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Toor T, Palyo S, Schopmeyer K, Simmons AN, Strigo IA. Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program. J Patient Rep Outcomes 2024; 8:42. [PMID: 38592366 PMCID: PMC11003939 DOI: 10.1186/s41687-024-00721-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE This study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment. METHODS Among 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program. RESULTS Compared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes. CONCLUSION The implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.
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Affiliation(s)
- Tiffany Toor
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA.
| | - Sarah Palyo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Kathryn Schopmeyer
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
| | - Alan N Simmons
- Department of Veterans Affairs (VA), San Diego Healthcare System, San Diego, CA, USA
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, 94121, San Francisco, CA, USA
| | - Irina A Strigo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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Strigo IA, Kadlec M, Mitchell JM, Simmons AN. Identification of group differences in predictive anticipatory biasing of pain during uncertainty: preparing for the worst but hoping for the best. Pain 2024:00006396-990000000-00554. [PMID: 38501988 DOI: 10.1097/j.pain.0000000000003207] [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: 08/23/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024]
Abstract
ABSTRACT Pain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Molly Kadlec
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
| | - Jennifer M Mitchell
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Alan N Simmons
- San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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Strigo IA, Andrew D, Simmons AN, Evrard HC, Blomqvist A, Dostrovsky JO. Interoception and AD (Bud) Craig's paradigm-shifting legacy. Pain 2024:00006396-990000000-00552. [PMID: 38501985 DOI: 10.1097/j.pain.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - David Andrew
- School of Clinical Dentistry, University of Sheffield, United Kingdom
| | - Alan N Simmons
- San Diego Veterans Affairs Health Care Center, San Diego, CA
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Henry C Evrard
- International Center for Primate Brain Research, Center for Excellence in Brain Science and Intelligence, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Werner Reichardt Center for Integrative Neuroscience, Karl Eberhard University of Tübingen, Tübingen, Germany
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anders Blomqvist
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Affiliation(s)
- Anders Blomqvist
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Henry C Evrard
- International Center for Primate Brain Research, Center for Excellence in Brain Science and Intelligence, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China.
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
- Werner Reichardt Center for Integrative Neuroscience, Karl Eberhard University of Tübingen, Tübingen, Germany.
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
| | | | - Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Wilfrid Jänig
- Institute of Physiology, Christian-Albrechts University of Kiel, Kiel, Germany
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Strigo IA, Simmons AN, Giebler J, Schilling JM, Moeller-Bertram T. Unsupervised learning for prognostic validity in patients with chronic pain in transdisciplinary pain care. Sci Rep 2023; 13:7581. [PMID: 37164996 PMCID: PMC10172363 DOI: 10.1038/s41598-023-34611-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
Chronic pain is not a singular disorder and presents in various forms and phenotypes. Here we show data from a cohort of patients seeking treatment in a transdisciplinary pain clinic. Patients completed a multidimensional patient-reported battery as part of routine initial evaluation at baseline and at each of the four subsequent visits over 1-year follow-up (0, 1, 3, 6, 12 months). The goal of this work was to use unsupervised modeling approach to identify whether patients with chronic pain undergoing transdisciplinary intensive rehabilitation treatment: (1) can be derived based upon self-reported outcome measures at baseline (or before treatment initiation), (2) are clinically validated based on their clinical diagnosis and medication use, and (3) differ in treatment trajectories over 1 year of transdisciplinary treatment. We applied unsupervised clustering on baseline outcomes using nine patient-reported symptoms and examined treatment trajectories. The three-cluster solution was internally validated. Psychiatric diagnosis, chronic back pain-related disability and symptoms severity determined cluster assignment and treatment prognosis. Conversely, clinical pain severity had lesser effect. Furthermore, clusters showed stability over time despite symptoms improvement. The accurate and meaningful subgrouping of the underlying chronic pain phenotypes would greatly enhance treatment and provide personalized and effective pain management.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Alan N Simmons
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, 92151, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | | | - Jan M Schilling
- Savas Health, Rancho Mirage, CA, USA
- Vitamed Research, LLC, Palm Desert, CA, USA
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Garcia Guerra S, Spadoni A, Mitchell J, Strigo IA. Pain-related opioidergic and dopaminergic neurotransmission: Dual meta-Analyses of PET radioligand studies. Brain Res 2023; 1805:148268. [PMID: 36754138 PMCID: PMC11018310 DOI: 10.1016/j.brainres.2023.148268] [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: 06/06/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Molecular mechanisms of the interaction between opioidergic and dopaminergic processing during pain-related experiences in the human brain are still incompletely understood. This is partially due to the invasive nature of the available techniques to visualize and measure metabolic activity. Positron Emission Tomography (PET) radioligand studies using radioactive substances are still the only available modality to date that allows for the investigation of the molecular mechanisms in the human brain. The most commonly studied PET radiotracers are [11C]-carfentanil (CFN) and [11C]- or [18F]-diprenorphine (DPN), which bind to opioid receptors, and [11C]-raclopride (RAC) and [18F]-fallypride (FAL) tracers, which bind to dopamine receptors. The current meta-analysis examines pain-related studies that used aforementioned opioid and dopamine radioligands in an effort to consolidate the available data into the most likely activated regions. Our primary goal was to identify regions of shared opioid/dopamine neurotransmission during pain-related experiences using within-subject approach. Seed-based d Mapping (SDM) analysis of previously published voxel coordinate data showed that opioidergic activations were strongest in the bilateral caudate, thalamus, right putamen, cingulate gyrus, midbrain, inferior frontal gyrus, and left superior temporal gyrus. The dopaminergic studies showed that the bilateral caudate, thalamus, right putamen, cingulate gyrus, and left putamen had the highest activations. We were able to see a clear overlap between opioid and dopamine activations in a majority of the regions during pain-related experiences, though there were some unique areas of dopaminergic activation such as the left putamen. Regions unique to opioidergic activation included the midbrain, inferior frontal gyrus, and left superior temporal gyrus. Here we provide initial evidence for the functional overlap between opioidergic and dopaminergic processing during aversive states in humans.
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Affiliation(s)
- Sergio Garcia Guerra
- Research Service, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Andrea Spadoni
- Research Service, San Diego Veterans Affairs Health Care Center, USA; University of California San Diego, La Jolla, CA 92093, USA
| | - Jennifer Mitchell
- Research Service, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Irina A Strigo
- Research Service, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA.
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Simmons AN, Strigo IA. Editorial: Understanding emotions using brain imaging and stimulation techniques. Front Hum Neurosci 2023; 17:1130140. [PMID: 36798688 PMCID: PMC9927392 DOI: 10.3389/fnhum.2023.1130140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Affiliation(s)
- Alan N. Simmons
- Veterans Affairs San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, CA, United States,University of California San Diego Health, University of California, San Diego, San Diego, CA, United States,*Correspondence: Alan N. Simmons ✉
| | - Irina A. Strigo
- San Francisco Veterans Affairs Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Strigo IA, Murphy E, Mitchell JM, Spadoni AD. Learning from addiction: Craving of prescription opioids in chronic pain sufferers. Neurosci Biobehav Rev 2022; 142:104904. [PMID: 36202255 PMCID: PMC10917419 DOI: 10.1016/j.neubiorev.2022.104904] [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: 06/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 01/19/2023]
Abstract
Prescription opioids are a primary driver of opioid-related deaths. Although craving is a substantial component of OUD, the degree to which craving leads to misuse among chronic pain patients on long-term prescription opioids is unknown. A clear understanding of the factors that lead to misuse in this vulnerable population is needed for the development of safe and effective practices for opioid taper. This narrative review summarizes the relevant literature on the role of craving in addiction and chronic pain through epidemiological and behavioral studies. The first part of this review examines the role of craving in predicting opioid use/misuse in individuals with chronic pain with and without OUD. The second part covers methods on how craving is evaluated experimentally using both subjective and objective measures and provides related findings. The overall goal of this review is to facilitate the development of a population-specific description of craving in those who use opioids to control chronic pain and to describe how it may be mechanistically linked to patterns of opioid (mis)use.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Emily Murphy
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Jennifer M Mitchell
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Department of Neurology, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - Andrea D Spadoni
- San Diego Veterans Affairs Healthcare Center, 3350 La Jolla Village Drive, San Diego, CA 92121, USA; Department of Psychiatry, University of California San Diego, San Diego, CA 92300, USA
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Hays Weeks CC, Simmons AN, Strigo IA, Timtim S, Ellis RJ, Keltner JR. Distal neuropathic pain in HIV is associated with functional connectivity patterns in default mode and salience networks. Front Pain Res (Lausanne) 2022; 3:1004060. [PMID: 36313219 PMCID: PMC9596968 DOI: 10.3389/fpain.2022.1004060] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
HIV-associated distal neuropathic pain (DNP) is one of the most prevalent, disabling, and treatment-resistant complications of HIV, but its biological underpinnings are incompletely understood. While data specific to mechanisms underlying HIV DNP are scarce, functional neuroimaging of chronic pain more broadly implicates the role of altered resting-state functional connectivity within and between salience network (SN) and default mode network (DMN) regions. However, it remains unclear the extent to which HIV DNP is associated with similar alterations in connectivity. The current study aimed to bridge this gap in the literature through examination of resting-state functional connectivity patterns within SN and DMN regions among people with HIV (PWH) with and without DNP. Resting state functional magnetic resonance imaging (rs-fMRI) scans were completed among 62 PWH with HIV-associated peripheral neuropathy, of whom 27 reported current DNP and 35 did not. Using subgrouping group iterative multiple estimation, we compared connectivity patterns in those with current DNP to those without. We observed weaker connectivity between the medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) and stronger connectivity between the anterior cingulate cortex (ACC) and thalamus among those reporting DNP. Overall, these findings implicate altered within DMN (i.e., MPFC-PCC) and within SN (i.e., ACC-thalamus) connectivity as potential manifestations of adaptation to pain from neuropathy and/or mechanisms underlying the development/maintenance of DNP. Findings are discussed in the context of differential brain response to pain (i.e., mind wandering, pain aversion, pain facilitation/inhibition) and therapeutic implications.
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Affiliation(s)
| | - Alan N. Simmons
- CESAMH, VA San Diego Healthcare System, San Diego, United States,Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Irina A. Strigo
- Department of Psychiatry, UC San Francisco, CA, United States
| | - Sara Timtim
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Ronald J. Ellis
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States,Department of Neurosciences, UC San Diego, La Jolla, CA, United States
| | - John R. Keltner
- CESAMH, VA San Diego Healthcare System, San Diego, United States,Department of Psychiatry, UC San Diego, La Jolla, CA, United States,Correspondence: John R. Keltner
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Toor T, Murphy E, Simmons AN, Palyo S, Librodo SC, Strigo IA. Craving of prescription opioids among veterans with chronic pain. Pain 2022; 163:2021-2030. [PMID: 35297818 PMCID: PMC9329486 DOI: 10.1097/j.pain.0000000000002598] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT The United States faces a crisis because of the high prevalence of chronic pain, concurrent opioid use disorder, and overdose deaths. Prescription opioids remain a primary driver of opioid-related deaths. Craving is a core symptom of addiction, yet the degree to which craving plays a role in prescription opioid use among patients with chronic pain is unknown. Understanding the degree to which craving should be considered in patients with chronic pain is critical for developing effective interventions for supporting patients through opioid tapering. The current work combines data collected from (1) 2152 veterans screened for eligibility at a pain specialty care clinic at the San Francisco VA Health Care System and (2) medical records obtained from the VA Corporate Data Warehouse. We found that prescription opioid craving among veterans with chronic pain was low, with 66.4% of the sample reporting no craving and 33.6% reporting craving. We also found that craving had a small association with morphine equivalent daily dose and pain severity but was more strongly associated with depression. Craving of prescription opioids among veterans with chronic pain is complex. Findings are discussed in relation to chronic pain symptoms, psychiatric comorbidities, and demographics.
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Affiliation(s)
- Tiffany Toor
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Emily Murphy
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Alan N. Simmons
- Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA
- University of California, San Diego, CA
| | - Sarah Palyo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Sara C. Librodo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Irina A. Strigo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
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Strigo IA, Spadoni AD, Simmons AN. Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling. Front Pain Res (Lausanne) 2022; 3:871961. [PMID: 35620636 PMCID: PMC9127988 DOI: 10.3389/fpain.2022.871961] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/07/2022] [Indexed: 01/19/2023]
Abstract
Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.
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Affiliation(s)
- Irina A. Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Irina A. Strigo
| | - Andrea D. Spadoni
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States,Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Alan N. Simmons
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States,Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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Myoraku A, Lang A, Taylor CT, Scott Mackin R, Meyerhoff DJ, Mueller S, Strigo IA, Tosun D. Age-dependent brain morphometry in Major Depressive disorder. Neuroimage Clin 2021; 33:102924. [PMID: 34959051 PMCID: PMC8718744 DOI: 10.1016/j.nicl.2021.102924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a complex disorder that affects nearly 264 million people worldwide. Structural brain abnormalities in multiple neuroanatomical networks have been implicated in the etiology of MDD, but the degree to which MDD affects brain structure during early to late adulthood is unclear. METHODS We examined morphometry of brain regions commonly implicated in MDD, including the amygdala, hippocampus, anterior cingulate gyrus, lateral orbitofrontal gyrus, subgenual cortex, and insular cortex subregions, from early to late adulthood. Harmonized measures for gray matter (GM) volume and cortical thickness of each region were estimated cross-sectionally for 305 healthy controls (CTLs) and 247 individuals with MDD (MDDs), collated from four research cohorts. We modeled the nonlinear associations of age with GM volume and cortical thickness using generalized additive modeling and tested for age-dependent group differences. RESULTS Overall, all investigated regions exhibited smaller GM volume and thinner cortical measures with increasing age. Compared to age matched CTLs, MDDs had thicker cortices and greater GM volume from early adulthood until early middle age (average 35 years), but thinner cortices and smaller GM volume during and after middle age in the lateral orbital gyrus and all insular subregions. Deviations of the MDD and CTL models for both GM volume and cortical thickness in these regions started as early as age 18. CONCLUSIONS The analyses revealed that brain morphometry differences between MDDs and CTLs are dependent on age and brain region. The significant age-by-group interactions in the lateral orbital frontal gyrus and insular subregions make these regions potential targets for future longitudinal studies of MDD.
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Affiliation(s)
- Alison Myoraku
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, United States.
| | - Adam Lang
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States
| | - Charles T Taylor
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA 92093, United States
| | - R Scott Mackin
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Dieter J Meyerhoff
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Susanne Mueller
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Irina A Strigo
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, United States; Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA 94121, United States
| | - Duygu Tosun
- Northern California Institute for Research and Education, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, United States
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Strigo IA, Keltner JR, Ellis RJ, Simmons AN. Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence. Brain Commun 2021; 3:fcab260. [PMID: 34859214 PMCID: PMC8633742 DOI: 10.1093/braincomms/fcab260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanisms underlying chronic neuropathic pain associated with HIV-associated distal sensory polyneuropathy are poorly understood, yet 40% of those with distal neuropathy (or 20% of all people with HIV) suffer from this debilitating condition. Central pain processing mechanisms are thought to contribute to the development of HIV neuropathic pain, yet studies investigating central mechanisms for HIV neuropathic pain are few. Considering the motivational nature of pain, we aimed to examine the degree to which expectation of pain onset and expectation of pain offset are altered in sixty-one male patients with HIV-related distal sensory polyneuropathy with (N = 30) and without (N = 31) chronic neuropathic pain. By contrasting painful (foot) and non-painful (hand) sites between those with and without neuropathic pain, we could identify unique neural structures that showed altered activation during expectation of pain offset or relief. Our results showed no evidence for peripheral mechanisms evidenced by lack of significant between group differences in thermo-sensation, subjective pain response or epidermal nerve fibre density. Likewise, we found no significant differences between groups in subjective or brain mechanisms underlying the expectation of pain onset. Conversely, we found significant interaction within right anterior insula during expectation of pain offset in our study in that individuals in the pain group compared to the no-pain group exhibited increased anterior insula activation on the painful compared to the non-painful site. Our findings are consistent with abnormal processing of expectation of pain offset or abnormal pain relief-related mechanisms potentially due to increased emotional distress regarding the experience of chronic endogenous pain.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory Research, San Francisco Veterans Affairs Health Care Center, San Francisco, CA 94121, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - John R Keltner
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Alan N Simmons
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,Center of Excellence in Stress and Mental Health Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92161, USA
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14
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Murphy JL, Palyo SA, Schmidt ZS, Hollrah LN, Banou E, Van Keuren CP, Strigo IA. The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative. Pain Med 2021; 22:430-443. [PMID: 33496787 DOI: 10.1093/pm/pnaa417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites. METHODS Outcomes were assessed using agreed-upon measures of patient-reported pain intensity, pain interference across various domains, pain catastrophizing, and sleep. RESULTS A total of 931 patients enrolled in the selected VA interdisciplinary pain programs, with 84.1% of participants completing the full course of treatment. Overall, all programs showed significant improvements from pretreatment to posttreatment in nearly all patient-reported outcomes. The effect sizes ranged from medium to large. Notably, the results demonstrate that positive outcomes were typical despite differences in structure and resources across programs. CONCLUSIONS The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach.
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Affiliation(s)
- Jennifer L Murphy
- James A. Haley Veterans' Hospital, Tampa, Florida, USA.,University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sarah A Palyo
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, California, USA
| | | | | | | | | | - Irina A Strigo
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, California, USA
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15
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Alter BJ, Aung MS, Strigo IA, Fields HL. Onset hyperalgesia and offset analgesia: Transient increases or decreases of noxious thermal stimulus intensity robustly modulate subsequent perceived pain intensity. PLoS One 2020; 15:e0231124. [PMID: 33290407 PMCID: PMC7723268 DOI: 10.1371/journal.pone.0231124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022] Open
Abstract
Reported pain intensity depends not only on stimulus intensity but also on previously experienced pain. A painfully hot temperature applied to the skin evokes a lower subjective pain intensity if immediately preceded by a higher temperature, a phenomenon called offset analgesia. Previous work indicated that prior pain experience can also increase subsequent perceived pain intensity. Therefore, we examined whether a given noxious stimulus is experienced as more intense when it is preceded by an increase from a lower temperature. Using healthy volunteer subjects, we observed a disproportionate increase in pain intensity at a given stimulus intensity when this intensity is preceded by a rise from a lower intensity. This disproportionate increase is similar in magnitude to that of offset analgesia. We call this effect onset hyperalgesia. Control stimuli, in which a noxious temperature is held constant, demonstrate that onset hyperalgesia is distinct from receptor or central sensitization. The absolute magnitudes of offset analgesia and onset hyperalgesia correlate with each other but not with the noxious stimulus temperature. Finally, the magnitude of both offset analgesia and onset hyperalgesia depends on preceding temperature changes. Overall, this study demonstrates that the perceptual effect of a noxious thermal stimulus is influenced in a bidirectional manner depending upon both the intensity and direction of change of the immediately preceding thermal stimulus.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Mya Sandi Aung
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Irina A. Strigo
- San Francisco VA Health Care System & Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Howard L. Fields
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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16
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Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 2018; 95:383-395. [DOI: 10.1016/j.neubiorev.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
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17
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [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: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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18
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Murray SB, Strigo IA. Anorexia nervosa, neuroimaging research, and the contextual salience of food cues: The food approach-avoidance conundrum. Int J Eat Disord 2018; 51:822-825. [PMID: 29846004 PMCID: PMC6230302 DOI: 10.1002/eat.22883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/07/2018] [Revised: 04/11/2018] [Accepted: 04/29/2018] [Indexed: 01/23/2023]
Abstract
Anorexia nervosa (AN) is characterized by an avoidance and marked apprehension around food intake, yet paradoxically, those with AN often display approach behaviors to food, engaging in food shopping or preparation activities which are described as rewarding. This approach-avoidance conundrum is of much importance as neuroimaging studies continue to probe mechanisms relating to core AN psychopathology. This Idea Worth Researching discusses the notion that neuroimaging studies relying on food cue presentation paradigms may be methodologically flawed without specifying the contextual salience of the food cues presented in paradigms. The appraisal of food cues may diverge as a function of one's intent-to-eat, and thus, neuroimaging studies not specifying the contextual salience of food cues (i.e., intent-to-eat or not) may confound two distinctly different processes.
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Affiliation(s)
- Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Irina A. Strigo
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- San Francisco Veterans Affairs Medical Center, San Francisco, California
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19
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Strigo IA, Spadoni AD, Inslicht SS, Simmons AN. Repeated Exposure to Experimental Pain Differentiates Combat Traumatic Brain Injury with and without Post-Traumatic Stress Disorder. J Neurotrauma 2017; 35:297-307. [PMID: 28931334 DOI: 10.1089/neu.2017.5061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) are highly comorbid conditions that often co-occur with chronic pain. We have shown that women with PTSD subsequent to intimate partner violence show attenuated brain response to repeated experimental pain that was related to symptoms of avoidance. The aim of this study was to extend our past findings to males with combat trauma and to examine brain response to experimental pain in men with and without PTSD who sustained mTBI during combat. Seventy male veterans performed an experimental pain paradigm during functional magnetic resonance imaging fMRI. Of the 70 total subjects, 46 self-reported a history of mTBI during combat (46 of 70). Of those with mTBI, 26 also met criteria for PTSD (26 of 46). As in our previous study, we examined change in brain activity to repeated heat pain with linear mixed-effects modeling for group by administration interaction effects. We observed a significant group by administration interaction to repeated heat pain within insular, frontal, and parietal cortices, such that the control group showed increased activation over time, whereas mTBI groups (mTBI-only, mTBI + PTSD) showed decreased activation within bilateral anterior insulas (AIs) between administrations. Importantly, change in the right AI response was inversely correlated with avoidance symptoms, but only in those with comorbid mTBI + PTSD. Further, in the comorbid group, greater AI attenuation was associated with decreased connectivity with anterior cingulate (ACC). The current study provides further evidence that repeated exposure to brief painful stimuli results in attenuation of insula activation over time in traumatized individuals. Further, in PTSD, AI shows greatest attenuation in those with the highest level of avoidance-a finding that was replicated across diverse samples. Thus, this mechanism may be a generalized mechanism of maladaptive response to experimental pain in those with significant trauma.
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Affiliation(s)
- Irina A Strigo
- 1 Veterans Affairs San Francisco Healthcare System , San Francisco, California.,2 University of California San Francisco , San Francisco, California
| | - Andrea D Spadoni
- 3 Veterans Affairs San Diego Healthcare System , San Diego, California.,4 University of California , San Diego, La Jolla, California
| | - Sabra S Inslicht
- 1 Veterans Affairs San Francisco Healthcare System , San Francisco, California.,2 University of California San Francisco , San Francisco, California
| | - Alan N Simmons
- 3 Veterans Affairs San Diego Healthcare System , San Diego, California.,4 University of California , San Diego, La Jolla, California
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20
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Strigo IA, Murray SB, Simmons AN, Bernard RS, Huang JS, Kaye WH. The clinical application of fMRI data in a single-patient diagnostic conundrum: Classifying brain response to experimental pain to distinguish between gastrointestinal, depressive and eating disorder symptoms. J Clin Neurosci 2017; 45:149-153. [PMID: 28823587 DOI: 10.1016/j.jocn.2017.07.023] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022]
Abstract
Patients with eating disorders (EDs) often present with psychiatric comorbidity, and functional and/or organic gastrointestinal (GI) symptomatology. Such multidiagnostic presentations can complicate diagnostic practice and treatment delivery. Here we describe an adolescent patient who presented with mixed ED, depressive, and GI symptomatology, who had received multiple contrasting diagnoses throughout treatment. We used a novel machine learning approach to classify (i) the patient's functional brain imaging during an experimental pain paradigm, and (ii) patient self-report psychological measures, to categorize the diagnostic phenotype most closely approximated by the patient. Specifically, we found that the patient's response to pain anticipation and experience within the insula and anterior cingulate cortices, and patient self-report data, were most consistent with patients with GI pain. This work is the first to demonstrate the possibility of using imaging data, alongside supervised learning models, for purposes of single patient classification in those with ED symptomatology, where diagnostic comorbidity is common.
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Affiliation(s)
- Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Alan N Simmons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States; San Diego Veterans Affairs Medical Center, San Diego, CA, United States
| | - Rebecca S Bernard
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Jeannie S Huang
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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Abstract
We briefly review the evidence for distinct neuroanatomical substrates that underlie interoception in humans, and we explain how they substantialize feelings from the body (in the insular cortex) that are conjoined with homeostatic motivations that guide adaptive behaviours (in the cingulate cortex). This hierarchical sensorimotor architecture coincides with the limbic cortical architecture that underlies emotions, and thus we regard interoceptive feelings and their conjoint motivations as homeostatic emotions We describe how bivalent feelings, emotions and sympathovagal balance can be organized and regulated efficiently in the bicameral forebrain as asymmetric positive/negative, approach/avoidance and parasympathetic/sympathetic components. We provide original evidence supporting this organization from studies of cardiorespiratory vagal activity in monkeys and functional imaging studies in healthy humans showing activation modulated by paced breathing and passively viewed emotional images. The neuroanatomical architecture of interoception provides deep insight into the functional organization of all emotional feelings and behaviours in humans.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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Affiliation(s)
- Irina A Strigo
- Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94121, USA
| | - Arthur D Bud Craig
- Neurosurgery Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA
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22
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Kosheleva E, Spadoni AD, Strigo IA, Buchsbaum MS, Simmons AN. Faking bad: The neural correlates of feigning memory impairment. Neuropsychology 2016; 30:377-84. [DOI: 10.1037/neu0000251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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23
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Simmons AN, Norman SB, Spadoni AD, Strigo IA. Neurosubstrates of remission following prolonged exposure therapy in veterans with posttraumatic stress disorder. Psychother Psychosom 2014; 82:382-9. [PMID: 24061484 DOI: 10.1159/000348867] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prolonged exposure (PE) therapy is the first-line treatment for posttraumatic stress disorder (PTSD) in combat veterans. The underlying brain changes of treatment effect in PTSD are currently unknown. METHODS A total of 31 veterans with PTSD completed an fMRI scan performing an affective anticipation task at baseline and were enrolled in PE therapy. Of these, 7 prematurely terminated therapy, while 24 individuals completed PE therapy and an identical follow-up fMRI scan. At follow-up, 15 of the 24 completers still had diagnosable PTSD (NR-PTSD) and 9 of the 24 completers showed complete remission from PTSD (R-PTSD), i.e. they did not meet diagnostic criteria for PTSD. RESULTS The left anterior insula showed a significant group by scan session interaction. Specifically, the R-PTSD group showed decreased activation during anticipation of negative images from pre- to posttreatment scans, while the NR-PTSD group showed increased activation during anticipation of positive images in this region. Furthermore, the change in functional activation in the insula co-occurred with increased connectivity between this insular region and the right cingulate and right mid-posterior insular region in R-PTSD. CONCLUSIONS These findings suggest that the capacity to effectively remit from PTSD symptoms after PE treatment requires the ability to connect with physiological signals and moderate the discomfort of anticipatory anxiety of exposure therapy. These processes appear to be controlled by a network where the anterior insula is connected with the cingulate and the mid-posterior insula.
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Affiliation(s)
- Alan N Simmons
- VA San Diego Healthcare System, University of California San Diego, La Jolla, Calif., USA
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24
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Moeller-Bertram T, Strigo IA, Simmons AN, Schilling JM, Patel P, Baker DG. Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder. Pain Med 2014; 15:762-71. [PMID: 24738563 DOI: 10.1111/pme.12424] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and pain have a well-documented high comorbidity; however, the underlying mechanisms of this comorbidity are currently poorly understood. The aim of this psychophysical study was to investigate the behavioral response to a prolonged suprathreshold pain stimulus in subjects with combat-related PTSD and combat controls (CC) for clinical evidence of central sensitization. METHODS Ten male subjects with current PTSD related to combat and 11 CC male subjects underwent baseline quantitative sensory testing (QST), temporal pain summation, and psychological profiling followed by an intramuscular injection of capsaicin into the quadriceps muscle. RESULTS There was no significant between-group difference for the initial maximal pain response or an initial pain reduction for the first 15 minutes postinjection on QST or pain ratings. However, we observed significantly higher scores in the PTSD group for the second 15 minutes postinjection on both pain intensity and pain unpleasantness ratings. Assessment of temporal summation to repetitive pressure stimuli showed significantly higher subjective pain in the PTSD group. CONCLUSION These findings are consistent with a significantly higher degree of acute central sensitization in individuals with PTSD. Increased acute central sensitization may underlie increased vulnerability for developing pain-related conditions following combat trauma.
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Affiliation(s)
- Tobias Moeller-Bertram
- Center of Excellence for Stress and Mental Health, San Diego, California, USA; VA San Diego Healthcare System, San Diego, California, USA; Department of Anesthesiology, University of California San Diego, San Diego, California, USA
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Strigo IA, Spadoni AD, Lohr J, Simmons AN. Too hard to control: compromised pain anticipation and modulation in mild traumatic brain injury. Transl Psychiatry 2014; 4:e340. [PMID: 24399043 PMCID: PMC3905226 DOI: 10.1038/tp.2013.116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/09/2022] Open
Abstract
Mild traumatic brain injury (MTBI) is a vulnerability factor for the development of pain-related conditions above and beyond those related to comorbid traumatic and emotional symptoms. We acquired functional magnetic resonance imaging (fMRI) on a validated pain anticipation task and tested the hypotheses that individuals with a reported history of MTBI, compared with healthy comparison subjects, would show increased brain response to pain anticipation and ineffective pain modulation after controlling for psychiatric symptoms. Eighteen male subjects with a reported history of blast-related MTBI related to combat, and eighteen healthy male subjects with no reported history of MTBI (healthy controls) underwent fMRI during an event-related experimental pain paradigm with cued high or low intensity painful heat stimuli. No subjects in either group met diagnostic criteria for current mood or anxiety disorder. We found that relative to healthy comparison subjects, after controlling for traumatic and depressive symptoms, participants with a reported history of MTBI showed significantly stronger activations within midbrain periaqueductual grey (PAG), right dorsolateral prefrontal cortex and cuneus during pain anticipation. Furthermore, we found that brain injury was a significant moderator of the relationship between anticipatory PAG activation and reported subjective pain. Our results suggest that a potentially disrupted neurocognitive anticipatory network may result from damage to the endogenous pain modulatory system and underlie difficulties with regulatory pain processing following MTBI. In other words, our findings are consistent with a notion that brain injury makes it more difficult to control acute pain. Understanding these mechanisms of dysfunctional acute pain processing following MTBI may help shed light on the underlying causes of increased vulnerability for the development of pain-related conditions in this population.
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Affiliation(s)
- I A Strigo
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,University of California San Diego, La Jolla, CA, USA,BioCircuits Institute, University of California San Diego, La Jolla, CA, USA,Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Dr, Building 13, MC 9151-B, La Jolla, CA 92161, USA. E-mail:
| | - A D Spadoni
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,University of California San Diego, La Jolla, CA, USA
| | - J Lohr
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,University of California San Diego, La Jolla, CA, USA
| | - A N Simmons
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,University of California San Diego, La Jolla, CA, USA
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26
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Simmons AN, Flagan TM, Wittmann M, Strigo IA, Matthews SC, Donovan H, Lohr JB, Paulus MP. The effects of temporal unpredictability in anticipation of negative events in combat veterans with PTSD. J Affect Disord 2013; 146:426-32. [PMID: 22910447 DOI: 10.1016/j.jad.2012.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/02/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exposure to psychological stress during combat can lead to posttraumatic stress disorder (PTSD). Anticipation of aversive events is often associated with an intense emotional state in individuals with PTSD. Both the valence (i.e., positive or negative) of the anticipated event and the degree of temporal predictability (i.e., one's ability to predict when an event will occur) have profound effects on an individual's emotional experience. This investigation tested the hypothesis that individuals with combat-related PTSD would show increased activation in the insula and related emotion-processing circuitry when anticipating emotionally significant events such as portrayed in combat-related images, and this heighted response within the insula would be particularly enhanced during temporal unpredictability. METHODS About 15 male veterans with PTSD and 15 male veterans with combat-exposure but no current or lifetime history of PTSD (combat exposed controls/CEC) performed a temporal unpredictability anticipation task of unpleasant (combat-related) and pleasant images during fMRI. RESULTS As expected, greater activation in the bilateral anterior insulae was observed in the PTSD versus the CEC subjects during anticipation of combat-related images when the anticipatory period was of uncertain duration (p<0.05). Furthermore, activation in the right anterior insula was related to greater perceived threat in the CEC group (ρ=0.619). LIMITATIONS The current study looks only at combat-related PTSD in a modest preliminary sized sample. CONCLUSIONS These findings suggest that an excessive anticipatory reaction in individuals with PTSD to temporally unpredictable aversive stimulus may relate to greater perceived threat. These findings are concordant with psychological models of PTSD that focus on the association of PTSD with the experience of decreased predictability and control.
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Affiliation(s)
- Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA 92130, USA.
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Abstract
Major depressive disorder (MDD) is characterized by impaired processing of negative information, possibly due to dysfunction in both, the bottom-up emotional network and top-down modulatory network. By acquiring functional magnetic resonance imaging (fMRI) on a pain-anticipation task, we tested the hypothesis that individuals with MDD would show increased negative biasing that may be associated with reduced frontal connectivity. Thirty-one (15 females) unmedicated young adults with current MDD and 22 (11 females) healthy subjects with no history of MDD were recruited. Groups did not differ significantly in age, race, level of education, marital status or gender distribution. fMRI data were collected during an event-related pain-anticipation paradigm, during which subjects were cued to anticipate painful heat stimuli of high or low intensity. All temperature stimuli were applied to each subject's left forearm. We found that relative to healthy comparison subjects, participants with MDD showed significantly stronger responses to high versus low pain anticipation within right ventral anterior insula (AI), but overlapping response within right dorsal AI, which correlated positively with the depression symptoms severity in the MDD group. Functional connectivity analyses showed increased functional connectivity between dorsal insula and posterior thalamus and decreased functional connectivity between dorsal insula and the right inferior frontal gyrus in the MDD compared with the non-MDD group. Our results demonstrate that unmedicated individuals with current MDD compared with healthy never-depressed subjects show both differential and overlapping response within AI during anticipation of pain. Furthermore, the overlapping insular response is less regulated by frontal brain systems and is more subservient to affective processing regions in the posterior thalamus in MDD. These results support and provide functional validation of the co-occurring enhanced 'bottom-up' and attenuated 'top-down' processing of salient, unpleasant emotional information in MDD.
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Affiliation(s)
- I A Strigo
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92161, USA.
| | - S C Matthews
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - A N Simmons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Strigo IA, Matthews SC, Simmons AN, Oberndorfer T, Klabunde M, Reinhardt LE, Kaye WH. Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation. Int J Eat Disord 2013; 46:23-33. [PMID: 22836447 PMCID: PMC3507323 DOI: 10.1002/eat.22045] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in individuals with AN, such as the insula. METHOD Functional magnetic resonance imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in 10 healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli. RESULTS REC AN compared with CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN participants. DISCUSSION REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from AN.
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Affiliation(s)
- Irina A. Strigo
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA,BioCircuits Institute (BCI), La Jolla, CA 92037
| | - Scott C. Matthews
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Alan N. Simmons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,Psychiatry Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Tyson Oberndorfer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Megan Klabunde
- Department of Child and Adolescent Psychiatry, Stanford University, Stanford, CA
| | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
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Mutschler I, Ball T, Wankerl J, Strigo IA. Pain and emotion in the insular cortex: evidence for functional reorganization in major depression. Neurosci Lett 2012; 520:204-9. [PMID: 22503725 DOI: 10.1016/j.neulet.2012.03.095] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/27/2012] [Accepted: 03/30/2012] [Indexed: 01/17/2023]
Abstract
Major Depressive Disorder (MDD) is among the top causes of disability worldwide and many patients with depression experience pain symptoms. Little is known regarding what makes depressed persons feel like they are in pain. An increasing number of neuroimaging studies show that both physical pain and depression involve the insular cortex. The present study aimed to investigate whether emotional processing in MDD patients is topologically shifted towards the insular area(s) involved in pain processing in healthy individuals. To achieve this aim, we investigated the functional organization of the insula by conducting meta-analyses of previously published neuroimaging studies on: (1) emotion in patients with MDD, (2) emotion in healthy subjects, and (3) physical pain in healthy subjects. Our results show that the dorsal part of the insula is reproducibly activated during experimental pain in healthy individuals, with multiple separate pain-related areas aligned along its dorsal border. Regions with maximal pain-related activation likelihood estimate (ALE) were located in the posterior (left) and dorsal mid-anterior insula (left and right). Furthermore, emotion-related peaks in healthy subjects were found both in its ventral (as shown in a previous meta-analysis) and dorsal anterior part. Importantly, emotion-related peaks in depressed patients were shifted to the dorsal anterior insula, where regions related to physical pain in healthy subjects are located. This shift was reflected in the observation that median z-coordinates of emotion-related responses in the left hemisphere were significantly larger in depressed patients than in healthy controls. This shift of emotion-related responses to the dorsal insula, i.e., where pain-processing takes place in healthy subjects, may play a role in "emotional allodynia" - a notion that individuals with MDD experience pain in response to stimuli that are normally not painful.
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Affiliation(s)
- Isabella Mutschler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
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Simmons AN, Thayer RE, Spadoni AD, Matthews SC, Strigo IA, Tapert SF. The parametric, psychological, neuropsychological, and neuroanatomical properties of self and world evaluation. PLoS One 2012; 7:e31509. [PMID: 22348093 PMCID: PMC3278451 DOI: 10.1371/journal.pone.0031509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 01/09/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As an individual moves from adolescence to adulthood, they need to form a new sense of self as their environment changes from a limited to a more expansive structure. During this critical stage in development the last dramatic steps of neural development occur and numerous psychiatric conditions begin to manifest. Currently, there is no measure that aids in the quantification of how the individual is adapting to, and conceptualizing their role in, these new structures. To fill this gap we created the Self and World Evaluation Expressions Test(SWEET). METHOD Sixty-five young adults (20.6 years-old), 36 with a history of drug use, completed the SWEET. A factor analysis was performed on the SWEET and the resultant factors were correlated with psychological, neuropsychological, and neuroanatomical battery that included both T1-wieghted and diffusion tensor magnetic resonance imaging scans. RESULTS WE DERIVED FOUR FACTORS: Self, Social-Emotional, Financial-Intellectual, and Spirituality. While showing limited relationships to psychological and neuropsychological measures, both white matter integrity and gray matter density showed significant relationships with SWEET factors. CONCLUSIONS These findings suggest that while individual responses may not be indicative of psychological or cognitive processes they may relate to changes in brain structure. Several of these structures, such as the negative correlation of the affective impact of world with the dorsal anterior corpus callosum white matter integrity have been observed in psychiatric conditions (e.g., obsessive-compulsive disorder). Further longitudinal research using the SWEET may help understand the impact of dramatic shifts in self/world conceptualization and potentially link these shifts to underlying changes in brain structure.
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Affiliation(s)
- Alan N Simmons
- Mental Health, VA San Diego Healthcare System, San Diego, California, United States of America.
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Brown GG, Lee JS, Strigo IA, Caligiuri MP, Meloy MJ, Lohr J. Voxel-based morphometry of patients with schizophrenia or bipolar I disorder: a matched control study. Psychiatry Res 2011; 194:149-56. [PMID: 21924872 PMCID: PMC3196272 DOI: 10.1016/j.pscychresns.2011.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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: 11/28/2009] [Revised: 05/06/2011] [Accepted: 05/15/2011] [Indexed: 12/25/2022]
Abstract
Controlled trials provide critical tests of hypotheses generated by meta-analyses. Two recent meta-analyses have reported that gray matter volumes of schizophrenia and bipolar I patients differ in the amygdala, hippocampus, or perigenual anterior cingulate. The present magnetic resonance imaging study tested these hypotheses in a cross-sectional voxel-based morphometry (VBM) design of 17 chronic schizophrenia and 15 chronic bipolar patients and 21 healthy subjects matched for age, gender and duration of illness. Whole brain gray matter volume of both the schizophrenia and bipolar groups was smaller than among healthy control subjects. Regional voxel-wise comparisons showed that gray matter volume was smallest within frontal and temporal regions of both patient groups. Region of interest analyses found moderately large to large differences between schizophrenia and healthy subjects in the amygdala and hippocampus. There were no group differences in the perigenual anterior cingulate. When schizophrenia and bipolar groups were directly compared, the schizophrenia group showed smaller gray matter volumes in right subcortical regions involving the right hippocampus, putamen, and amygdala. The hippocampal and amygdala findings confirm predictions derived from recent meta-analyses. These structural abnormalities may be important factors in the differential manifestations of these two functional psychotic disorders.
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Moeller-Bertram T, Keltner J, Strigo IA. Pain and post traumatic stress disorder - review of clinical and experimental evidence. Neuropharmacology 2011; 62:586-97. [PMID: 21586297 DOI: 10.1016/j.neuropharm.2011.04.028] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 03/29/2011] [Accepted: 04/23/2011] [Indexed: 01/09/2023]
Abstract
Pain and Post Traumatic Stress Disorder (PTSD) are highly comorbid conditions. Patients with chronic pain have higher rates of PTSD. Likewise, patients with PTSD are often diagnosed with numerous chronic pain conditions. Despite the high pain-PTSD comorbidity, the neurobehavioral mechanisms underlying this phenomenon are incompletely understood and only recently researchers have started investigating it using experimental models. In this article, we systematically review the substantial clinical evidence on the co-occurrence of pain and PTSD, and the limited experimental evidence of pain processing in this disorder. We provide a detailed overview of the psychophysical and brain imaging experiments that compared somatosensory and pain processing in PTSD and non-PTSD populations. Based on the presented evidence, an extensive body of literature substantiates the clinical coexistence of pain and PTSD in patients but the limited experimental data show inconsistent results highlighting the need for well-controlled future studies. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
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Oberndorfer TA, Kaye WH, Simmons AN, Strigo IA, Matthews SC. Demand-specific alteration of medial prefrontal cortex response during an inhibition task in recovered anorexic women. Int J Eat Disord 2011; 44:1-8. [PMID: 20127942 DOI: 10.1002/eat.20750] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE It is well known that individuals with anorexia nervosa (AN) are inhibited and over-controlled. This study investigated a prefrontal-cingulate network that is involved in inhibitory control. METHOD To avoid the confounds of malnutrition, 12 recovered (RAN) subjects were compared to 12 matched control women (CW) using a validated inhibition task (i.e., a stop signal task) during functional magnetic resonance imaging. RESULTS Consistent with the a priori hypothesis, RAN subjects showed altered task-related activation in the medial prefrontal cortex (mPFC), a critical node of the inhibitory control network. Specifically, whereas RAN and CW showed similar mPFC activity during trials when inhibitory demand was low (i.e., easy trials), RAN relative to CW showed significantly less mPFC activation as inhibition trials became more difficult (i.e., hard trials), suggesting a demand-specific modulation of inhibitory control circuitry in RAN. DISCUSSION These findings support a neural basis for altered impulse control symptoms in AN.
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Affiliation(s)
- Tyson A Oberndorfer
- Department of Psychiatry, University of California-San Diego, La Jolla, CA 92037, USA
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Simmons AN, Stein MB, Strigo IA, Arce E, Hitchcock C, Paulus MP. Anxiety positive subjects show altered processing in the anterior insula during anticipation of negative stimuli. Hum Brain Mapp 2010; 32:1836-46. [PMID: 21181800 DOI: 10.1002/hbm.21154] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 12/30/2022] Open
Abstract
Prior neuroimaging studies support the hypothesis that anticipation, an important component of anxiety, may be mediated by activation within the insular and medial prefrontal cortices including the anterior cingulate cortex. However, there is an insufficient understanding of how affective anticipation differs across anxiety groups in emotional brain loci and networks. We examined 14 anxiety positive (AP) and 14 anxiety normative (AN) individuals completing an affective picture anticipation task during functional magnetic resonance imaging (fMRI). Brain activation was examined across groups for cued anticipation (to aversive or pleasant stimuli). Both groups showed greater activation in the bilateral anterior insula during cued differential anticipation (i.e., aversive vs. pleasant), and activation on the right was significantly higher in AP compared to AN subjects. Functional connectivity showed that the left anterior insula was involved in a similar network during pleasant anticipation in both groups. The left anterior insula during aversive and the right anterior insula during all anticipation conditions coactivated with a cortical network consisting of frontal and parietal lobes in the AP group to a greater degree. These results are consistent with the hypothesis that anxiety is related to greater anticipatory reactivity in the brain and that there may be functional asymmetries in the brain that interact with psychiatric traits.
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Affiliation(s)
- Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, California 92161, USA.
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Strigo IA, Simmons AN, Matthews SC, Craig ADB. The relationship between amygdala activation and passive exposure time to an aversive cue during a continuous performance task. PLoS One 2010; 5:e15093. [PMID: 21124739 PMCID: PMC2993966 DOI: 10.1371/journal.pone.0015093] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/20/2010] [Indexed: 11/18/2022] Open
Abstract
The allocation of attention modulates negative emotional processing in the amygdala. However, the role of passive exposure time to emotional signals in the modulation of amygdala activity during active task performance has not been examined. In two functional Magnetic Resonance Imaging (fMRI) experiments conducted in two different groups of healthy human subjects, we examined activation in the amygdala due to cued anticipation of painful stimuli while subjects performed a simple continuous performance task (CPT) with either a fixed or a parametrically varied trial duration. In the first experiment (N = 16), engagement in the CPT during a task with fixed trial duration produced the expected attenuation of amygdala activation, but close analysis suggested that the attenuation occurred during the period of active engagement in CPT, and that amygdala activity increased proportionately during the remainder of each trial, when subjects were passively exposed to the pain cue. In the second experiment (N = 12), the duration of each trial was parametrically varied, and we found that amygdala activation was linearly related to the time of passive exposure to the anticipatory cue. We suggest that amygdala activation during negative anticipatory processing depends directly on the passive exposure time to the negative cue.
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Affiliation(s)
- Irina A Strigo
- University of California San Diego, La Jolla, California, USA.
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Strigo IA, Simmons AN, Matthews SC, Grimes EM, Allard CB, Reinhardt LE, Paulus MP, Stein MB. Neural correlates of altered pain response in women with posttraumatic stress disorder from intimate partner violence. Biol Psychiatry 2010; 68:442-50. [PMID: 20553750 DOI: 10.1016/j.biopsych.2010.03.034] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/02/2010] [Accepted: 03/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is one of the most common causes of posttraumatic stress disorder (PTSD) in women. Women with IPV-related PTSD often experience comorbid chronic pain and pain-related disability. Despite the high comorbidity between PTSD and chronic pain, recent evidence suggests that male veterans with combat-related PTSD report decreased sensitivity to experimental pain. The aim of this study was to examine the neurobehavioral correlates of experimental pain in women with IPV-related PTSD. METHODS Functional magnetic resonance neuroimaging data were collected during an event-related experimental pain paradigm that was administered twice to 23 women with IPV-related PTSD and 15 age-, race- and education-comparable nontraumatized control women. Brief thermal heat stimuli were repeatedly applied to the left volar forearm, and subjects rated the perceived temperature intensity with a button-box. RESULTS Women with IPV-related PTSD relative to nontraumatized control women showed: 1) increased activation of right middle insula and right dorsolateral prefrontal cortex during initial painful stimulation, and 2) subsequent decrease in subjective intensity ratings with repeated exposure to pain, which was accompanied by attenuation of activation within right anterior insula that was associated with avoidance symptoms of PTSD. CONCLUSIONS These results suggest that women with IPV-related PTSD show dysregulated functional brain activity during pain processing, which might drive maladaptive coping mechanisms, such as avoidance and numbing.
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Affiliation(s)
- Irina A Strigo
- University of California at San Diego, La Jolla, California 92161, USA.
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Matthews SC, Simmons AN, Strigo IA, Arce E, Stein MB, Paulus MP. Escitalopram attenuates posterior cingulate activity during self-evaluation in healthy volunteers. Psychiatry Res 2010; 182:81-7. [PMID: 20418072 PMCID: PMC2882791 DOI: 10.1016/j.pscychresns.2010.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 08/20/2009] [Revised: 01/20/2010] [Accepted: 02/04/2010] [Indexed: 11/22/2022]
Abstract
Medial cortex is critically involved in self-referential processing. Little is known about how selective serotonin reuptake inhibitors (SSRIs) affect medial cortical activity during self-assessment. We hypothesized that a 3-week oral course of escitalopram,10 mg/day, would alter activity related to self-referential processing in medial cortex. Fifteen healthy females performed a self-assessment task during functional magnetic resonance imaging on two occasions--once after 3 weeks of placebo and once at the end of 3 weeks of escitalopram. Task conditions involved responding "yes" or "no" to whether various positive and negative adjectives described the subject (i.e., "self" evaluation trials) or the subject's best friend (i.e., "other" evaluation trials), whereas the comparison condition involved responding whether the valence of various adjectives was positive or negative (i.e., "word" evaluation trials). Behaviorally after escitalopram, subjects less frequently endorsed that negative adjectives described themselves. Three main neuroimaging results were observed: (1) increased activation in medial prefrontal cortex and posterior cingulate related to self minus word evaluation trials, (2) increased activation in posterior cingulate related to escitalopram minus placebo for self and word evaluation trials, and (3) drug by task interactions in the insula, cerebellum and prefrontal cortex. These results show that SSRIs change medial cortical activity and may alter self-evaluation.
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Affiliation(s)
- Scott C Matthews
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Matthews SC, Strigo IA, Simmons AN, O'Connell RM, Reinhardt LE, Moseley SA. A multimodal imaging study in U.S. veterans of Operations Iraqi and Enduring Freedom with and without major depression after blast-related concussion. Neuroimage 2010; 54 Suppl 1:S69-75. [PMID: 20451622 DOI: 10.1016/j.neuroimage.2010.04.269] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 03/18/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022] Open
Abstract
Although the exact number of affected individuals is unknown, it has been estimated that approximately 20% of U.S. veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) have experienced mild traumatic brain injury (mTBI) (i.e., concussion), which is defined as a brief loss or alteration of consciousness from a blow or jolt to the head. Blast exposure is among the most common causes of concussion in OEF-OIF warriors. Although the mechanism is unknown, major depressive disorder (MDD) after head injury is common. The purpose of this study was to use diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) to examine the structural and functional neural correlates of MDD in OEF-OIF combat veterans with a self-reported history of blast-related concussion. We hypothesized that subjects in the MDD group (i.e., individuals with a history of blast-related concussion who were experiencing current MDD) relative to individuals in the non-MDD group (i.e., individuals with a history of blast-related concussion but no current or lifetime history of MDD) would show amygdala hyperactivity and disruption of white matter tracts connecting prefrontal and limbic brain regions. To test these hypotheses, 11 MDD and 11 non-MDD individuals underwent DTI and performed a validated emotional face matching task during fMRI. MDD relative to non-MDD individuals showed greater activity during fear matching trials in the amygdala and other emotion processing structures, lower activity during fear matching trials in emotional control structures such as the dorsolateral prefrontal cortex and lower fractional anisotropy (FA) in several white matter tracts including the superior longitudinal fasciculus (SLF). Greater depressive symptom severity correlated negatively with FA in the SLF. These results suggest a biological basis of MDD in OEF-OIF veterans who have experienced blast-related concussion, and may contribute to the development of treatments aimed at improving the clinical care of this unique population of wounded warriors.
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Strigo IA, Simmons AN, Matthews SC, Craig AD. Time-Dependent Amygdala Activation During Anticipation of Pain. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Simmons AN, Matthews SC, Strigo IA, Donovan H, Baker DG, Paulus MP. Anticipatory processing in combat related PTSD. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Strigo IA, Simmons AN, Matthews SC, Craig ADB, Paulus MP. Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. ACTA ACUST UNITED AC 2008; 65:1275-84. [PMID: 18981339 DOI: 10.1001/archpsyc.65.11.1275] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Chronic pain and depression are highly comorbid conditions, yet little is known about the neurobiological basis of pain processing in major depressive disorder (MDD). OBJECTIVE To examine the neural substrates underlying anticipation and processing of heat pain in a group of unmedicated young adults with current MDD. DESIGN Functional magnetic resonance neuroimaging data were collected during an event-related factorial experimental pain paradigm. Painful and nonpainful heat stimuli were applied to the left volar forearm while different color shapes explicitly signaled the intensity of the upcoming stimulus. SETTING University brain imaging center. Patients Fifteen (12 female) young adults with current MDD and 15 (10 female) healthy subjects with no history of MDD were recruited and matched for age and level of education. The Structured Clinical Interview for DSM-IV was administered to all participants by a board-certified psychiatrist. Main Outcome Measure Between-group differences in blood oxygen level-dependent functional magnetic resonance neuroimaging signal change to anticipation and processing of painful vs nonpainful temperature stimuli. RESULTS Subjects with MDD compared with healthy controls showed (1) increased activation in the right anterior insular region, dorsal anterior cingulate, and right amygdala during anticipation of painful relative to nonpainful stimuli, (2) increased activation in the right amygdala and decreased activation in periaqueductal gray matter and the rostral anterior cingulate and prefrontal cortices during painful stimulation relative to nonpainful stimulation, and (3) greater activation in the right amygdala during anticipation of pain, which was associated with greater levels of perceived helplessness. CONCLUSIONS These findings suggest that increased emotional reactivity during the anticipation of heat pain may lead to an impaired ability to modulate pain experience in MDD. Future studies should examine the degree to which altered functional brain response during anticipatory processing affects the ability to modulate negative affective states in MDD, which is a core characteristic of this disorder.
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Affiliation(s)
- Irina A Strigo
- Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Dr, Bldg 13, MC 9151-B, La Jolla, CA 92161, USA.
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Matthews SC, Strigo IA, Simmons AN, Yang TT, Paulus MP. Decreased functional coupling of the amygdala and supragenual cingulate is related to increased depression in unmedicated individuals with current major depressive disorder. J Affect Disord 2008; 111:13-20. [PMID: 18603301 DOI: 10.1016/j.jad.2008.05.022] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 05/29/2008] [Accepted: 05/29/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) show abnormal functional coupling (FC) between several nodes of a widely distributed cortico-limbic network that includes the amygdala and anterior cingulate. The aim of this study was to examine the degree to which alterations in amygdala-cingulate FC relate to severity of current depressive symptoms in a group of depressed individuals without significant co-morbidities. METHODS Fifteen young, unmedicated subjects with current MDD and 16 healthy controls (HC) with no lifetime history of psychiatric illness performed a validated emotional face-matching task during functional magnetic resonance imaging. Amygdala activity and strength of amygdala-cingulate FC during emotional face processing were contrasted between the groups. RESULTS Although both groups activated the extended amygdala (EA) during emotion processing, the MDD relative to the HC group showed more task-related co-activation of the subgenual cingulate, which is involved in processing negative self-referential information; and less co-activation of the supragenual cingulate, which is involved in the cognitive control of emotion. Greater depressive symptom severity correlated positively with decreased FC between bilateral EA and supragenual cingulate in MDD subjects. LIMITATIONS This study included a demographically homogeneous population of subjects, which may limit the generalizability of the findings. CONCLUSIONS These results elaborate current neurobiological models of MDD by providing unique evidence that decreased FC between the EA and supragenual cingulate is related to increased severity of current depressive symptoms. We speculate that the clinical manifestations of MDD may result in part from a failed ability to co-activate a cognitive control network during emotion processing.
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Affiliation(s)
- Scott C Matthews
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0603, United States.
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Olausson H, Charron J, Marchand S, Villemure C, Strigo IA, Bushnell MC. Feelings of warmth correlate with neural activity in right anterior insular cortex. Neurosci Lett 2005; 389:1-5. [PMID: 16051437 DOI: 10.1016/j.neulet.2005.06.065] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 06/02/2005] [Accepted: 06/23/2005] [Indexed: 11/28/2022]
Abstract
The neural coding of perception can differ from that for the physical attributes of a stimulus. Recent studies suggest that activity in right anterior insular cortex may underlie thermal perception, particularly that of cold. We now examine whether this region is also important for the perception of warmth. We applied cutaneous warm stimuli on the left leg (warmth) in normal subjects (n = 7) during functional magnetic resonance imaging (fMRI). After each stimulus, subjects rated their subjective intensity of the stimulus using a visual analogue scale (VAS), and correlations were determined between the fMRI signal and the VAS ratings. We found that intensity ratings of warmth correlated with the fMRI signal in the right (contralateral to stimulation) anterior insular cortex. These results, in conjunction with previous reports, suggest that the right anterior insular cortex is important for different types of thermal perception.
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Affiliation(s)
- H Olausson
- Centre for Research on Pain, McGill University, Montréal, Qué., Canada.
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Strigo IA, Albanese MC, Bushnell MC, Duncan GH. Visceral and cutaneous pain representation in parasylvian cortex. Neurosci Lett 2005; 384:54-9. [PMID: 15905031 DOI: 10.1016/j.neulet.2005.04.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 03/25/2005] [Accepted: 04/11/2005] [Indexed: 11/21/2022]
Abstract
The ability to localize both touch and pain has been attributed mainly to the primary somatosensory cortex (S1), based on its fine somatotopic mapping of tactile inputs. Recently, S1 has also been implicated in the differentiation of noxious stimulation, such as distinguishing between pain arising from viscera and skin. Recent MEG and fMRI studies show that there is at least a rudimentary tactile topographic representation in the supra-sylvian cortex [encompassing secondary somatosensory area (S2)], suggesting that this area may contribute to touch localization. Nevertheless, the role of this region in pain localization or its role in the differentiation of various types of pain has not been clearly established. Healthy subjects (four males, three females) underwent fMRI-scanning (1.5 T, standard head coil, BOLD analysis) during painful balloon distention of the distal esophagus and painful heat on the midline chest in the zone of referred pain for the esophageal stimulation. Five of the seven subjects exhibited significant activation of the parasylvian region in both experimental conditions, and in each of these five subjects activation related to esophageal pain was represented more laterally within the parasylvian cortex than that associated with cutaneous trunk pain (paired t-test, p's < 0.01). Our results suggest segregation of visceral esophageal and cutaneous chest afferents within parasylvian cortex, possibly implicating this region in the perceptual differentiation of visceral and cutaneous pain.
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Affiliation(s)
- Irina A Strigo
- Department of Anesthesia, McGill University, Montreal, Canada H3G 1Y6.
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Hua LH, Strigo IA, Baxter LC, Johnson SC, Craig ADB. Anteroposterior somatotopy of innocuous cooling activation focus in human dorsal posterior insular cortex. Am J Physiol Regul Integr Comp Physiol 2005; 289:R319-R325. [PMID: 15805097 DOI: 10.1152/ajpregu.00123.2005] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [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: 11/22/2022]
Abstract
Prior data indicate that graded activation by innocuous thermal stimuli occurs in the dorsal posterior insular (dpIns) cortex of humans, rather than the parietal somatosensory regions traditionally thought necessary for discriminative somatic sensations. We hypothesized that if the dpIns subserves the haptic capacity of localization in addition to discrimination, then it should be somatotopically organized. Using functional magnetic resonance imaging to detect activation in the dpIns by graded cooling stimuli applied to the hand and neck, we found unimodal foci arranged in an anteroposterior somatotopographic pattern, consistent with participation of the dpIns in localization as well as discrimination. This gradient is orthogonal to the mediolateral somatotopy of parietal somatosensory regions, which supports the fundamental conceptual differentiation of the interoceptive somatic representation in the dpIns from the parietal exteroceptive representations. These data also support the suggestion that the poststroke central pain syndrome associated with lesions of the dpIns is a thermoregulatory dysfunction. Finally, another focus of strongly graded activation, which we interpret to represent thermoregulatory behavioral motivation elicited by dynamic cooling, was observed in the dorsal medial cortex.
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Affiliation(s)
- Le H Hua
- Atkinson Research Laboratory, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Pukall CF, Strigo IA, Binik YM, Amsel R, Khalifé S, Bushnell MC. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain 2005; 115:118-27. [PMID: 15836975 DOI: 10.1016/j.pain.2005.02.020] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Revised: 01/14/2005] [Accepted: 02/14/2005] [Indexed: 11/16/2022]
Abstract
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Recent evidence points to the importance of the sensory component in VVS, particularly the heightened processing of tactile and pain sensation in the vulvar vestibule. The goal of the present study was to examine the neural basis of heightened sensitivity to touch (i.e. allodynia) in women with VVS. Using functional magnetic resonance imaging, we compared regions of neural activity in 14 women with VVS and 14 age- and contraceptive-matched control women in response to the application of mild and moderate pressure to the posterior portion of the vulvar vestibule. Intensity and unpleasantness ratings were recorded after each scan; these ratings were significantly higher for women with VVS than controls. All women with VVS described moderate pressure as painful and unpleasant, and 6 of the 14 women with VVS described mild pressure as painful and unpleasant. In contrast, none of the stimuli was painful for control women. Correspondingly, women with VVS showed more significant activations during pressure levels that they found to be either painful or non-painful than did controls during comparable pressure levels. During pressure described as painful by women with VVS, they had significantly higher activation levels in the insular and frontal cortical regions than did control women. These results suggest that women with VVS exhibit an augmentation of genital sensory processing, which is similar to that observed for a variety of syndromes causing hypersensitivity, including fibromyalgia, idiopathic back pain, irritable bowel syndrome, and neuropathic pain.
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Affiliation(s)
- Caroline F Pukall
- Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, Ont., Canada K7L 3N6.
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Strigo IA, Duncan GH, Bushnell CM, Boivin M, Wainer I, Rodriguez Rosas EM, Persson J. The effects of racemic ketamine on painful stimulation of skin and viscera in human subjects. Pain 2005; 113:255-264. [PMID: 15661431 DOI: 10.1016/j.pain.2004.10.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2004] [Revised: 10/06/2004] [Accepted: 10/18/2004] [Indexed: 01/24/2023]
Abstract
Evidence suggests that NMDA receptors may have a differential role in the modulation of visceral and somatic pain. Specifically, animal data indicate an analgesic role of NMDA-R antagonists in acute visceral but not acute somatic pain. In humans analgesic effects are documented in acute somatic pain, while the role of NMDA-R antagonists in acute visceral pain is still questionable. We, therefore, conducted a study in humans comparing the analgesic effects of ketamine in an experimental model of visceral and cutaneous pain. In a double-blind, randomized, cross-over study, 11 healthy volunteers (3M, 8F) participated in two experimental sessions in which they evaluated perceptions induced by balloon distention of the distal esophagus and contact heat on the upper chest during continuous computer-controlled i.v. infusion of either ketamine (60 and 120 ng/mL) or saline. Two stimulus intensities producing non-painful and painful sensation were used for each stimulus modality. Subjects reported maximum pain intensity and unpleasantness on visual analog scales (VAS). For noxious visceral stimulation, low dose ketamine produced significant attenuation of both pain intensity and unpleasantness. In contrast, for noxious cutaneous stimulation, ketamine reduced pain unpleasantness, but not perceived intensity. In addition, ketamine did not alter the perception of innocuous stimuli in either modality. Our results confirm the analgesic effects of low-dose ketamine, with minimal side effects, on acute visceral pain and indicate a similar but smaller effect on acute cutaneous pain. A decrease in the unpleasantness but not in the intensity of cutaneous pain may reflect the differential effect of NMDA-R antagonists for the two pain states observed in animal models.
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Affiliation(s)
- Irina A Strigo
- Department of Anesthesia, Centre for Research on Pain, McGill University, 3640 University Street, Rm. M/19, Montreal, Que. H3A 2B2, Canada Département de stomatologie, Faculté de médecine dentaire, Centre de recherche en sciences neurologiques, Université de Montréal, Montreal, Que. H3C 3J7, Canada Département de gastroentérologie, Université de Montréal, Montreal, Que. H3C 3J7, Canada Gerontology Center, National Institute of Aging, NIH, Baltimore, MD 21224, USA Departments of Anesthesiology and Intensive Care and Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
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Abstract
The widespread convergence of information from visceral, cutaneous, and muscle tissues onto CNS neurons invites the question of how to identify pain as being from the viscera. Despite referral of visceral pain to cutaneous areas, individuals regularly distinguish cutaneous and visceral pain and commonly have contrasting behavioral reactions to each. Our study addresses this dilemma by directly comparing human neural processing of intensity-equated visceral and cutaneous pain. Seven subjects underwent fMRI scanning during visceral and cutaneous pain produced by balloon distention of the distal esophagus and contact heat on the midline chest. Stimulus intensities producing nonpainful and painful sensations, interleaved with rest periods, were presented in each functional run. Analyses compared painful to nonpainful conditions. A similar neural network, including secondary somatosensory and parietal cortices, thalamus, basal ganglia, and cerebellum, was activated by visceral and cutaneous painful stimuli. However, cutaneous pain evoked higher activation bilaterally in the anterior insular cortex. Further, cutaneous but not esophageal pain activated ventrolateral prefrontal cortex, despite higher affective scores for visceral pain. Visceral but not cutaneous pain activated bilateral inferior primary somatosensory cortex, bilateral primary motor cortex, and a more anterior locus within anterior cingulate cortex. Our results reveal a common cortical network subserving cutaneous and visceral pain that could underlie similarities in the pain experience. However, we also observed differential activation patterns within insular, primary somatosensory, motor, and prefrontal cortices that may account for the ability to distinguish visceral and cutaneous pain as well as the differential emotional, autonomic and motor responses associated with these different sensations.
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Affiliation(s)
- Irina A Strigo
- Department of Physiology, McGill University, Montreal, Quebec H3G 1Y6, Canada
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Abstract
Clinical evidence suggests that cutaneous and visceral pain differ in sensory, affective, and motivational realms, yet there has been little comparative characterization of these types of pain. This study uses psychophysical measures to compare directly visceral and cutaneous pain and sensitivity. Healthy subjects (10 males, seven females, age 19-29) evaluated perceptions evoked by balloon distention of the distal esophagus and contact heat on the upper chest. Subjects gave continuous ratings of pain intensity using an on-line visual analog scale (VAS), reported maximum pain intensity and unpleasantness on printed VASs, chose phrases from the McGill Pain Questionnaire and Spielberger State-Trait Anxiety Inventory, and drew the area of perceived sensation. For esophageal distention, the threshold for pain intensity was higher than that observed for unpleasantness, whereas for contact heat, pain and unpleasantness thresholds did not differ for either phasic (10s) or tonic (36s) stimulus application. The relative unpleasantness, calculated as the difference between the unpleasantness and the intensity ratings, was higher during esophageal distention than during either phasic or tonic cutaneous heat; this difference in relative unpleasantness was seen at all intensities of esophageal stimulation. Subjects chose significantly more affective words and reported more anxiety during visceral pain than during phasic cutaneous heat pain. A similar tendency was observed when visceral pain was compared to tonic cutaneous heat pain. Subjects also chose a wider range of words to describe visceral than cutaneous pain. On-line VAS ratings revealed greater pain sensation after stimulus termination during visceral than during phasic cutaneous pain; likewise, a similar tendency was observed between visceral and tonic cutaneous pain. Finally, visceral pain led to a more spatially diffuse sensation and was referred to the entire chest and sometimes to the back. Our results show that visceral pain is more unpleasant, diffuse, and variable than cutaneous pain of similar intensity, independent of the duration of the presented stimuli. The data suggest the likelihood of both similarities and differences in the neural substrates underlying visceral and cutaneous pain.
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Affiliation(s)
- Irina A Strigo
- Department of Physiology McGill University, Montreal, Quebec, Canada, H3G 1Y6 Department of Anesthesia, Anesthesia Research Unit, Room 1225, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec, Canada, H3G 1Y6 Département de gastroenétrologie, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada, H3C 3J7 Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montreal, Quebec, Canada, H3C 3J7 Centre de recherche en sciences neurologiques, Faculté de médecine dentaire, Université de Montréal, Montreal, Quebec, Canada, H3C 3J7
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Abstract
BACKGROUND Animal studies show reduced nociceptive responses to noxious heat stimuli and increases in endogenous beta-endorphin levels in cold environments, suggesting that human pain perception may be dependent on ambient temperature. However, studies of changes in local skin temperature on human pain perception have yielded variable results. This study examines the effect of both warm and cool ambient temperature on the perception of noxious and innocuous mechanical and thermal stimuli. METHODS Ten subjects (7 men and 3 women, aged 20-23 yr) used visual analog scales to rate the stimulus intensity, pain intensity, and unpleasantness of thermal (0-50 degrees C) and mechanical (1.2-28.9 g) stimuli applied on the volar forearm with a 1-cm2 contact thermode and von Frey filaments, respectively. Mean skin temperatures were measured throughout the experiment by infrared pyrometer. Each subject was tested in ambient temperatures of 15 degrees C (cool), 25 degrees C (neutral), and 35 degrees C (warm) on separate days, after a 30-min acclimation to the environment. Studies began in the morning after an 8-h fast. RESULTS Mean skin temperature was altered by ambient temperature (cool room: 30.1 degrees C; neutral room: 33.4 degrees C; warm room: 34.5 degrees C; P < 0.0001). Ambient temperature affected both heat (44-50 degrees C) and cold (25-0 degrees C) perception (P < 0.01). Stimulus intensity ratings tended to be lower in the cool than in the neutral environment (P < 0.07) but were not different between the neutral and warm environments. Unpleasantness ratings revealed that cold stimuli were more unpleasant than hot stimuli in the cool room and that noxious heat stimuli were more unpleasant in a warm environment. Environmental temperature did not alter ratings of warm (37 and 40 degrees C) or mechanical stimuli. CONCLUSIONS These results indicate that, in humans, a decrease in skin temperature following exposure to cool environments reduces thermal pain. Suppression of Adelta primary afferent cold fiber activity has been shown to increase cold pain produced by skin cooling. Our current findings may represent the reverse phenomenon, i.e., a reduction in thermal nociceptive transmission by the activation of Adelta cutaneous cold fibers.
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Affiliation(s)
- I A Strigo
- Department of Physiology, McGill University, Montreal, Quebec, Canada
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