-Rojas LG, Mekonen HK, Hanson S, Melemedjian O, Scott AJ, Ernst RK, Seminowicz DA, Traub RJ. Sex differences in visceral sensitivity and brain activity in a rat model of comorbid pain: a longitudinal study. Pain 2024; 165:698-706. [PMID: 37756658 PMCID: PMC10859847 DOI: 10.1097/j.pain.0000000000003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
ABSTRACT Temporomandibular disorder (TMD) and irritable bowel syndrome (IBS) are 2 chronic overlapping pain conditions (COPCs) that present with significant comorbidity. Both conditions are more prevalent in women and are exacerbated by stress. While peripheral mechanisms might contribute to pain hypersensitivity for each individual condition, mechanisms underlying the comorbidity are poorly understood, complicating pain management when multiple conditions are involved. In this study, longitudinal behavioral and functional MRI-based brain changes have been identified in an animal model of TMD-like pain (masseter muscle inflammation followed by stress) that induces de novo IBS-like comorbid visceral pain hypersensitivity in rats. In particular, data indicate that increased activity in the insula and regions of the reward and limbic systems are associated with more pronounced and longer-lasting visceral pain behaviors in female rats, while the faster pain resolution in male rats may be due to increased activity in descending pain inhibitory pathways. These findings suggest the critical role of brain mechanisms in chronic pain conditions and that sex may be a risk factor of developing COPCs.
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Affiliation(s)
- Joyce T. Da Silva
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Luis G. Hernandez-Rojas
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
- Department of Computing, School of Engineering and Sciences, Tecnologico de Monterrey, Zapopan, Mexico
| | - Hayelom K. Mekonen
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Shelby Hanson
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - Ohannes Melemedjian
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
| | - Alison J. Scott
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, MD, United States
- Maastricht Multimodal Molecular Imaging (M4I) Institute, Maastricht University, Maastricht, the Netherlands
| | - Robert K. Ernst
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - David A. Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Richard J. Traub
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
- UM Center to Advance Chronic Pain Research, Baltimore, MD, United States
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3
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Finan PH, Hunt C, Keaser ML, Smith K, Lerman S, Bingham CO, Barrett F, Garland EL, Zeidan F, Seminowicz DA. Effects of Savoring Meditation on Positive Emotions and Pain-Related Brain Function: A Mechanistic Randomized Controlled Trial in People With Rheumatoid Arthritis. J Pain 2024:S1526-5900(24)00346-8. [PMID: 38244899 DOI: 10.1016/j.jpain.2024.01.343] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
Positive emotions are a promising target for intervention in chronic pain, but mixed findings across trials to date suggest that existing interventions may not be optimized to efficiently engage the target. The aim of the current pilot mechanistic randomized controlled trial was to test the effects of a positive emotion-enhancing intervention called Savoring Meditation on pain-related neural and behavioral targets in patients with rheumatoid arthritis. Participants included 44 patients with a physician-confirmed diagnosis of rheumatoid arthritis (n = 29 included in functional magnetic resonance imaging (fMRI) analyses), who were randomized to either Savoring Meditation or a Slow Breathing control. Both meditation interventions were brief (four 20-minute sessions). Self-report measures were collected pre-and post-intervention. An fMRI task was conducted at post-intervention, during which participants practiced the meditation technique on which they had been trained while exposed to non-painful and painful thermal stimuli. Savoring significantly reduced experimental pain intensity ratings relative to rest (P < .001). Savoring also increased cerebral blood flow in the ventromedial prefrontal cortex and increased connectivity between the ventromedial prefrontal cortex and caudate during noxious thermal stimulation relative to Slow Breathing (z = 2.3 voxelwise, false discovery rate cluster corrected P = .05). Participants in the Savoring condition also reported significantly increased positive emotions (ps < .05) and reduced anhedonic symptoms (P < .01) from pre- to post-intervention. These findings suggest that Savoring recruits reward-enhancing corticostriatal circuits in the face of pain, and future work should extend these findings to evaluate if these mechanisms of Savoring are associated with improved clinical pain outcomes in diverse patient populations. PERSPECTIVE: Savoring Meditation is a novel positive emotion-enhancing intervention designed for patients with chronic pain. The present findings provide preliminary evidence that Savoring Meditation is acutely analgesic, and engages neural and subjective emotional targets that are relevant to pain self-management. Future work should evaluate the clinical translation of these findings.
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Affiliation(s)
- Patrick H Finan
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carly Hunt
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD
| | - Katie Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sheera Lerman
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifton O Bingham
- Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Frederick Barrett
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT
| | - Fadel Zeidan
- Department of Anesthesiology, University of California-San Diego, San Diego, CA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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4
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Meeker TJ, Kim HJ, Tulloch IK, Keaser ML, Seminowicz DA, Dorsey SG. Secondary analysis: heat and self-report pain sensitivity associate with biological sex and racialized sociocultural group but may not be mediated by anxiety or pain catastrophizing. Pain Rep 2024; 9:e1133. [PMID: 38283650 PMCID: PMC10811695 DOI: 10.1097/pr9.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Previous studies have demonstrated associations between sex and racialized group on pain sensitivity and tolerance. We analyzed the association of sex and racialized group on heat pain sensitivity, sensibility to painful suprathreshold mechanical pain (STMP), and pain sensitivity questionnaire (PSQ). We hypothesized that anxiety and pain catastrophizing reported by racialized minority groups and women would mediate enhanced pain sensitivity. Our secondary aim was to evaluate validity of the PSQ in a diverse population. Methods Using quantitative sensory testing for painful heat, STMP (forces: 64, 128, 256, and 512 mN), and PSQ, we evaluated pain sensitivity in 134 healthy participants [34 (18 women) Asian, 25 (13 women) Black, and 75 (41 women) White]. We used general linear and linear mixed models to analyze outcomes. We assessed mediation of state and trait anxiety and pain catastrophizing on pain sensitivity. Results Racialized minority status was associated with greater heat pain sensitivity (F = 7.63; P = 0.00074) and PSQ scores (F = 15.45; P = 9.84 × 10-7) but not associated with STMP (F = 1.50; P = 0.23). Female sex was associated with greater heat pain sensitivity (F = 4.9; P = 0.029) and lower PSQ (F = 9.50; P = 0.0025) but not associated with STMP (F = 0.0018; P = 0.97). Neither anxiety nor pain catastrophizing mediated associations between sex or racialized group with heat pain threshold or PSQ. Differential experience of individual items (F = 19.87; P = 3.28 × 10-8) limited PSQ face validity in racialized minorities. Conclusion Consistent with previous research, sensitivity to painful heat was associated with racialized minority status and female sex. By contrast, there was no significant effect of racialized minority status or female sex on STMP. Some PSQ items are inapplicable to participants from racialized minority groups.
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Affiliation(s)
- Timothy J. Meeker
- Department of Biology, Morgan State University, Baltimore, MD, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Hee Jun Kim
- Community of Acute and Chronic Care, The George Washington University, Washington, DC, USA
| | - Ingrid K. Tulloch
- Department of Psychology, Morgan State University, Baltimore, MD, USA
| | - Michael L. Keaser
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan G. Dorsey
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
- Department of Pain and Translational Symptom Sciences, University of Maryland School of Nursing, Baltimore, MD, USA
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5
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Chowdhury NS, Chiang AKI, Millard SK, Skippen P, Chang WJ, Seminowicz DA, Schabrun SM. Combined transcranial magnetic stimulation and electroencephalography reveals alterations in cortical excitability during pain. eLife 2023; 12:RP88567. [PMID: 37966464 PMCID: PMC10651174 DOI: 10.7554/elife.88567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has been used to examine inhibitory and facilitatory circuits during experimental pain and in chronic pain populations. However, current applications of TMS to pain have been restricted to measurements of motor evoked potentials (MEPs) from peripheral muscles. Here, TMS was combined with electroencephalography (EEG) to determine whether experimental pain could induce alterations in cortical inhibitory/facilitatory activity observed in TMS-evoked potentials (TEPs). In Experiment 1 (n=29), multiple sustained thermal stimuli were administered to the forearm, with the first, second, and third block of thermal stimuli consisting of warm but non-painful (pre-pain block), painful (pain block) and warm but non-painful (post-pain block) temperatures, respectively. During each stimulus, TMS pulses were delivered while EEG (64 channels) was simultaneously recorded. Verbal pain ratings were collected between TMS pulses. Relative to pre-pain warm stimuli, painful stimuli led to an increase in the amplitude of the frontocentral negative peak ~45 ms post-TMS (N45), with a larger increase associated with higher pain ratings. Experiments 2 and 3 (n=10 in each) showed that the increase in the N45 in response to pain was not due to changes in sensory potentials associated with TMS, or a result of stronger reafferent muscle feedback during pain. This is the first study to use combined TMS-EEG to examine alterations in cortical excitability in response to pain. These results suggest that the N45 TEP peak, which indexes GABAergic neurotransmission, is implicated in pain perception and is a potential marker of individual differences in pain sensitivity.
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Affiliation(s)
- Nahian Shahmat Chowdhury
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- University of New South WalesSydneyAustralia
| | - Alan KI Chiang
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- University of New South WalesSydneyAustralia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- University of New South WalesSydneyAustralia
| | - Patrick Skippen
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
| | - Wei-Ju Chang
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanAustralia
| | - David A Seminowicz
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western OntarioLondonCanada
| | - Siobhan M Schabrun
- Center for Pain IMPACT, Neuroscience Research AustraliaSydneyAustralia
- The Gray Centre for Mobility and Activity, University of Western OntarioLondonCanada
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6
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Mathur VA, Payano Sosa JS, Keaser ML, Meiller TF, Seminowicz DA. The social context of burning mouth syndrome: an exploratory pilot study of stigma, discrimination, and pain. Pain Med 2023; 24:1213-1218. [PMID: 37314981 PMCID: PMC10628978 DOI: 10.1093/pm/pnad078] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The social context of burning mouth syndrome (BMS) has received little attention in the scientific literature. However, social psychological theory and insights from those with lived experiences suggest that people living with BMS experience compounding effects of stigma related to their pain, diagnosis (or lack thereof), and intersectional identities. OBJECTIVE Our aim is to provide initial evidence and to motivate new directions for research on BMS. Here, we present the results of an exploratory pilot study (n = 16) of women living with BMS in the United States. METHODS Participants completed self-report measures of stigma, discrimination, and pain, as well as laboratory assessments of pain through quantitative sensory testing. RESULTS Results indicate a high prevalence of internalized BMS stigma, experience of BMS-related discrimination from clinicians, and gender stigma consciousness in this population. Moreover, results provide initial evidence that these experiences are related to pain outcomes. The most robust pattern of findings is that internalized BMS stigma was related to greater clinical pain severity, interference, intensity, and unpleasantness. CONCLUSION Given the prevalence and pain-relevance of intersectional stigma and discrimination identified in this pilot study, lived experience and social context should be incorporated into future research on BMS.
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Affiliation(s)
- Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, United States
| | - Janell S Payano Sosa
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Timothy F Meiller
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
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7
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Stewart BW, Keaser ML, Lee H, Margerison SM, Cormie MA, Moayedi M, Lindquist MA, Chen S, Mathur BN, Seminowicz DA. Pathological claustrum activity drives aberrant cognitive network processing in human chronic pain. bioRxiv 2023:2023.11.01.564054. [PMID: 37961503 PMCID: PMC10635040 DOI: 10.1101/2023.11.01.564054] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Aberrant cognitive network activity and cognitive deficits are established features of chronic pain. However, the nature of cognitive network alterations associated with chronic pain and their underlying mechanisms require elucidation. Here, we report that the claustrum, a subcortical nucleus implicated in cognitive network modulation, is activated by acute painful stimulation and pain-predictive cues in healthy participants. Moreover, we discover pathological activity of the claustrum and a lateral aspect of the right dorsolateral prefrontal cortex (latDLPFC) in migraine patients. Dynamic causal modeling suggests a directional influence of the claustrum on activity in this latDLPFC region, and diffusion weighted imaging (DWI) verifies their structural connectivity. These findings advance understanding of claustrum function during acute pain and provide evidence of a possible circuit mechanism driving cognitive impairments in chronic pain.
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Affiliation(s)
- Brent W. Stewart
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Hwiyoung Lee
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Catonsville, MD, USA
| | - Sarah M. Margerison
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
- Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew A. Cormie
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada
- Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Clinical & Computational Neuroscience, Krembil Brain Institute, University Health Network
| | | | - Shuo Chen
- Department of Epidemiology & Public Health, Maryland Psychiatric Research Center, Catonsville, MD, USA
| | - Brian N. Mathur
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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8
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Mazaheri A, Furman AJ, Seminowicz DA. Fear and pain slow the brain. Pain 2023; 165:00006396-990000000-00444. [PMID: 38112650 PMCID: PMC11045659 DOI: 10.1097/j.pain.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health (CHBH), University of Birmingham, Birmingham, UK
| | - Andrew J. Furman
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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9
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Finan PH, Hunt C, Keaser ML, Smith K, Lerman S, Bingham CO, Barrett F, Garland EL, Zeidan F, Seminowicz DA. Effects of Savoring Meditation on Positive Emotions and Pain-Related Brain Function: A Mechanistic Randomized Controlled Trial in People With Rheumatoid Arthritis. medRxiv 2023:2023.09.07.23294949. [PMID: 37732231 PMCID: PMC10508795 DOI: 10.1101/2023.09.07.23294949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Positive emotions are a promising target for intervention in chronic pain, but mixed findings across trials to date suggest that existing interventions may not be optimized to efficiently engage the target. The aim of the current mechanistic randomized controlled trial was to test the effects of a single skill positive emotion-enhancing intervention called Savoring Meditation on pain-related neural and behavioral targets in patients with rheumatoid arthritis (RA). Participants included 44 patients with a physician-confirmed diagnosis of RA (n=29 included in fMRI analyses), who were randomized to either Savoring Meditation or a Slow Breathing control. Both meditation interventions were brief (four 20-minute sessions). Self-report measures were collected pre- and post-intervention. An fMRI task was conducted at post-intervention, during which participants practiced the meditation technique on which they had been trained while exposed to non-painful and painful thermal stimuli. Relative to Slow Breathing, Savoring significantly reduced experimental pain intensity ratings relative to rest (p<.001), increased cerebral blood flow in the ventromedial prefrontal cortex (vmPFC) and increased connectivity between the vmPFC and caudate during noxious thermal stimulation (z=2.3 voxelwise, FDR cluster corrected p=0.05). Participants in the Savoring condition also reported significantly increased positive emotions (ps<.05) and reduced anhedonic symptoms (p<.01) from pre- to post-intervention. These findings suggest that that Savoring recruits reward-enhancing corticostriatal circuits in the face of pain, and future work should extend these findings to evaluate if these mechanisms of Savoring are associated with improved clinical pain outcomes in diverse patient populations.
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Affiliation(s)
- Patrick H. Finan
- Department of Anesthesiology, University of Virginia School of Medicine
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Carly Hunt
- Department of Anesthesiology, University of Virginia School of Medicine
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry
- Center to Advance Chronic Pain Research, University of Maryland Baltimore
| | - Katie Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sheera Lerman
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Clifton O. Bingham
- Department of Medicine, Division of Rheumatology, Johns Hopkins University
| | - Frederick Barrett
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah
| | - Fadel Zeidan
- Department of Anesthesiology, University of California-San Diego
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry
- Center to Advance Chronic Pain Research, University of Maryland Baltimore
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario
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10
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Chowdhury NS, Chiang AKI, Millard SK, Skippen P, Chang WJ, Seminowicz DA, Schabrun SM. Alterations in cortical excitability during pain: A combined TMS-EEG Study. bioRxiv 2023:2023.04.20.537735. [PMID: 37131586 PMCID: PMC10153239 DOI: 10.1101/2023.04.20.537735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Transcranial magnetic stimulation (TMS) has been used to examine inhibitory and facilitatory circuits during experimental pain and in chronic pain populations. However, current applications of TMS to pain have been restricted to measurements of motor evoked potentials (MEPs) from peripheral muscles. Here, TMS was combined with electroencephalography (EEG) to determine whether experimental pain could induce alterations in cortical inhibitory/facilitatory activity observed in TMS-evoked potentials (TEPs). In Experiment 1 (n = 29), multiple sustained thermal stimuli were administered to the forearm, with the first, second and third block of thermal stimuli consisting of warm but non-painful (pre-pain block), painful (pain block) and warm but non-painful (post-pain block) temperatures respectively. During each stimulus, TMS pulses were delivered while EEG (64 channels) was simultaneously recorded. Verbal pain ratings were collected between TMS pulses. Relative to pre-pain warm stimuli, painful stimuli led to an increase in the amplitude of the frontocentral negative peak ~45ms post-TMS (N45), with a larger increase associated with higher pain ratings. Experiments 2 and 3 (n = 10 in each) showed that the increase in the N45 in response to pain was not due to changes in sensory potentials associated with TMS, or a result of stronger reafferent muscle feedback during pain. This is the first study to use combined TMS-EEG to examine alterations in cortical excitability in response to pain. These results suggest that the N45 TEP peak, which indexes GABAergic neurotransmission, is implicated in pain perception and is a potential marker of individual differences in pain sensitivity.
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Affiliation(s)
- Nahian S Chowdhury
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Alan KI Chiang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Skippen
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David A Seminowicz
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Siobhan M Schabrun
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- The Gray Centre for Mobility and Activity, University of Western Ontario, London, Canada
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11
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Kulesa KM, Furman AJ, Krimmel SR, Keaser ML, Seminowicz DA, Gullapalli RP, Da Silva JT. The Role Of Peak Alpha Frequency In Determining The Neural Mechanisms Of Pain. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.226] [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: 04/07/2023]
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12
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Keaser M, Reid M, Finan PH, Seminowicz DA. Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine. Mindfulness (N Y) 2023; 14:769-783. [PMID: 38435377 PMCID: PMC10907069 DOI: 10.1007/s12671-023-02105-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
Objectives Mindfulness-based interventions (MBIs) have emerged as promising prophylactic episodic migraine treatments. The present study investigated biopsychosocial predictors and outcomes associated with formal, daily-life meditation practice in migraine patients undergoing MBI, and whether augmented mindfulness mechanistically underlies change. Methods Secondary analyses of clinical trial data comparing a 12-week enhanced mindfulness-based stress reduction course (MBSR + ; n = 50) to stress management for headache (SMH; n = 48) were conducted. Results Pre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) predicted greater meditation practice duration over MBSR + (r = 0.58, p = 0.001), as well as the change in headache frequency from pre- to post-treatment (B = -12.60, p = 0.02) such that MBSR + participants with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. MBSR + participants who meditated more showed greater increases in mindfulness (B = 0.52, p = 0.02) and reductions in the helplessness facet of pain catastrophizing (B = -0.13, p = 0.01), but not headache frequency, severity, or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR + , but not headache frequency. Conclusions Mesocorticolimbic system function is implicated in motivated behavior, and thus, motivation-enhancing interventions might be delivered alongside mindfulness-based training to enhance meditation practice engagement. Formal, daily-life meditation practice duration appears to benefit pain-related cognitions, but not clinical pain, while mindfulness emerges as a mechanism of MBIs on headache impact, but not frequency. Further research is needed to investigate the day-to-day effects of formal, daily-life meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes. Preregistration This study is not preregistered.
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Affiliation(s)
- Carly A. Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - Janelle E. Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel R. Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shana A. B. Burrowes
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02218, USA
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Matthew Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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13
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Meeker T, Tulloch IK, Kim HJ, Keaser ML, Seminowicz DA, Dorsey SG. Racialized Minorities Demonstrate Greater Pain Sensitivity And Sensibility To Heat And Self-Reported Acute Pain Despite Limitations Of Pain Sensitivity Questionnaire In Diverse Populations. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.067] [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: 04/07/2023]
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14
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Margerison S, Stewart B, Furman AJ, Keaser ML, Spies D, Seminowicz DA. BOLD Functional Connectivity Associated With Alpha Power Decreases During Thermal Pain. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.231] [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: 04/07/2023]
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15
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Chowdhury NS, Skippen P, Si E, Chiang AKI, Millard SK, Furman AJ, Chen S, Schabrun SM, Seminowicz DA. The reliability of two prospective cortical biomarkers for pain: EEG peak alpha frequency and TMS corticomotor excitability. J Neurosci Methods 2023; 385:109766. [PMID: 36495945 PMCID: PMC9848447 DOI: 10.1016/j.jneumeth.2022.109766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many pain biomarkers fail to move from discovery to clinical application, attributed to poor reliability and an inability to accurately classify at-risk individuals. Preliminary evidence has shown that high pain sensitivity is associated with slow peak alpha frequency (PAF), and depression of corticomotor excitability (CME), potentially due to impairments in ascending sensory and descending motor pathway signalling respectively NEW METHOD: The present study evaluated the reliability of PAF and CME responses during sustained pain. Specifically, we determined whether, over several days of pain, a) PAF remains stable and b) individuals show two stable and distinct CME responses: facilitation and depression. Participants were given an injection of nerve growth factor (NGF) into the right masseter muscle on Day 0 and Day 2, inducing sustained pain. Electroencephalography (EEG) to assess PAF and transcranial magnetic stimulation (TMS) to assess CME were recorded on Day 0, Day 2 and Day 5. RESULTS Using a weighted peak estimate, PAF reliability (n = 75) was in the excellent range even without standard pre-processing and ∼2 min recording length. Using a single peak estimate, PAF reliability was in the moderate-good range. For CME (n = 74), 80% of participants showed facilitation or depression of CME beyond an optimal cut-off point, with the stability of these changes in the good range. COMPARISON WITH EXISTING METHODS No study has assessed the reliability of PAF or feasibility of classifying individuals as facilitators/depressors, in response to sustained pain. PAF was reliable even in the presence of pain. The use of a weighted peak estimate for PAF is recommended, as excellent test-retest reliability can be obtained even when using minimal pre-processing and ∼2 min recording. We also showed that 80% of individuals exhibit either facilitation or depression of CME, with these changes being stable across sessions. CONCLUSIONS Our study provides support for the reliability of PAF and CME as prospective cortical biomarkers. As such, our paper adds important methodological advances to the rapidly growing field of pain biomarkers.
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Affiliation(s)
- Nahian S Chowdhury
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
| | - Patrick Skippen
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Emily Si
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Alan K I Chiang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew J Furman
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, USA
| | - Shuo Chen
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, USA
| | - Siobhan M Schabrun
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Physical Therapy, University of Western Ontario, London, Canada
| | - David A Seminowicz
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, USA; Department of Medical Biophysics, University of Western Ontario, London, Canada
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16
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Goyal M, Haythornthwaite JA, Jain S, Peterlin BL, Mehrotra M, Levine D, Rosenberg JD, Minges M, Seminowicz DA, Ford DE. Intensive Mindfulness Meditation Reduces Frequency and Burden of Migraine: An Unblinded Single-Arm Trial. Mindfulness (N Y) 2023; 14:406-417. [PMID: 38282695 PMCID: PMC10810247 DOI: 10.1007/s12671-023-02073-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Objectives Preventing migraine headaches and improving the quality of life for patients with migraine remains a challenge. We hypothesized intensive meditation training would reduce the disease burden of migraine. Method An unblinded trial was analyzed as a single cohort exposed to a silent 10-day Vipassana meditation retreat that included 100 hr of sitting meditation. Participants with chronic or episodic migraine were enrolled and followed for 1 year. The primary outcome was a change in mean monthly migraine days at 12 months from baseline. Secondary outcomes included headache frequency and intensity, acute medication use, work days missed, home meditation, sleep quality, general health, quality of life, migraine impact, positive and negative affect, perceived stress, mindfulness, and pain catastrophizing. Results Three hundred people were screened and 58 (19%) agreed to participate and enrolled in the intensive meditation training. Forty-six participants with chronic migraine (≥ 15 headaches/month of which ≥ 8 were migraines) and 12 with episodic migraine (< 15 and ≥ 4 migraines/month) attended and 45 (78%) completed the retreat. At 12 months, the average migraine frequency was reduced by 2.7 days (from 16.6 at baseline) per 28 days (95%CI - 4.3, - 1.3) and headaches by 3.4 (20.1 at baseline) per 28 days (- 4.9, - 1.9). Fifty percent responder rate was 29% for migraine. Acute medication use dropped by an average of 2.2 days (- 3.9, - 0.5) per 28 days, and participants reported 2.3 fewer days (- 4.0, - 0.5) on which they reduced their activity due to migraines. The most striking and promising effects were in several secondary outcomes, including migraine-specific quality of life, pain catastrophizing, and perceived stress. The significant improvements observed immediately following the intervention were sustained at 12 months follow-up. Conclusions Training in Vipassana meditation via a 10-day retreat may reduce the frequency and burden of migraine. Preregistration ClinicalTrials.gov: NCT00663585.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Center for Primary Care, NorthBay Healthcare, Vacaville, CA, USA
| | | | - Sharat Jain
- Mid-Atlantic Vipassana Association, Claymont, DE, USA
| | - Barbara Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Megha Mehrotra
- Department of Epidemiology and Biostatistics, Univ of California, San Francisco, USA
| | - David Levine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jason D. Rosenberg
- Department of Neurology, Mid-Atantic Permanente Medical Group, MD, Halethorpe, USA
| | - Mary Minges
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - David A. Seminowicz
- Department of Neural & Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, USA
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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17
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Qadir H, Stewart BW, VanRyzin JW, Wu Q, Chen S, Seminowicz DA, Mathur BN. The mouse claustrum synaptically connects cortical network motifs. Cell Rep 2022; 41:111860. [PMID: 36543121 PMCID: PMC9838879 DOI: 10.1016/j.celrep.2022.111860] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Spatially distant areas of the cerebral cortex coordinate their activity into networks that are integral to cognitive processing. A common structural motif of cortical networks is co-activation of frontal and posterior cortical regions. The neural circuit mechanisms underlying such widespread inter-areal cortical coordination are unclear. Using a discovery based functional magnetic resonance imaging (fMRI) approach in mouse, we observe frontal and posterior cortical regions that demonstrate significant functional connectivity with the subcortical nucleus, the claustrum. Examining whether the claustrum synaptically supports such frontoposterior cortical network architecture, we observe cortico-claustro-cortical circuits reflecting the fMRI data: significant trans-claustral synaptic connectivity from frontal cortices to posteriorly lying sensory and sensory association cortices contralaterally. These data reveal discrete cortical pathways through the claustrum that are positioned to support cortical network motifs central to cognitive control functions and add to the canon of major extended cortico-subcortico-cortical systems in the mammalian brain.
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Affiliation(s)
- Houman Qadir
- Department of Pharmacology, University of Maryland School of Medicine, HSF III 9179, Baltimore, MD 21201, USA
| | - Brent W. Stewart
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Jonathan W. VanRyzin
- Department of Pharmacology, University of Maryland School of Medicine, HSF III 9179, Baltimore, MD 21201, USA
| | - Qiong Wu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuo Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA,Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Brian N. Mathur
- Department of Pharmacology, University of Maryland School of Medicine, HSF III 9179, Baltimore, MD 21201, USA,Lead contact,Correspondence:
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18
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Madden MB, Stewart BW, White MG, Krimmel SR, Qadir H, Barrett FS, Seminowicz DA, Mathur BN. A role for the claustrum in cognitive control. Trends Cogn Sci 2022; 26:1133-1152. [PMID: 36192309 PMCID: PMC9669149 DOI: 10.1016/j.tics.2022.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 01/12/2023]
Abstract
Early hypotheses of claustrum function were fueled by neuroanatomical data and yielded suggestions that the claustrum is involved in processes ranging from salience detection to multisensory integration for perceptual binding. While these hypotheses spurred useful investigations, incompatibilities inherent in these views must be reconciled to further conceptualize claustrum function amid a wealth of new data. Here, we review the varied models of claustrum function and synthesize them with developments in the field to produce a novel functional model: network instantiation in cognitive control (NICC). This model proposes that frontal cortices direct the claustrum to flexibly instantiate cortical networks to subserve cognitive control. We present literature support for this model and provide testable predictions arising from this conceptual framework.
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Affiliation(s)
- Maxwell B Madden
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Brent W Stewart
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD 21201, USA
| | - Michael G White
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD 21201, USA
| | - Houman Qadir
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD 21224, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD 21201, USA; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Brian N Mathur
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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19
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Margerison SM, Westlake KP, Seminowicz DA. Beyond pain in the brain: A clinician's guide to interpreting the spinal cord's role in the pain experience. Musculoskelet Sci Pract 2022; 62:102664. [PMID: 36116418 DOI: 10.1016/j.msksp.2022.102664] [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: 04/05/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Physical therapy practice has greatly improved in providing a biopsychosocial approach when considering persistent pain. However, the spinal cord is often overlooked as a structure with an important role in modulating nociceptive information. PURPOSE This article highlights the role of the dorsal horn (DH) in nociceptive processing and its impact on persistent pain conditions as they appear clinically. Key processes occurring in the spinal cord are described, including cellular changes and local spinal network responses to nociceptive stimuli. Additionally, associated clinical symptoms are discussed and some aspects of physical therapy evaluation are challenged based on the mechanisms of nociceptive processing presented in this commentary. IMPLICATIONS The spinal cord is an active participant in nociceptive processing, directly impacting the intensity, spread, and recurrence of pain, including within the context of central sensitization. Changes in the behavior of DH neurons are possible with sufficient stimulation and may occur after injury. Additionally, spinal cord activation patterns may lead to bilateral symptoms given adequate strength and duration despite a single peripheral driver. Viewing the spinal cord as a dynamic structure capable of up or down regulating its response to stimuli gives the clinician a better understanding of the nervous system's complex response to prolonged nociceptive input.
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Affiliation(s)
- Sarah M Margerison
- Physical Therapy and Rehabilitation Science University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.
| | - Kelly P Westlake
- Physical Therapy and Rehabilitation Science University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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20
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Finan PH, Vetter M, Seminowicz DA. Is Mindfulness Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network? A Replication and Extension Study in Healthy and Episodic Migraine Participants. J Pain 2022; 23:2110-2120. [PMID: 35934277 PMCID: PMC9729370 DOI: 10.1016/j.jpain.2022.07.011] [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] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023]
Abstract
Formal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network, implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state default mode network functional connectivity in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold, pain intensity or unpleasantness, or pain catastrophizing in healthy controls, or between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients. There was no association between default mode network connectivity and mindfulness in either sample when probed via seed-based functional connectivity analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived default mode network node (ie, posterior cingulate cortex) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater functional connectivity between the posterior cingulate cortex-and cerebellum. Collectively, these findings suggest that the relationship between mindfulness and default mode network functional connectivity may be nuanced or non-robust, and encourage further investigation of how mindfulness relates to pain. PERSPECTIVE: This study found few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.
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Affiliation(s)
- Carly A Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Shana A B Burrowes
- Department of Medicine, Boston University School of Medicine, Section of Infectious Diseases, Boston, Maryland; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Vetter
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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21
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Chowdhury NS, Chang WJ, Millard SK, Skippen P, Bilska K, Seminowicz DA, Schabrun SM. The Effect of Acute and Sustained Pain on Corticomotor Excitability: A Systematic Review and Meta-Analysis of Group and Individual Level Data. J Pain 2022; 23:1680-1696. [PMID: 35605763 DOI: 10.1016/j.jpain.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
Pain alters motor function. This is supported by studies showing reduced corticomotor excitability in response to experimental pain lasting <90 minutes. Whether similar reductions in corticomotor excitability are present with pain of longer durations or whether alterations in corticomotor excitability are associated with pain severity is unknown. Here we evaluated the evidence for altered corticomotor excitability in response to experimental pain of differing durations in healthy individuals. Databases were systematically searched for eligible studies. Measures of corticomotor excitability and pain were extracted. Meta-analyses were performed to examine: (1) group-level effect of pain on corticomotor excitability, and (2) individual-level associations between corticomotor excitability and pain severity. 49 studies were included. Corticomotor excitability was reduced when pain lasted milliseconds-seconds (hedges g's = -1.26 to -1.55) and minutes-hours (g's = -0.55 to -0.9). When pain lasted minutes-hours, a greater reduction in corticomotor excitability was associated with lower pain severity (g = -0.24). For pain lasting days-weeks, there were no group level effects (g = -0.18 to 0.27). However, a greater reduction in corticomotor excitability was associated with higher pain severity (g = 0.229). In otherwise healthy individuals, suppression of corticomotor excitability may be a beneficial short-term strategy with long-term consequences. PERSPECTIVE: This systematic review synthesised the evidence for altered corticomotor excitability in response to experimentally induced pain. Reduced corticomotor excitability was associated with lower acute pain severity but higher sustained pain severity, suggesting suppression of corticomotor excitability may be a beneficial short-term adaptation with long-term consequences.
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Affiliation(s)
- Nahian S Chowdhury
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Skippen
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Katarzyna Bilska
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Siobhan M Schabrun
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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22
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Krimmel SR, Keaser ML, Speis D, Haythornthwaite JA, Seminowicz DA. Migraine disability, pain catastrophizing, and headache severity are associated with evoked pain and targeted by mind-body therapy. Pain 2022; 163:e1030-e1037. [PMID: 35297801 PMCID: PMC9288557 DOI: 10.1097/j.pain.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Meta-analysis suggests that migraine patients are no more sensitive to experimentally evoked pain than healthy control subjects. At the same time, studies have linked some migraine symptoms to quantitative sensory testing (QST) profiles. Unfortunately, previous studies associating migraine symptoms and QST have important methodological shortcomings, stemming from small sample sizes, and frequent use of univariate statistics for multivariate research questions. In the current study, we seek to address these limitations by using a large sample of episodic migraine patients (n = 103) and a multivariate analysis that associates pain ratings from many thermal intensities simultaneously with 12 clinical measures ranging from headache frequency to sleep abnormalities. We identified a single dimension of association between thermal QST and migraine symptoms that relates to pain ratings for all stimulus intensities and a subset of migraine symptoms relating to disability (Headache Impact Test 6 and Brief Pain Inventory interference), catastrophizing (Pain Catastrophizing Scale), and pain severity (average headache pain, Brief Pain Inventory severity, and Short-Form McGill Pain Questionnaire 2). Headache frequency, allodynia, affect, and sleep disturbances were unrelated to this dimension. Consistent with previous research, we did not observe any difference in QST ratings between migraine patients and healthy control subjects. Additionally, we found that the linear combination of symptoms related to QST was modified by the mind-body therapy enhanced mindfulness-based stress reduction (MBSR+). These results suggest that QST has a selective relationship with pain symptoms even in the absence of between-subjects differences between chronic pain patients and healthy control subjects.
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Affiliation(s)
- Samuel R. Krimmel
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland School of
Medicine, Baltimore, MD, 21201 USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Darrah Speis
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
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23
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Mazaheri A, Seminowicz DA, Furman AJ. Peak alpha frequency as a candidate biomarker of pain sensitivity: the importance of distinguishing slow from slowing. Neuroimage 2022; 262:119560. [PMID: 35973563 DOI: 10.1016/j.neuroimage.2022.119560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
The study by Valentini et al. (2022) observed that the peak alpha frequency (PAF) of participants became slower after they were exposed to painful, as well as non-painful but unpleasant stimuli. The authors interpreted this as a challenge to our previous studies which propose that the speed of resting PAF, independently of pain-induced changes to PAF, can be a reliable biomarker marker for gaging individual pain sensitivity. While investigations into the role that PAF plays in pain perception are timely, we have some concerns about the assumptions and methodology employed by Valentini et al. Moreover, we believe the authors here have also misrepresented some of our previous work. In the current commentary, we detail the critical differences between our respective studies, with the ultimate aim of guiding future investigations.
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Affiliation(s)
- Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, UK; Centre for Human Brain Health (CHBH), University of Birmingham, Birmingham, UK.
| | - David A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrew J Furman
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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24
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Krimmel SR, DeSouza DD, Keaser ML, Sanjanwala BM, Cowan RP, Lindquist MA, Haythornthwaite JA, Seminowicz DA. Three Dimensions of Association Link Migraine Symptoms and Functional Connectivity. J Neurosci 2022; 42:6156-6166. [PMID: 35768210 PMCID: PMC9351635 DOI: 10.1523/jneurosci.1796-21.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/27/2022] [Accepted: 06/18/2022] [Indexed: 02/05/2023] Open
Abstract
Migraine is a heterogeneous disorder with variable symptoms and responsiveness to therapy. Because of previous analytic shortcomings, variance in migraine symptoms has been inconsistently related to brain function. In the current analysis, we used data from two sites (n = 143, male and female humans), and performed canonical correlation analysis, relating resting-state functional connectivity (RSFC) with a broad range of migraine symptoms, ranging from headache characteristics to sleep abnormalities. This identified three dimensions of covariance between symptoms and RSFC. The first dimension related to headache intensity, headache frequency, pain catastrophizing, affect, sleep disturbances, and somatic abnormalities, and was associated with frontoparietal and dorsal attention network connectivity, both of which are major cognitive networks. Additionally, RSFC scores from this dimension, both the baseline value and the change from baseline to postintervention, were associated with responsiveness to mind-body therapy. The second dimension was related to an inverse association between pain and anxiety, and to default mode network connectivity. The final dimension was related to pain catastrophizing, and salience, sensorimotor, and default mode network connectivity. In addition to performing canonical correlation analysis, we evaluated the current clustering of migraine patients into episodic and chronic subtypes, and found no evidence to support this clustering. However, when using RSFC scores from the three significant dimensions, we identified a novel clustering of migraine patients into four biotypes with unique functional connectivity patterns. These findings provide new insight into individual variability in migraine, and could serve as the foundation for novel therapies that take advantage of migraine heterogeneity.SIGNIFICANCE STATEMENT Using a large multisite dataset of migraine patients, we identified three dimensions of multivariate association between symptoms and functional connectivity. This analysis revealed neural networks that relate to all measured symptoms, but also to specific symptom ensembles, such as patient propensity to catastrophize painful events. Using these three dimensions, we found four biotypes of migraine informed by clinical and neural variation together. Such findings pave the way for precision medicine therapy for migraine.
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Affiliation(s)
- Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Danielle D DeSouza
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
| | - Bharati M Sanjanwala
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Robert P Cowan
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Martin A Lindquist
- Department Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
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25
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Millard SK, Furman AJ, Kerr A, Seminowicz DA, Gao F, Naidu BV, Mazaheri A. Predicting postoperative pain in lung cancer patients using preoperative peak alpha frequency. Br J Anaesth 2022; 128:e346-e348. [PMID: 35393099 DOI: 10.1016/j.bja.2022.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Samantha K Millard
- School of Psychology, University of Birmingham, Birmingham, UK; Faculty of Medicine, Wallace Wurth Building, University of New South Wales (UNSW), Sydney, Kensington, NSW, Australia; Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.
| | - Andrew J Furman
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Amy Kerr
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medicine and Dentistry Science, University of Birmingham, Birmingham, UK; Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Fang Gao
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medicine and Dentistry Science, University of Birmingham, Birmingham, UK; Department of Anaesthesia, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Babu V Naidu
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medicine and Dentistry Science, University of Birmingham, Birmingham, UK; Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, UK; Centre for Human Brain Health (CHBH), University of Birmingham, Birmingham, UK.
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26
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Xu H, Seminowicz DA, Krimmel SR, Zhang M, Gao L, Wang Y. Altered Structural and Functional Connectivity of Salience Network in Patients with Classic Trigeminal Neuralgia. J Pain 2022; 23:1389-1399. [PMID: 35381362 DOI: 10.1016/j.jpain.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 12/27/2022]
Abstract
Classic trigeminal neuralgia (CTN) is a neuropathic pain disorder displaying spontaneously stabbing or electric shock-like paroxysms in the face. Previous research suggests structural and functional abnormalities in brain regions related to sensory and cognitive-affective dimensions of pain contribute to the pathophysiology of CTN. However, few studies to date have investigated how changes in whole-brain functional networks and white matter connectivity are related to CTN. We performed an independent component analysis to examine abnormalities in resting state functional connectivity of large-scale networks in 48 patients with CTN compared to 46 matched healthy participants. Then, diffusion tensor tractography was performed to test whether these alterations of functional connectivity in intrinsic networks were associated with impairment of the white matter tracts connecting them. Distinct patterns of functional connectivity were detected within default mode network, somatosensory network, and salience network (SN) in the CTN group when compared with healthy controls. Furthermore, abnormality of SN was negatively correlated with pain severity. In support of aberrant functional connectivity within SN, structural disintegration was observed in the white matter tract from left anterior insula (aIns) to left anterior cingulate cortex (ACC) in CTN. These results suggest that altered structural and functional connectivity between aIns and ACC may underpin the aberrant SN in patients with CTN and provide an alternative target for clinical interventions. PERSPECTIVE: This article presents distinctive abnormalities of functional and structural connectivity from aIns to ACC in the patients with CTN, which is associated with pain ratings. This measure could potentially provide an alternative target for clinicians to alleviate this type of intermittent and refractory pain.
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Affiliation(s)
- Hui Xu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Gao
- Department of Mechanical Engineering, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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27
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Burrowes SAB, Goloubeva O, Stafford K, McArdle PF, Goyal M, Peterlin BL, Haythornthwaite JA, Seminowicz DA. Enhanced mindfulness-based stress reduction in episodic migraine-effects on sleep quality, anxiety, stress, and depression: a secondary analysis of a randomized clinical trial. Pain 2022; 163:436-444. [PMID: 34407032 PMCID: PMC8669060 DOI: 10.1097/j.pain.0000000000002372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/18/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Patients with migraine suffer from high morbidity related to the repeated headache attacks, characteristic of the disorder, poor sleep, and a high prevalence of comorbid psychosocial disorders. Current pharmacological therapies do not address these aspects of migraine, but nonpharmacological treatments such as mindfulness-based stress reduction (MBSR) have been shown to improve both pain and psychological well-being. In this secondary analysis, we examined the change over time in sleep quality and psychosocial outcomes from the magnetic resonance imaging outcomes for mindfulness meditation clinical trial and assessed how these mediated treatment response (50% reduction in headache frequency postintervention). We also examined the relationship between baseline values and treatment response. The trial (primary outcomes previously reported) included 98 patients with episodic migraine randomized to either enhanced MBSR (MBSR+) or stress management for headache. They completed psychosocial questionnaires and headache diaries at baseline (preintervention), midintervention (10 weeks after baseline), and postintervention (20 weeks after baseline). There was a significant improvement in sleep quality from baseline to postintervention (P = 0.0025) in both groups. There were no significant changes from baseline or between groups in anxiety, depression, and stress. There was also no significant association between baseline scores and treatment response. Mediation analysis showed a significant indirect effect of 6% for sleep: In other words, small improvements in sleep may have contributed to the efficacy of MBSR+.Trial registration: NCT02133209.
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Affiliation(s)
- Shana AB Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston MA, USA 02118
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Olga Goloubeva
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Kristen Stafford
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Patrick F. McArdle
- Department of Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Madhav Goyal
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - B. Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA 17601
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
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28
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Burrowes SAB, Goloubeva O, Keaser ML, Haythornthwaite JA, Seminowicz DA. Differences in gray matter volume in episodic migraine patients with and without prior diagnosis or clinical care: a cross-sectional study. J Headache Pain 2021; 22:127. [PMID: 34688253 PMCID: PMC8542322 DOI: 10.1186/s10194-021-01340-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Migraine sufferers face difficulties getting appropriate care and treatment. Migraine is associated with reduced gray matter volume (GMV) in several brain regions, which could be related to various clinical characteristics of the disorder. Objectives To examine differences in GMV in migraine patients with and without prior clinical care for migraine and examine differences in migraine clinical variables, psychosocial symptoms and their relationship with GMV. Methods We utilized the baseline MRI scan and psychosocial symptom questionnaires from a longitudinal randomized controlled trial. Prior care of migraine was determined by diagnosis by a medical practitioner or prescription of migraine specific medication. Results 117 patients were included in the study. Patients without prior care (n=23) had reduced GMV in the right dorsal medial prefrontal cortex (dMPFC) relative to patients who had prior care (p=0.034, FWE corrected). Both patient groups had reduced GMV compared to healthy controls (n=36). Patient groups did not differ in headache clinical variables. Regardless of care status, increasing scores on the stress (Perceived Stress Score) and depression questionnaires (Patient Health Questionnaire) were associated with increased GMV in the dMPFC. Conclusions Clinical care may impact GMV in migraine patients. Patients may need different treatment options to address this baseline deficit. Trial registration NCT02133209. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01340-5.
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Affiliation(s)
- Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 02218, Boston, MA, USA. .,Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 21201, Baltimore, MD, USA. .,Center to Advance Chronic Pain Research, University of Maryland Baltimore, 21201, Baltimore, MD, USA. .,Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, 21201, Baltimore, MD, USA. .,Boston University School of Medicine, 801 Massachusetts Avenue Room 2004, MA, 02118, Boston, USA.
| | - Olga Goloubeva
- Greenebaum Comprehensive Cancer Center, University of Maryland, University of Maryland Baltimore, 21201, Baltimore, MD, USA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 21201, Baltimore, MD, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, 21201, Baltimore, MD, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 21201, Baltimore, MD, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, 21201, Baltimore, MD, USA
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29
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Payano Sosa JS, Da Silva JT, Burrowes SAB, Yoo SY, Keaser ML, Meiller TF, Seminowicz DA. Time of Day Influences Psychophysical Measures in Women With Burning Mouth Syndrome. Front Neurosci 2021; 15:698164. [PMID: 34658757 PMCID: PMC8519262 DOI: 10.3389/fnins.2021.698164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Burning mouth syndrome (BMS) is a chronic orofacial pain condition that mainly affects postmenopausal women. BMS type I patients report little to no spontaneous pain in the morning and increases in pain through the day, peaking in the afternoon. Quantitative sensory testing (QST) findings from BMS type 1 patients are inconsistent as they fail to capture this temporal variation. We examined how QST in BMS type 1 (n = 18) compared to healthy participants (n = 33) was affected by time of day. QST of the face and forearm included warmth detection threshold (WDT), cold detection threshold (CDT), and heat pain thresholds (HPT), ratings of suprathreshold heat, and pressure pain thresholds (PPT), and was performed twice: once in the morning and once in the afternoon. Compared to healthy participants, BMS patients had higher pain sensitivity to phasic heat stimuli at most temperatures (35°C U = 126.5, p = 0.0006, 39°C U = 186.5, p = 0.0386, 41°C U = 187.5, p = 0.0412, 43°C U = 171, p = 0.0167, 45°C U = 168.5, p = 0.0146) on the forearm, but no differences in pain thresholds (HPT and PPT) regardless of time of day or body area tested. BMS patients had higher WDT (U = 123, p = 0.0172), and lower CDT (U = 98, p = 0.0021) of the forearm and lower WDT of the face (U = 55, p = 0.0494). The differences in forearm WDT (U = 71.5, p = 0.0113) and CDT (U = 70, p = 0.0096) were most pronounced in the morning. In summary, BMS type I patients had increased pain sensitivity on the forearm, but no differences in pain thresholds on the face or forearm. Patients also showed altered thermal sensitivity, which depended on body area tested (heightened in the orofacial region but blunted on the forearm), and was more pronounced in the morning plausibly due to hypervigilance.
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Affiliation(s)
- Janell S Payano Sosa
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Joyce T Da Silva
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Soo Y Yoo
- Montefiore Medical Center, The Bronx, NY, United States
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Timothy F Meiller
- Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
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30
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Meeker TJ, Schmid AC, Liu Y, Keaser ML, Dorsey SG, Seminowicz DA, Greenspan JD. During capsaicin-induced central sensitization, brush allodynia is associated with baseline warmth sensitivity, whereas mechanical hyperalgesia is associated with painful mechanical sensibility, anxiety and somatization. Eur J Pain 2021; 25:1971-1993. [PMID: 34051016 DOI: 10.1002/ejp.1815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/23/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mechanical hyperalgesia and allodynia incidence varies considerably amongst neuropathic pain patients. This study explored whether sensory or psychological factors associate with mechanical hyperalgesia and brush allodynia in a human experimental model. METHODS Sixty-six healthy volunteers (29 male) completed psychological questionnaires and participated in two quantitative sensory testing (QST) sessions. Warmth detection threshold (WDT), heat pain threshold (HPT) and suprathreshold mechanical pain (STMP) ratings were measured before exposure to a capsaicin-heat pain model (C-HP). After C-HP exposure, brush allodynia and STMP were measured in one session, whilst mechanical hyperalgesia was measured in another session. RESULTS WDT and HPT measured in sessions separated by 1 month demonstrated significant but moderate levels of reliability (WDT: ICC = 0.5, 95%CI [0.28, 0.77]; HPT: ICC = 0.62, 95%CI [0.40, 0.77]). Brush allodynia associated with lower WDT (z = -3.06, p = 0.002; ϕ = 0.27). Those with allodynia showed greater hyperalgesia intensity (F = 7.044, p = 0.010, ηp 2 = 0.107) and area (F = 9.319, p = 0.004, ηp 2 = 0.163) than those without allodynia. No psychological self-report measures were significantly different between allodynic and nonallodynic groups. Intensity of hyperalgesia in response to lighter mechanical stimuli was associated with lower HPT, higher STMP ratings and higher Pain Sensitivity Questionnaire scores at baseline. Hyperalgesia to heavier probe stimuli associated with state anxiety and to a lesser extent somatic awareness. Hyperalgesic area associated with lower baseline HPT and higher STMP ratings. Hyperalgesic area was not correlated with allodynic area across individuals. CONCLUSIONS These findings support research in neuropathic pain patients and human experimental models that peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role. SIGNIFICANCE We evaluated differential relationships of psychological and perceptual sensitivity to the development of capsaicin-induced mechanical allodynia and hyperalgesia. Fifty percent of healthy volunteers failed to develop mechanical allodynia. Baseline pain sensitivity was greater in those developing allodynia and was related to the magnitude and area of hyperalgesia. State psychological factors, whilst unrelated to allodynia, were related to mechanical hyperalgesia. This supports that the intensity of peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role.
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Affiliation(s)
- Timothy J Meeker
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Anne-Christine Schmid
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Clinical Neuroengineering, BrainMind Institute and Centre of Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.,Swiss Federal Institute of Technology Valais (EPFL Valais), Sion, Switzerland.,WyssCenter of Bio and Neuroengineering, Geneva, Switzerland
| | - Yiming Liu
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Pain Medicine, Peking University People's Hospital, Beijing, China
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
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31
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Burrowes SAB, Rhodes CS, Meeker TJ, Greenspan JD, Gullapalli RP, Seminowicz DA. Decreased grey matter volume in mTBI patients with post-traumatic headache compared to headache-free mTBI patients and healthy controls: a longitudinal MRI study. Brain Imaging Behav 2021; 14:1651-1659. [PMID: 30980274 DOI: 10.1007/s11682-019-00095-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Traumatic brain injury (TBI) occurs in 1.7 million people annually and many patients go on to develop persistent disorders including post-traumatic headache (PTH). PTH is considered chronic if it continues past 3 months. In this study we aimed to identify changes in cerebral grey matter volume (GMV) associated with PTH in mild TBI patients. 50 mTBI patients (31 Non-PTH; 19 PTH) underwent MRI scans: within 10 days post-injury, 1 month, 6 months and 18 months. PTH was assessed at visit 4 by a post-TBI headache questionnaire. Healthy controls (n = 21) were scanned twice 6 months apart. Compared to non-PTH, PTH patients had decreased GMV across two large clusters described as the right anterior-parietal (p = 0.012) and left temporal-opercular (p = 0.027). Compared to healthy controls non-PTH patients had decreased GMV in the left thalamus (p = 0.047); PTH patients had decreased GMV in several extensive clusters: left temporal-opercular (p = 0.003), temporal-parietal (p = 0.041), superior frontal gyrus (p = 0.008) and right middle frontal/superior frontal gyrus (0.004) and anterior-parietal (p = 0.003). Differences between PTH and non-PTH patients were most striking at early time points. These early changes may be associated with an increased risk of PTH. Patients with these changes should be monitored for chronic PTH.
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Affiliation(s)
- Shana A B Burrowes
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Chandler Sours Rhodes
- Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Timothy J Meeker
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Rao P Gullapalli
- Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA. .,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.
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Oswald LM, Dunn KE, Seminowicz DA, Storr CL. Early Life Stress and Risks for Opioid Misuse: Review of Data Supporting Neurobiological Underpinnings. J Pers Med 2021; 11:315. [PMID: 33921642 PMCID: PMC8072718 DOI: 10.3390/jpm11040315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
A robust body of research has shown that traumatic experiences occurring during critical developmental periods of childhood when neuronal plasticity is high increase risks for a spectrum of physical and mental health problems in adulthood, including substance use disorders. However, until recently, relatively few studies had specifically examined the relationships between early life stress (ELS) and opioid use disorder (OUD). Associations with opioid use initiation, injection drug use, overdose, and poor treatment outcome have now been demonstrated. In rodents, ELS has also been shown to increase the euphoric and decrease antinociceptive effects of opioids, but little is known about these processes in humans or about the neurobiological mechanisms that may underlie these relationships. This review aims to establish a theoretical model that highlights the mechanisms by which ELS may alter opioid sensitivity, thereby contributing to future risks for OUD. Alterations induced by ELS in mesocorticolimbic brain circuits, and endogenous opioid and dopamine neurotransmitter systems are described. The limited but provocative evidence linking these alterations with opioid sensitivity and risks for OUD is presented. Overall, the findings suggest that better understanding of these mechanisms holds promise for reducing vulnerability, improving prevention strategies, and prescribing guidelines for high-risk individuals.
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Affiliation(s)
- Lynn M. Oswald
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA;
| | - Kelly E. Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21230, USA;
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA;
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD 21201, USA
| | - Carla L. Storr
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA;
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Da Silva JT, Tricou C, Zhang Y, Tofighbakhsh A, Seminowicz DA, Ro JY. Pain modulatory network is influenced by sex and age in a healthy state and during osteoarthritis progression in rats. Aging Cell 2021; 20:e13292. [PMID: 33400367 PMCID: PMC7884031 DOI: 10.1111/acel.13292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/11/2020] [Revised: 10/26/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022] Open
Abstract
Old age and female sex are risk factors for the development of osteoarthritis (OA) and chronic pain. We investigated the effects of sex and age on pain modulatory networks in a healthy state and during OA progression. We used functional MRI to determine the effects of sex and age on periaqueductal gray functional connectivity (PAG FC) in a healthy state (pre‐OA) and during the early and late phases of monosodium iodoacetate‐induced OA in rats. We then examined how sex and age affect longitudinal changes in PAG FC in OA. In a healthy state, females exhibited more widespread PAG FC than males, and this effect was exaggerated with aging. Young males had moderate PAG FC changes during the early phase but recruited additional brain regions, including the rostral anterior cingulate cortex (ACC), during the late phase. Young females exhibited widespread PAG FC in the early phase, which includes connections to insula, caudal ACC, and nucleus accumbens (NAc). Older groups had strong PAG FC with fewer regions in the early phase, but they recruited additional brain regions, including NAc, in the late phase. Overall, our findings show that PAG FC is modulated by sex and age in a healthy state. A widespread PAG network in the early phase of OA pain may contribute to the transition from acute to chronic OA pain and the increased risk of developing chronic pain for females. Enhanced PAG FC with the reward system may represent a potential mechanism underlying chronic OA pain in elderly patients.
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Affiliation(s)
- Joyce T. Da Silva
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
- Department of Psychiatry School of Medicine Johns Hopkins University Baltimore Maryland USA
| | - Christina Tricou
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
| | - Youping Zhang
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
| | - Amir Tofighbakhsh
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
| | - Jin Y. Ro
- Department of Neural and Pain Sciences School of Dentistry University of Maryland Baltimore Baltimore Maryland USA
- Center to Advance Chronic Pain Research University of Maryland Baltimore Baltimore Maryland USA
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Barrett FS, Krimmel SR, Griffiths RR, Seminowicz DA, Mathur BN. Psilocybin acutely alters the functional connectivity of the claustrum with brain networks that support perception, memory, and attention. Neuroimage 2020; 218:116980. [PMID: 32454209 PMCID: PMC10792549 DOI: 10.1016/j.neuroimage.2020.116980] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
Psychedelic drugs, including the serotonin 2a (5-HT2A) receptor partial agonist psilocybin, are receiving renewed attention for their possible efficacy in treating a variety of neuropsychiatric disorders. Psilocybin induces widespread dysregulation of cortical activity, but circuit-level mechanisms underlying this effect are unclear. The claustrum is a subcortical nucleus that highly expresses 5-HT2A receptors and provides glutamatergic inputs to arguably all areas of the cerebral cortex. We therefore tested the hypothesis that psilocybin modulates claustrum function in humans. Fifteen healthy participants (10M, 5F) completed this within-subjects study in which whole-brain resting-state blood-oxygenation level-dependent (BOLD) signal was measured 100 min after blinded oral administration of placebo and 10 mg/70 kg psilocybin. Left and right claustrum signal was isolated using small region confound correction. Psilocybin significantly decreased both the amplitude of low frequency fluctuations as well as the variance of BOLD signal in the left and right claustrum. Psilocybin also significantly decreased functional connectivity of the right claustrum with auditory and default mode networks (DMN), increased right claustrum connectivity with the fronto-parietal task control network (FPTC), and decreased left claustrum connectivity with the FPTC. DMN integrity was associated with right-claustrum connectivity with the DMN, while FPTC integrity and modularity were associated with right claustrum and left claustrum connectivity with the FPTC, respectively. Subjective effects of psilocybin predicted changes in the amplitude of low frequency fluctuations and the variance of BOLD signal in the left and right claustrum. Observed effects were specific to claustrum, compared to flanking regions of interest (the left and right insula and putamen). This study used a pharmacological intervention to provide the first empirical evidence in any species for a significant role of 5-HT2A receptor signaling in claustrum functioning, and supports a possible role of the claustrum in the subjective and therapeutic effects of psilocybin.
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Affiliation(s)
- Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA; Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, 21201, USA
| | - Roland R Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA; Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, 21201, USA
| | - Brian N Mathur
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
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Seminowicz DA, Burrowes SAB, Kearson A, Zhang J, Krimmel SR, Samawi L, Furman AJ, Keaser ML, Gould NF, Magyari T, White L, Goloubeva O, Goyal M, Peterlin BL, Haythornthwaite JA. Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 2020; 161:1837-1846. [PMID: 32701843 PMCID: PMC7487005 DOI: 10.1097/j.pain.0000000000001860] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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] [Indexed: 01/03/2023]
Abstract
We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
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Affiliation(s)
- David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Shana AB Burrowes
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Alexandra Kearson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Jing Zhang
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Luma Samawi
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Andrew J Furman
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Neda F. Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Trish Magyari
- Private Mindfulness-based Psychotherapy Practice, 3511 N Calvert St, Baltimore, MD 21218
| | - Linda White
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Olga Goloubeva
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Madhav Goyal
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - B. Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA 17601
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
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Furman AJ, Prokhorenko M, Keaser ML, Zhang J, Chen S, Mazaheri A, Seminowicz DA. Sensorimotor Peak Alpha Frequency Is a Reliable Biomarker of Prolonged Pain Sensitivity. Cereb Cortex 2020; 30:6069-6082. [PMID: 32591813 DOI: 10.1093/cercor/bhaa124] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 02/14/2020] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 01/28/2023] Open
Abstract
Previous research has observed that the speed of alpha band oscillations (8-12 Hz range) recorded during resting electroencephalography is slowed in chronic pain patients. While this slowing may reflect pathological changes that occur during the chronification of pain, an alternative explanation is that healthy individuals with slower alpha oscillations are more sensitive to prolonged pain, and by extension, more susceptible to developing chronic pain. To test this hypothesis, we examined the relationship between the pain-free, resting alpha oscillation speed of healthy individuals and their sensitivity to two models of prolonged pain, Phasic Heat Pain and Capsaicin Heat Pain, at two visits separated by 8 weeks on average (n = 61 Visit 1, n = 46 Visit 2). We observed that the speed of an individual's pain-free alpha oscillations was negatively correlated with sensitivity to both models and that this relationship was reliable across short (minutes) and long (weeks) timescales. Furthermore, the speed of pain-free alpha oscillations can successfully identify the most pain sensitive individuals, which we validated on data from a separate, independent study. These results suggest that alpha oscillation speed is a reliable biomarker of prolonged pain sensitivity with potential for prospectively identifying pain sensitivity in the clinic.
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Affiliation(s)
- Andrew J Furman
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Mariya Prokhorenko
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Jing Zhang
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Shuo Chen
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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Seminowicz DA, Thapa T, Schabrun SM. Corticomotor Depression is Associated With Higher Pain Severity in the Transition to Sustained Pain: A Longitudinal Exploratory Study of Individual Differences. The Journal of Pain 2019; 20:1498-1506. [DOI: 10.1016/j.jpain.2019.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/03/2019] [Accepted: 06/01/2019] [Indexed: 12/19/2022]
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Letzen JE, Remeniuk B, Smith MT, Irwin MR, Finan PH, Seminowicz DA. Individual differences in pain sensitivity are associated with cognitive network functional connectivity following one night of experimental sleep disruption. Hum Brain Mapp 2019; 41:581-593. [PMID: 31617662 PMCID: PMC6981017 DOI: 10.1002/hbm.24824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/21/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022] Open
Abstract
Previous work suggests that sleep disruption can contribute to poor pain modulation. Here, we used experimental sleep disruption to examine the relationship between sleep disruption-induced pain sensitivity and functional connectivity (FC) of cognitive networks contributing to pain modulation. Nineteen healthy individuals underwent two counterbalanced experimental sleep conditions for one night each: uninterrupted sleep versus sleep disruption. Following each condition, participants completed functional MRI including a simple motor task and a noxious thermal stimulation task. Pain ratings and stimulus temperatures from the latter task were combined to calculate a pain sensitivity change score following sleep disruption. This change score was used as a predictor of simple motor task FC changes using bilateral executive control networks (RECN, LECN) and the default mode network (DMN) masks as seed regions of interest (ROIs). Increased pain sensitivity after sleep disruption was positively associated with increased RECN FC to ROIs within the DMN and LECN (F(4,14) = 25.28, pFDR = 0.05). However, this pain sensitivity change score did not predict FC changes using LECN and DMN masks as seeds (pFDR > 0.05). Given that only RECN FC was associated with sleep loss-induced hyperalgesia, findings suggest that cognitive networks only partially contribute to the sleep-pain dyad.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bethany Remeniuk
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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Furman AJ, Thapa T, Summers SJ, Cavaleri R, Fogarty JS, Steiner GZ, Schabrun SM, Seminowicz DA. Cerebral peak alpha frequency reflects average pain severity in a human model of sustained, musculoskeletal pain. J Neurophysiol 2019; 122:1784-1793. [PMID: 31389754 PMCID: PMC6843105 DOI: 10.1152/jn.00279.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 05/09/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
Heightened pain sensitivity, the amount of pain experienced in response to a noxious event, is a known risk factor for development of chronic pain. We have previously reported that pain-free, sensorimotor peak alpha frequency (PAF) is a reliable biomarker of pain sensitivity for thermal, prolonged pains lasting tens of minutes. To test whether PAF can provide information about pain sensitivity occurring over clinically relevant timescales (i.e., weeks), EEG was recorded before and while participants experienced a long-lasting pain model, repeated intramuscular injection of nerve growth factor (NGF), that produces progressively developing muscle pain for up to 21 days. We demonstrate that pain-free, sensorimotor PAF is negatively correlated with NGF pain sensitivity; increasingly slower PAF is associated with increasingly greater pain sensitivity. Furthermore, PAF remained stable following NGF injection, indicating that the presence of NGF pain for multiple weeks is not sufficient to induce the PAF slowing reported in chronic pain. In total, our results demonstrate that slower pain-free, sensorimotor PAF is associated with heightened sensitivity to a long-lasting musculoskeletal pain and also suggest that the apparent slowing of PAF in chronic pain may reflect predisease pain sensitivity.NEW & NOTEWORTHY Pain sensitivity, the intensity of pain experienced after injury, has been identified as an important risk factor in the development of chronic pain. Biomarkers of pain sensitivity have the potential to ease chronic pain burdens by preventing disease emergence. In the current study, we demonstrate that the speed of pain-free, sensorimotor peak alpha frequency recorded during resting-state EEG predicts pain sensitivity to a clinically-relevant, human model of prolonged pain that persists for weeks.
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Affiliation(s)
- Andrew J Furman
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tribikram Thapa
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Simon J Summers
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Rocco Cavaleri
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Jack S Fogarty
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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40
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Hoegh M, Seminowicz DA, Graven-Nielsen T. Delayed effects of attention on pain sensitivity and conditioned pain modulation. Eur J Pain 2019; 23:1850-1862. [PMID: 31343803 DOI: 10.1002/ejp.1458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/09/2019] [Accepted: 07/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Efficacy of pain modulation is assessed as the difference in pain sensitivity during a painful conditioning, compared to before (conditioning pain modulation, CPM). Attention can be assessed with the Stroop task, in which participants report the number of words on a screen; either congruent or incongruent with the value of the words. Attention away from painful stimuli during CPM enhances the CPM effect. However, it is unknown if attention influences CPM effects when the two are done in sequence. METHODS Healthy men (n = 25) underwent cuff algometry CPM-assessment where the pressure-pain detection and tolerance thresholds (PTT) were recorded on one leg with and without contralateral conditioning. Two identical sessions of four test stimuli equal to PTT (5 s, 1-min interval, scored on a visual analogue scale, VAS) with a painful conditioning from the second to the last test-stimulus were performed. Stroop sessions were followed by test stimuli with or without painful conditioning. RESULTS The VAS scores in the first two sessions showed excellent reliability (ICC = 0.92). VAS scores were lower in sessions with Stroop compared to sessions without Stroop (p = .05) indicating an analgesic effect of Stroop. Participants were subgrouped into CPM responders and CPM non-responders according to CPM effects in the first two sessions. CPM non-responders (n = 13) showed facilitation to repeated noxious stimuli in all sessions with no effect of conditioning or Stroop (p = .02). CONCLUSION Attention and CPM both modulate pain in healthy men. Attention-induced analgesia works in CPM non-responders. Results indicate that attention and CPM are not the same and that they do not demonstrate additive effects when applied in sequence. SIGNIFICANCE Pain sensitivity is reduced after an attention task in healthy men. The delayed effects from attention only have minor effects on Conditioned Pain Modulation (CPM), and results support that attention-driven analgesia works independently of CPM. Results indicate that individual strategies for pain inhibition exist and that an overlap between the mechanisms of CPM and selective attention is limited. Moreover, painful phasic stimuli may increase the number of healthy volunteers with negative CPM effects.
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Affiliation(s)
- Morten Hoegh
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - David A Seminowicz
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark.,Department of Neural and Pain Sciences, Center to Advance Chronic Pain Research, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
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41
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Meeker TJ, Keaser ML, Khan SA, Gullapalli RP, Seminowicz DA, Greenspan JD. Non-invasive Motor Cortex Neuromodulation Reduces Secondary Hyperalgesia and Enhances Activation of the Descending Pain Modulatory Network. Front Neurosci 2019; 13:467. [PMID: 31139047 PMCID: PMC6519323 DOI: 10.3389/fnins.2019.00467] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Central sensitization is a driving mechanism in many chronic pain patients, and manifests as hyperalgesia and allodynia beyond any apparent injury. Recent studies have demonstrated analgesic effects of motor cortex (M1) stimulation in several chronic pain disorders, yet its neural mechanisms remain uncertain. We evaluated whether anodal M1 transcranial direct current stimulation (tDCS) would mitigate central sensitization as measured by indices of secondary hyperalgesia. We used a capsaicin-heat pain model to elicit secondary mechanical hyperalgesia in 27 healthy subjects. In an assessor and subject-blind randomized, sham-controlled, crossover trial, anodal M1 tDCS decreased the intensity of pinprick hyperalgesia more than cathodal or sham tDCS. To elucidate the mechanism driving analgesia, subjects underwent fMRI of painful mechanical stimuli prior to and following induction of the pain model, after receiving M1 tDCS. We hypothesized that anodal M1 tDCS would enhance engagement of a descending pain modulatory (DPM) network in response to mechanical stimuli. Anodal tDCS normalized the effects of central sensitization on neurophysiological responses to mechanical pain in the medial prefrontal cortex, pregenual anterior cingulate cortex, and periaqueductal gray, important regions in the DPM network. Taken together, these results provide support for the hypothesis that anodal M1-tDCS reduces central sensitization-induced hyperalgesia through the DPM network in humans.
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Affiliation(s)
- Timothy J. Meeker
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Shariq A. Khan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Rao P. Gullapalli
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
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42
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Krimmel SR, White MG, Panicker MH, Barrett FS, Mathur BN, Seminowicz DA. Resting state functional connectivity and cognitive task-related activation of the human claustrum. Neuroimage 2019; 196:59-67. [PMID: 30954711 DOI: 10.1016/j.neuroimage.2019.03.075] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 12/12/2018] [Revised: 03/07/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022] Open
Abstract
Structural and functional analyses of the human claustrum, a poorly understood telencephalic gray matter structure, are hampered by its sheet-like anatomical arrangement. Here, we first describe a functional magnetic resonance imaging (fMRI) method to reveal claustrum signal with no linear relationship with adjacent regions in human subjects. We applied this approach to resting state functional connectivity (RSFC) analysis of the claustrum at high resolution (1.5 mm isotropic voxels) using a 7T dataset (n = 20) and a separate 3T dataset for replication (n = 35). We then assessed claustrum activation during performance of a cognitive task, the multi-source interference task, at 3T (n = 33). Extensive functional connectivity was observed between claustrum and cortical regions associated with cognitive control, including anterior cingulate, prefrontal and parietal cortices. Cognitive task performance was associated with widespread activation and deactivation that overlapped with the cortical areas showing functional connectivity to the claustrum. Furthermore, during high cognitive conflict conditions of the task, the claustrum was significantly activated at the onset of the task, but not during the remainder of the difficult condition. Both of these findings suggest that the human claustrum can be functionally isolated with fMRI, and that it may play a role in cognitive control, and specifically task switching, independent of sensorimotor processing.
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Affiliation(s)
- Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, 21201, USA
| | - Michael G White
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Matthew H Panicker
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Brian N Mathur
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, 21201, USA
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43
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Krimmel SR, Qadir H, Hesselgrave N, White MG, Reser DH, Mathur BN, Seminowicz DA. Resting State Functional Connectivity of the Rat Claustrum. Front Neuroanat 2019; 13:22. [PMID: 30853902 PMCID: PMC6395398 DOI: 10.3389/fnana.2019.00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/08/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
The claustrum is structurally connected with many cortical areas.A major hurdle standing in the way of understanding claustrum function is the difficulty in assessing the global functional connectivity (FC) of this structure. The primary issues lie in the inability to isolate claustrum signal from the adjacent insular cortex (Ins), caudate/putamen (CPu), and endopiriform nucleus (Endo). To address this issue, we used (7T) fMRI in the rat and describe a novel analytic method to study claustrum without signal contamination from the surrounding structures. Using this approach, we acquired claustrum signal distinct from Ins, CPu, and Endo, and used this claustrum signal to determine whole brain resting state functional connectivity (RSFC). Claustrum RSFC was distinct from the adjacent structures and displayed extensive connections with sensory cortices and the cingulate cortex, consistent with known structural connectivity of the claustrum. These results suggest fMRI and improved analysis can be combined to accurately assay claustrum function.
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Affiliation(s)
- Samuel R Krimmel
- Center to Advance Chronic Pain Research, Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, United States
| | - Houman Qadir
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Natalie Hesselgrave
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Michael G White
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - David H Reser
- Graduate Entry Medicine Program, Monash Rural Health-Churchill, Churchill, VIC, Australia.,Department of Physiology, Monash University, Clayton, VIC, Australia
| | - Brian N Mathur
- Department of Pharmacology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - David A Seminowicz
- Center to Advance Chronic Pain Research, Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, United States
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44
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De Martino E, Seminowicz DA, Schabrun SM, Petrini L, Graven-Nielsen T. High frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex modulates sensorimotor cortex function in the transition to sustained muscle pain. Neuroimage 2019; 186:93-102. [DOI: 10.1016/j.neuroimage.2018.10.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022] Open
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45
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da Silva JT, Evangelista BG, Venega RA, Seminowicz DA, Chacur M. Anti-NGF treatment can reduce chronic neuropathic pain by changing peripheral mediators and brain activity in rats. Behav Pharmacol 2019; 30:79-88. [DOI: 10.1097/fbp.0000000000000422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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46
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Qadir H, Krimmel SR, Mu C, Poulopoulos A, Seminowicz DA, Mathur BN. Structural Connectivity of the Anterior Cingulate Cortex, Claustrum, and the Anterior Insula of the Mouse. Front Neuroanat 2018; 12:100. [PMID: 30534060 PMCID: PMC6276828 DOI: 10.3389/fnana.2018.00100] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/09/2018] [Accepted: 11/08/2018] [Indexed: 01/06/2023] Open
Abstract
The claustrum is a narrow subcortical brain structure that resides between the striatum and insular cortex. The function of the claustrum is not fully described, and while our previous work supports a role for the claustrum in top-down cognitive control of action, other evidence suggests the claustrum may be involved in detecting salient changes in the external environment. The anterior cingulate cortex (ACC) and the anterior insular (aINS) are the two major participants in the salience network of human brain regions that activate in response to salient stimuli. While bidirectional connections between the ACC and the claustrum exist from mouse to non-human primate, the aINS connectivity with claustrum remains unclear, particularly in mouse. Here, we explored structural connections of the aINS with the claustrum and ACC through adeno-associated virus neuronal tract tracer injections into the ACC and aINS of the mouse. We detected sparse projections from the claustrum to the aINS and diffuse projections from the aINS to the borders of the claustrum were observed in some cases. In contrast, the insular cortex and endopiriform nucleus surrounding the claustrum had rich interconnectivity with aINS. Additionally, we observed a modest interconnectivity between ACC and the aINS. These data support the idea that claustrum neuron responses to salient stimuli may be driven by the ACC rather than the aINS.
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Affiliation(s)
- Houman Qadir
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
| | - Chaoqi Mu
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alexandros Poulopoulos
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
| | - Brian N Mathur
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
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47
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Ayoub LJ, Seminowicz DA, Moayedi M. A meta-analytic study of experimental and chronic orofacial pain excluding headache disorders. Neuroimage Clin 2018; 20:901-912. [PMID: 30292089 PMCID: PMC6176551 DOI: 10.1016/j.nicl.2018.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 01/08/2023]
Abstract
Chronic orofacial pain (COFP) disorders are prevalent and debilitating pain conditions affecting the head, neck and face areas. Neuroimaging studies have reported functional and grey matter abnormalities, but not all the studies have reported consistent findings. Identifying convergent abnormalities across COFPs provides a basis for future hypothesis-driven research aimed at elucidating common CNS mechanisms. Here, we perform three coordinate-based meta-analyses according to PRISMA guidelines to elucidate the central mechanisms of orofacial pain disorders. Specifically, we investigated consistent patterns of: (1) brain function to experimental orofacial pain in healthy subjects, (2) structural and (3) functional brain abnormalities in COFP. We computed our coordinate-based meta-analyses using GingerALE. The experimental pain meta-analysis revealed increased brain activity in bilateral thalami, posterior mid-cingulate cortices, and secondary somatosensory cortices, the right posterior parietal cortex extending to the orofacial region of the right primary somatosensory cortex and the right insula, and decreased activity in the right somatomotor regions. The structural COFP meta-analysis identified consistent higher grey matter volume/concentration in the right ventral thalamus and posterior putamen of COFP patients compared to healthy controls. The functional COFP meta-analysis identified a consistent increase in brain activity in the left medial and posterior thalamus and lesser activity in the left posterior insula in COFP, compared to healthy controls. Overall, these findings provide evidence of brain abnormalities in pain-related regions, namely the thalamus and insula, across different COFP disorders. The convergence of thalamic abnormalities in both structure and function suggest a key role for this region in COFP pathophysiology. Identifying convergent abnormalities in COFP can elucidate novel therapeutic targets. Experimental orofacial pain is associated with activity in nociceptive processing brain areas. Chronic orofacial pain (COFP) is associated with abnormal thalamic activity and grey matter. Our review highlights the need for more high quality COFP brain imaging studies.
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Affiliation(s)
- Lizbeth J Ayoub
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, United States; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States
| | - Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada.
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48
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Seminowicz DA, de Martino E, Schabrun SM, Graven-Nielsen T. Left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation reduces the development of long-term muscle pain. Pain 2018; 159:2486-2492. [DOI: 10.1097/j.pain.0000000000001350] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Da Silva JT, Zhang Y, Asgar J, Ro JY, Seminowicz DA. Diffuse noxious inhibitory controls and brain networks are modulated in a testosterone-dependent manner in Sprague Dawley rats. Behav Brain Res 2018; 349:91-97. [PMID: 29733874 PMCID: PMC7184319 DOI: 10.1016/j.bbr.2018.04.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Abstract
Diffuse noxious inhibitory control (DNIC), which involves endogenous pain modulation, has been investigated as a potential mechanism for the differences in pain modulation observed between men and women, though the literature shows contradictory findings. We used a capsaicin-induced DNIC behavioral assay and resting state functional magnetic resonance imaging (rsfMRI) to assess the effect of testosterone on pain modulation and related brain circuitry in rats. We hypothesized that testosterone is required for DNIC that leads to efficient pain inhibition by increasing descending pain modulation. Male, female, and orchidectomized (GDX) male rats had a capsaicin injection into the forepaw to induce DNIC and mechanical thresholds were observed on the hindpaw. rsfMRI scans were acquired before and after capsaicin injection to analyze the effects of DNIC on periaqueductal gray (PAG), anterior cingulate cortex (ACC) and nucleus accumbens (NAc) connectivity to the whole brain. The strength of DNIC was higher in males compared to females and GDX males. PAG connectivity with prelimbic cortex (PrL), ACC and insula was stronger in males compared to females and GDX males, whereas females and GDX males had increased connectivity between the right ACC, hippocampus and thalamus. GDX males also showed a stronger connectivity between right ACC and NAc, and right NAc with PrL, ACC, insula and thalamus. Our findings suggest that testosterone plays a key role in reinforcing the endogenous pain inhibitory system, while circuitries related to reward and emotion are more strongly recruited in the absence of testosterone.
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Affiliation(s)
- Joyce T Da Silva
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States.
| | - Youping Zhang
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - Jamila Asgar
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - Jin Y Ro
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, United States
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50
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Liao X, Mao C, Wang Y, Zhang Q, Cao D, Seminowicz DA, Zhang M, Yang X. Brain gray matter alterations in Chinese patients with chronic knee osteoarthritis pain based on voxel-based morphometry. Medicine (Baltimore) 2018; 97:e0145. [PMID: 29561420 PMCID: PMC5895331 DOI: 10.1097/md.0000000000010145] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Altered cerebral gray matter volume (GMV) is commonly found in patients with chronic pain. Chronic pain is the prominent characteristic of knee osteoarthritis (KOA), yet little is known about its morphological changes in the brain. Here an MRI study was performed to examine the structural brain abnormalities in 30 KOA patients with knee pain and age-matched healthy subjects. We detected that the patients exhibited significant almost 2-fold age-related decreases of GMV compared to healthy controls. Moreover, KOA patients also had significant loss of regional GMV including in the bilateral orbital frontal cortex (OFC), the right lateral prefrontal cortex (lPFC), and precentral and postcentral cortices. In addition, a high proportion of KOA patients exerted abnormal scores of Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), Mini Mental State examination (MMSE), and Montreal Cognitive Assessment (MoCA) compare to controls. Our results imply that chronic pain conditions which preferentially involve PFC might consider as a "cognitive state." And emotion and cognitive function about chronic pain should be highly regarded.
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Affiliation(s)
- Xia Liao
- Department of Pain
- Department of Nutrition
| | - Cuiping Mao
- Department of Medical Imaging, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Yuan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi’an Jiaotong University
| | | | - Dongyuan Cao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Stomatological Hospital, Xi’an, Jiaotong University, Xi’an, Shaanxi, China
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi’an Jiaotong University
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