1
|
Bonanno M, Papa D, Cerasa A, Maggio MG, Calabrò RS. Psycho-Neuroendocrinology in the Rehabilitation Field: Focus on the Complex Interplay between Stress and Pain. Medicina (Kaunas) 2024; 60:285. [PMID: 38399572 PMCID: PMC10889914 DOI: 10.3390/medicina60020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Chronic stress and chronic pain share neuro-anatomical, endocrinological, and biological features. However, stress prepares the body for challenging situations or mitigates tissue damage, while pain is an unpleasant sensation due to nociceptive receptor stimulation. When pain is chronic, it might lead to an allostatic overload in the body and brain due to the chronic dysregulation of the physiological systems that are normally involved in adapting to environmental challenges. Managing stress and chronic pain (CP) in neurorehabilitation presents a significant challenge for healthcare professionals and researchers, as there is no definitive and effective solution for these issues. Patients suffering from neurological disorders often complain of CP, which significantly reduces their quality of life. The aim of this narrative review is to examine the correlation between stress and pain and their potential negative impact on the rehabilitation process. Moreover, we described the most relevant interventions used to manage stress and pain in the neurological population. In conclusion, this review sheds light on the connection between chronic stress and chronic pain and their impact on the neurorehabilitation pathway. Our results emphasize the need for tailored rehabilitation protocols to effectively manage pain, improve treatment adherence, and ensure comprehensive patient care.
Collapse
Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (R.S.C.)
| | - Davide Papa
- International College of Osteopathic Medicine, 20092 Cinisello Balsamo, Italy;
| | - Antonio Cerasa
- S’Anna Institute, 88900 Crotone, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (R.S.C.)
| | | |
Collapse
|
2
|
Yao D, Chen Y, Chen G. The role of pain modulation pathway and related brain regions in pain. Rev Neurosci 2023; 34:899-914. [PMID: 37288945 DOI: 10.1515/revneuro-2023-0037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
Pain is a multifaceted process that encompasses unpleasant sensory and emotional experiences. The essence of the pain process is aversion, or perceived negative emotion. Central sensitization plays a significant role in initiating and perpetuating of chronic pain. Melzack proposed the concept of the "pain matrix", in which brain regions associated with pain form an interconnected network, rather than being controlled by a singular brain region. This review aims to investigate distinct brain regions involved in pain and their interconnections. In addition, it also sheds light on the reciprocal connectivity between the ascending and descending pathways that participate in pain modulation. We review the involvement of various brain areas during pain and focus on understanding the connections among them, which can contribute to a better understanding of pain mechanisms and provide opportunities for further research on therapies for improved pain management.
Collapse
Affiliation(s)
- Dandan Yao
- Department of Anesthesiology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Yeru Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Gang Chen
- Department of Anesthesiology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| |
Collapse
|
3
|
Dreismickenbecker E, Zinn S, Romero-Richter M, Kohlhaas M, Fricker LR, Petzel-Witt S, Walter C, Kreuzer M, Toennes SW, Anders M. Electroencephalography-Based Effects of Acute Alcohol Intake on the Pain Matrix. Brain Sci 2023; 13:1659. [PMID: 38137107 PMCID: PMC10741681 DOI: 10.3390/brainsci13121659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The effects of acute and chronic intakes of high doses of alcohol on pain perception are well known, ranging from short-term analgesic effects to long-term sensitization and polyneuropathies. The short-term analgesic effects of ethanol consumption on subjective pain perception have been well studied in the literature. Recent advances in neuroimaging allow for an insight into pain-related structures in the brain, fostering the mechanistic understanding of the processing of nociceptive input and pain. We aimed to utilize EEG, combined with standardized noxious mechanical/thermal stimulation and subjective pain testing, to research the effects of acute alcohol intake on nociceptive processing and pain perception. We recruited 12 healthy subjects in an unblinded cross-over study design and aimed at achieving a blood alcohol level of 0.1%. Our data revealed a significant reduction in subjective pain ratings to noxious thermal and mechanical stimuli after alcohol ingestion. Our EEG data revealed suppressing effects on the cortical structures responsible for processing pain, the "pain matrix". We conclude that in addition to its analgesic effects, as expressed by the reduction in subjective pain, alcohol has a further impact on the "pain matrix" and directly affects the salience to a nociceptive stimulus.
Collapse
Affiliation(s)
- Elias Dreismickenbecker
- Center for Pediatric and Adolescent Medicine, Department of Pediatric Hematology/Oncology, University Medical Center Mainz, 55131 Mainz, Germany
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Sebastian Zinn
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Mara Romero-Richter
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Madeline Kohlhaas
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Lukas R. Fricker
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Silvana Petzel-Witt
- Institute of Legal Medicine, University Hospital, Goethe University, 60590 Frankfurt, Germany
| | - Carmen Walter
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | - Stefan W. Toennes
- Institute of Legal Medicine, University Hospital, Goethe University, 60590 Frankfurt, Germany
| | - Malte Anders
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| |
Collapse
|
4
|
Yang J, Jiang X, Gu L, Li J, Wu Y, Li L, Xiong J, Lv H, Kuang H, Jiang J. Decreased Functional Connectivity of the Core Pain Matrix in Herpes Zoster and Postherpetic Neuralgia Patients. Brain Sci 2023; 13:1357. [PMID: 37891726 PMCID: PMC10605464 DOI: 10.3390/brainsci13101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to explore the resting-state functional connectivity (FC) changes among the pain matrix and other brain regions in herpes zoster (HZ) and postherpetic neuralgia (PHN) patients. Fifty-four PHN patients, 52 HZ patients, and 54 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. We used a seed-based FC approach to investigate whether HZ and PHN patients exhibited abnormal FC between the pain matrix and other brain regions compared to HCs. A random forest (RF) model was constructed to explore the feasibility of potential neuroimaging indicators to distinguish the two groups of patients. We found that PHN patients exhibited decreased FCs between the pain matrix and the putamen, superior temporal gyrus, middle frontal gyrus, middle cingulate gyrus, amygdala, precuneus, and supplementary motor area compared with HCs. Similar results were observed in HZ patients. The disease durations of PHN patients were negatively correlated with those aforementioned impaired FCs. The results of machine learning experiments showed that the RF model combined with FC features achieved a classification accuracy of 75%. Disrupted FC among the pain matrix and other regions in HZ and PHN patients may affect multiple dimensions of pain processing.
Collapse
Affiliation(s)
- Jiaojiao Yang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Xiaofeng Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Lili Gu
- Department of Pain, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China;
| | - Jiahao Li
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, China;
| | - Ying Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Linghao Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Jiaxin Xiong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Huiting Lv
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Hongmei Kuang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, China; (J.Y.); (X.J.); (Y.W.); (L.L.); (J.X.); (H.L.); (H.K.)
- Neuroimaging Laboratory, Jiangxi Province Medical Imaging Research Institute, 17 Yongwaizheng Street, Nanchang 330006, China
| |
Collapse
|
5
|
Cui Y, Neyama H, Hu D, Huang T, Hayashinaka E, Wada Y, Watanabe Y. FDG PET Imaging of the Pain Matrix in Neuropathic Pain Model Rats. Biomedicines 2022; 11. [PMID: 36672571 DOI: 10.3390/biomedicines11010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Pain is an unpleasant subjective experience that is usually modified by complex multidimensional neuropsychological processes. Increasing numbers of neuroimaging studies in humans have characterized the hierarchical brain areas forming a pain matrix, which is involved in the different dimensions of pain components. Although mechanistic investigations have been performed extensively in rodents, the homologous brain regions involved in the multidimensional pain components have not been fully understood in the rodent brain. Herein, we successfully identified several brain regions activated in response to mechanical allodynia in neuropathic pain rat models using an alternative neuroimaging method based on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography (FDG PET) scanning. Regions such as the medial prefrontal cortex, primary somatosensory cortex hindlimb region, and the centrolateral thalamic nucleus were identified. Moreover, brain activity in these regions was positively correlated with mechanical allodynia-related behavioral changes. These results suggest that FDG PET imaging in neuropathic pain model rats enables the evaluation of regional brain activity encoding the multidimensional pain aspect. It could thus be a fascinating tool to bridge the gap between preclinical and clinical investigations.
Collapse
|
6
|
Pergolizzi JV, Varrassi G, Magnusson P, Breve F, Raffa RB, Christo PJ, Chopra M, Paladini A, LeQuang JA, Mitchell K, Coluzzi F. Pharmacologic agents directed at the treatment of pain associated with maladaptive neuronal plasticity. Expert Opin Pharmacother 2021; 23:105-116. [PMID: 34461795 DOI: 10.1080/14656566.2021.1970135] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The definition of nociplastic pain in 2016 has changed the way maladaptive chronic pain is viewed in that it may emerge without neural lesions or neural disease. Many endogenous and pharmacologic substances are being investigated for their role in treating the pain associated with neuronal plasticity. AREAS COVERED The authors review promising pharmacologic agents for the treatment of pain associated with maladaptive neuronal plasticity. The authors then provide the reader with their expert opinion and provide their perspectives for the future. EXPERT OPINION An imbalance between the amplification of ascending pain signals and the poor activation of descending inhibitory signals may be at the root of many chronic pain syndromes. The inhibitory activity of noradrenaline reuptake may play a role in neuropathic and nociplastic analgesia. A better understanding of the brain's pain matrix, its signaling cascades, and the complex bidirectional communication between the immune system and the nervous system may help meet the urgent and unmet medical need for safe, effective chronic pain treatment, particularly for pain with a neuropathic and/or nociplastic component.
Collapse
Affiliation(s)
| | | | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Frank Breve
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, USA
| | - Robert B Raffa
- College of Pharmacy (Adjunct), University of Arizona, Tucson, USA.,Temple University School of Pharmacy (Professor Emeritus), Philadelphia, USA
| | - Paul J Christo
- Associate Professor, the Johns Hopkins School of Medicine, Baltimore, USA
| | | | | | | | | | - Flaminia Coluzzi
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| |
Collapse
|
7
|
Hosp JA, Reisert M, von Kageneck C, Rijntjes M, Weiller C. Approximation to pain-signaling network in humans by means of migraine. Hum Brain Mapp 2021; 42:766-779. [PMID: 33112461 PMCID: PMC7814755 DOI: 10.1002/hbm.25261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
Nociceptive signals are processed within a pain-related network of the brain. Migraine is a rather specific model to gain insight into this system. Brain networks may be described by white matter tracts interconnecting functionally defined gray matter regions. Here, we present an overview of the migraine-related pain network revealed by this strategy. Based on diffusion tensor imaging data from subjects in the Human Connectome Project (HCP) database, we used a global tractography approach to reconstruct white matter tracts connecting brain regions that are known to be involved in migraine-related pain signaling. This network includes an ascending nociceptive pathway, a descending modulatory pathway, a cortical processing system, and a connection between pain-processing and modulatory areas. The insular cortex emerged as the central interface of this network. Direct connections to visual and auditory cortical association fields suggest a potential neural basis of phono- or photophobia and aura phenomena. The intra-axonal volume (Vintra ) as a measure of fiber integrity based on diffusion microstructure was extracted using an innovative supervised machine learning approach in form of a Bayesian estimator. Self-reported pain levels of HCP subjects were positively correlated with tract integrity in subcortical tracts. No correlation with pain was found for the cortical processing systems.
Collapse
Affiliation(s)
- Jonas Aurel Hosp
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Marco Reisert
- Faculty of Medicine, Department of Stereotactic and Functional NeurosurgeryUniversity of FreiburgFreiburgGermany
- Department of Medical PhysicsFreiburg University Medical CenterFreiburgGermany
| | - Charlotte von Kageneck
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Michel Rijntjes
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Cornelius Weiller
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| |
Collapse
|
8
|
Kohashi R, Shinozaki T, Sekine N, Watanabe K, Takanezawa D, Nishihara C, Ozasa K, Ikeda M, Noma N, Okada-Ogawa A, Imamura Y. Time-dependent responses in brain activity to ongoing hot stimulation in burning mouth syndrome. J Oral Sci 2020; 62:170-174. [PMID: 32224570 DOI: 10.2334/josnusd.18-0431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/01/2022]
Abstract
Burning mouth syndrome (BMS) is classified into idiopathic orofacial pain conditions. Although central and peripheral neuropathic mechanisms are believed to be involved, the etiology remains to be fully elucidated. The present study examined temporal brain responses to an ongoing hot stimulus to investigate the pain modulating system in patients with BMS. The thermal stimulation sequence comprised baseline (32°C, 40 s) to warm (40°C, 32 s) to baseline (32°C, 40 s) to hot (49°C, 32 s), which was repeated four times using a Peltier thermode. These warm and hot stimuli were applied on the right palm and right lower lip in two separate sessions. Functional magnetic resonance imaging data were acquired by recording echo-planar images with a block design. Brain activity induced by purely hot stimulation (49°C vs. 40°C) applied to the palm was more pronounced than that induced by lip stimulation and in patients with BMS compared with controls. Comparison of brain activity between the first 16 s and second 16 s of the stimulus revealed pronounced time-dependent facilitation in patients with BMS during lip stimulation. These findings indicate that the pain modulating system in patients with BMS is dysregulated and that the brain in BMS is highly sensitized to pain information originating from the trigeminal system.
Collapse
Affiliation(s)
- Ryutaro Kohashi
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Takahiro Shinozaki
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Study, Nihon University Dental Research Center
| | - Naohiko Sekine
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Kosuke Watanabe
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Daiki Takanezawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Chisa Nishihara
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Kana Ozasa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Mariko Ikeda
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Study, Nihon University Dental Research Center
| | - Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Study, Nihon University Dental Research Center
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Study, Nihon University Dental Research Center
| |
Collapse
|
9
|
Abstract
Several control conditions, such as penetrating sham acupuncture and non-penetrating placebo needles, have been used in clinical trials on acupuncture effects in chronic pain syndromes. All these control conditions are surprisingly effective with regard to their analgesic properties. These findings have fostered a discussion as to whether acupuncture is merely a placebo. Meta-analyses on the clinical effectiveness of placebo revealed that placebo interventions in general have minor, clinically important effects. Only in trials on pain and nausea, including acupuncture studies, did placebo effects vary from negligible to clinically important. At the same time, individual patient meta-analyses confirm that acupuncture is effective for the treatment of chronic pain, including small but statistically significant differences between acupuncture and sham acupuncture. All acupuncture control conditions induce de qi, a distinct stimulation associated with pain and needling which has been shown to be a nociceptive/pain stimulus. Acupuncture therefore probably activates the pain matrix in the brain in a bottom-up fashion via the spino-thalamic tract. Central nervous system effects of acupuncture can be modulated through expectations, which are believed to be a central component of the placebo response. However, further investigation is required to determine how strong the influence of placebo on the attenuation of activity in the pain matrix really is. A meta-analysis of individual participant functional magnetic imaging data reveals only weak effects of placebo on the activity of the pain network. The clinical acupuncture setting is comprised of a combination of a distinct neurophysiological stimulus, the needling stimulus/experience, and a complex treatment situation. A broader definition of placebo, such as that proposed by Howick (2017) acknowledges a role for expectation, treatment context, emotions, learning, and other contextual variables of a treatment situation. The inclusion of particular treatment feature as a definitional element permits a contextual definition of placebo, which in turn can be helpful in constructing future clinical trials on acupuncture.
Collapse
Affiliation(s)
- Frauke Musial
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine, NAFKAM, Faculty of Health Science, UiT - The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
10
|
Liang M, Su Q, Mouraux A, Iannetti GD. Spatial Patterns of Brain Activity Preferentially Reflecting Transient Pain and Stimulus Intensity. Cereb Cortex 2019; 29:2211-2227. [PMID: 30844052 PMCID: PMC6458907 DOI: 10.1093/cercor/bhz026] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 08/06/2018] [Revised: 01/29/2019] [Indexed: 01/19/2023] Open
Abstract
How pain emerges in the human brain remains an unresolved question. Neuroimaging studies have suggested that several brain areas subserve pain perception because their activation correlates with perceived pain intensity. However, painful stimuli are often intense and highly salient; therefore, using both intensity- and saliency-matched control stimuli is crucial to isolate pain-selective brain responses. Here, we used these intensity/saliency-matched painful and non-painful stimuli to test whether pain-selective information can be isolated in the functional magnetic resonance imaging responses elicited by painful stimuli. Using two independent datasets, multivariate pattern analysis was able to isolate features distinguishing the responses triggered by (1) intensity/saliency-matched painful versus non-painful stimuli, and (2) high versus low-intensity/saliency stimuli regardless of whether they elicit pain. This indicates that neural activity in the so-called "pain matrix" is functionally heterogeneous, and part of it carries information related to both painfulness and intensity/saliency. The response features distinguishing these aspects are spatially distributed and cannot be ascribed to specific brain structures.
Collapse
Affiliation(s)
- M Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Q Su
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - A Mouraux
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | - G D Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
- Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome, Italy
| |
Collapse
|
11
|
Wippert PM, Wiebking C. Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment. Int J Environ Res Public Health 2018; 15:E785. [PMID: 29670003 PMCID: PMC5923827 DOI: 10.3390/ijerph15040785] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 12/18/2022]
Abstract
The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts.
Collapse
Affiliation(s)
- Pia-Maria Wippert
- Sociology of Health and Physical Activity, Department of Health Science, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany.
- Department of Health Sciences and Technology, ETH Zürich, HCP, Leopold-Ruzicka-Weg 4, CH-8093 Zürich, Switzerland.
| | - Christine Wiebking
- Sociology of Health and Physical Activity, Department of Health Science, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany.
- Institute of Psychology and Education, Applied Emotion and Motivation Research, Ulm University, 89081 Ulm, Germany.
| |
Collapse
|
12
|
Abstract
Background Empathy for pain helps us to understand the pain of others indirectly. To better comprehend the processing of empathic pain, we report the frequency-dependent modulation of cortical oscillations induced by watching movies depicting pain using high-density electroencephalography (EEG), magnetoencephalography (MEG), and motor evoked potentials (MEP). Methods Event-related desynchronization of EEG and MEG was assessed while participants viewed videos of painful (needle) or neutral (cotton swab) situations. The amplitudes of MEPs were also compared between the needle and cotton swab conditions. Results The degree of suppression in α/β band power was significantly increased, whereas that of γ band power was significantly decreased, in the needle condition compared with the cotton swab condition. EEG revealed that significant differences in α/β band were distributed in the right frontocentral and left parietooccipital regions, whereas significant γ band differences were distributed predominantly over the right hemisphere, which were confirmed by source estimation using MEG. There was a significant positive correlation between the difference in γ power of the two conditions and the visual analog scale subjective rating of aversion, but not in the α/β band. The amplitude of MEPs decreased in the needle condition, which confirmed the inhibition of the primary motor cortex. Conclusion MEP suppression supports that modulation of cortical oscillations by viewing movies depicting pain involves sensorimotor processing. Our results suggest that α/β oscillations underlie the sensory qualities of others’ pain, whereas the γ band reflects the cognitive aspect. Therefore, α/β and γ band oscillations are differentially involved in empathic pain processing under the condition of motor cortical suppression.
Collapse
Affiliation(s)
- Yoshimasa Motoyama
- Department of Clinical Neurophysiology, Neurological Institute.,Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Ogata
- Department of Clinical Neurophysiology, Neurological Institute
| | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute
| |
Collapse
|
13
|
Édes AE, Juhász G. [Functional magnetic resonance imaging studies in pain research]. Ideggyogy Sz 2016; 69:307-312. [PMID: 29638094 DOI: 10.18071/isz.69.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Functional imaging studies opened a new way to understand the neural activity underlying pain perception and the pathomechanism of chronic pain syndromes. In the last twenty years several results of functional magnetic resonance imaging (fMRI) studies have been published about examining the different aspects of complex pain experience. The aim of these studies is to understand the functioning of the pain control system, the so-called pain matrix, activated by acute nociceptive stimulus. Another important field of pain research is the investigation of neuronal processes underlying chronic pain, since the pathomechanism of this is still unclear. Our review aims to provide insight into the methods of pain research using fMRI and the achievements of the last few years.
Collapse
Affiliation(s)
- Andrea Edit Édes
- MTA-SE-NAP B Genetikai Agyi Képalkotó Migrén Kutató Csoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország.,MTA-SE Neuropszichofarmakológiai és Neurokémiai munkacsoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország
| | - Gabriella Juhász
- MTA-SE-NAP B Genetikai Agyi Képalkotó Migrén Kutató Csoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország.,MTA-SE Neuropszichofarmakológiai és Neurokémiai munkacsoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország.,Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom and Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Semmelweis Egyetem, Gyógyszerésztudományi Kar, Gyógyszerhatástani Intézet, Budapest, Magyarország
| |
Collapse
|
14
|
Bastuji H, Frot M, Perchet C, Magnin M, Garcia-Larrea L. Pain networks from the inside: Spatiotemporal analysis of brain responses leading from nociception to conscious perception. Hum Brain Mapp 2016; 37:4301-4315. [PMID: 27391083 DOI: 10.1002/hbm.23310] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022] Open
Abstract
Conscious perception of painful stimuli needs the contribution of an extensive cortico-subcortical network, and is completed in less than one second. While initial activities in operculo-insular and mid-cingulate cortices have been extensively assessed, the activation timing of most areas supporting conscious pain has barely been studied. Here we used intracranial EEG to investigate the dynamics of 16 brain regions (insular, parietal, prefrontal, cingulate, hippocampal and limbic) during the first second following nociceptive-specific laser pulses. Three waves of activation could be defined according to their temporal relation with conscious perception, ascertained by voluntary motor responses. Pre-conscious activities were recorded in the posterior insula, operculum, mid-cingulate and amygdala. Antero-insular, prefrontal and posterior parietal activities started later and developed during time-frames consistent with conscious voluntary reactions. Responses from hippocampus, perigenual and perisplenial cingulate developed latest and persisted well after conscious perception occurred. Nociceptive inputs reach simultaneously sensory and limbic networks, probably through parallel spino-thalamic and spino-parabrachial pathways, and the initial limbic activation precedes conscious perception of pain. Access of sensory information to consciousness develops concomitant to fronto-parietal activity, while late-occurring responses in the hippocampal region, perigenual and posterior cingulate cortices likely underlie processes linked to memory encoding, self-awareness and pain modulation. Hum Brain Mapp 37:4301-4315, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Hélène Bastuji
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France.,Unité D'Hypnologie, Service De Neurologie Fonctionnelle Et D'Épileptologie, Hôpital Neurologique, Hospices Civils De Lyon, Bron, F-69677, France
| | - Maud Frot
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Caroline Perchet
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Michel Magnin
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center, INSERM U1028; CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France.,Centre D'évaluation Et De Traitement De La Douleur, Hôpital Neurologique, Lyon, France
| |
Collapse
|
15
|
Nakata H, Sakamoto K, Kakigi R. Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus. Front Psychol 2014; 5:1489. [PMID: 25566158 PMCID: PMC4267182 DOI: 10.3389/fpsyg.2014.01489] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/03/2014] [Indexed: 12/31/2022] Open
Abstract
Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging, and neurophysiological methods, such as magnetoencephalography and electroencephalography, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC) and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation.’ In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation.
Collapse
Affiliation(s)
- Hiroki Nakata
- Department of Integrative Physiology, National Institute for Physiological Sciences Okazaki, Japan ; Department of Health Sciences, Faculty of Human Life and Environment, Nara Women's University Nara, Japan
| | - Kiwako Sakamoto
- Department of Integrative Physiology, National Institute for Physiological Sciences Okazaki, Japan
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences Okazaki, Japan
| |
Collapse
|
16
|
Chou KH, Yang FC, Fuh JL, Huang CC, Lirng JF, Lin YY, Lee PL, Kao HW, Lin CP, Wang SJ. Altered white matter microstructural connectivity in cluster headaches: a longitudinal diffusion tensor imaging study. Cephalalgia 2014; 34:1040-52. [PMID: 24668118 DOI: 10.1177/0333102414527649] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Functional and structural disruptions to the pain matrix, which may involve changes in white matter (WM) pathways connecting the pain-processing system and hypothalamus, have been implicated in the pathophysiology of cluster headache (CH). However, previous studies have obtained inconclusive results regarding WM changes in CH, and WM variations between "in-bout" and "out-of-bout" periods of CH remain to be determined. METHODS Multiple diffusivity indices obtained by diffusion tensor imaging (DTI) and post-hoc probabilistic tractography were used to elucidate CH pathophysiology. RESULTS Compared to healthy participants, in-bout CH patients showed regionally higher absolute (radial and mean) diffusivities in the left medial frontal gyrus and frontal sub-gyrus and lower absolute (axial, radial and mean) diffusivities in the right parahippocampal gyrus of the limbic lobe. These changes during the in-bout period generally persisted in the out-of-bout period, except for the left cerebellar tonsil. Post-hoc probabilistic tractography showed highly consistent anatomical connections between these altered areas and the hypothalamus across participants. CONCLUSIONS Distinct WM changes were observed in episodic CH. Connections between the pain-modulation areas and hypothalamus may be involved in CH pathophysiology.
Collapse
Affiliation(s)
- Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taiwan Brain Research Center, National Yang-Ming University, Taiwan
| | - Fu-Chi Yang
- Institute of Brain Science, National Yang-Ming University, Taiwan Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, National Yang-Ming University, Taiwan Department of Neurology, Taipei Veterans General Hospital, Taiwan
| | - Chu-Chung Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, National Yang-Ming University, Taiwan Department of Radiology, Taipei, Veterans General Hospital, Taiwan
| | - Yung-Yang Lin
- Brain Research Center, National Yang-Ming University, Taiwan Institute of Brain Science, National Yang-Ming University, Taiwan Department of Neurology, National Yang-Ming University, Taiwan Department of Neurology, Taipei Veterans General Hospital, Taiwan
| | - Pei-Lin Lee
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taiwan
| | - Hung-Wen Kao
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taiwan Brain Research Center, National Yang-Ming University, Taiwan Institute of Brain Science, National Yang-Ming University, Taiwan Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang-Ming University, Taiwan Institute of Brain Science, National Yang-Ming University, Taiwan Department of Neurology, National Yang-Ming University, Taiwan Department of Neurology, Taipei Veterans General Hospital, Taiwan
| |
Collapse
|
17
|
Fox GR, Sobhani M, Aziz-Zadeh L. Witnessing hateful people in pain modulates brain activity in regions associated with physical pain and reward. Front Psychol 2013; 4:772. [PMID: 24167496 PMCID: PMC3805980 DOI: 10.3389/fpsyg.2013.00772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 07/03/2013] [Accepted: 10/01/2013] [Indexed: 12/19/2022] Open
Abstract
How does witnessing a hateful person in pain compare to witnessing a likable person in pain? The current study compared the brain bases for how we perceive likable people in pain with those of viewing hateful people in pain. While social bonds are built through sharing the plight and pain of others in the name of empathy, viewing a hateful person in pain also has many potential ramifications. In this functional Magnetic Resonance Imaging (fMRI) study, Caucasian Jewish male participants viewed videos of (1) disliked, hateful, anti-Semitic individuals, and (2) liked, non-hateful, tolerant individuals in pain. The results showed that, compared with viewing liked people, viewing hateful people in pain elicited increased responses in regions associated with observation of physical pain (the insular cortex, the anterior cingulate cortex (ACC), and the somatosensory cortex), reward processing (the striatum), and frontal regions associated with emotion regulation. Functional connectivity analyses revealed connections between seed regions in the left ACC and right insular cortex with reward regions, the amygdala, and frontal regions associated with emotion regulation. These data indicate that regions of the brain active while viewing someone in pain may be more active in response to the danger or threat posed by witnessing the pain of a hateful individual more so than the desire to empathize with a likable person's pain.
Collapse
Affiliation(s)
- Glenn R Fox
- Neuroscience Graduate Program, University of Southern California Los Angeles, CA, USA ; Brain and Creativity Institute Los Angeles, CA, USA
| | | | | |
Collapse
|
18
|
Abstract
How do we understand and empathize with individuals whose bodies are drastically different from our own? We investigated the neural processes by which an individual with a radically different body, a congenital amputee who is born without limbs, engages her own sensory-motor representations as a means to understand other people's body actions or emotional states. Our results support the prediction that when the goal of the action is possible for the observer, one's own motor regions are involved in processing action observation, just as when individuals viewed those similar to themselves. However, when the observed actions are not possible, mentalizing mechanisms, relying on a different set of neural structures, are additionally recruited to process the actions. Furthermore, our results indicate that when individuals view others experiencing pain in body parts that they have, the insula and somatosensory cortices are activated, consistent with previous reports. However, when an individual views others experiencing pain in body parts that she does not have, the insula and secondary somatosensory cortices are still active, but the primary somatosensory cortices are not. These results provide a novel understanding for how we understand and empathize with individuals who drastically differ from the self.
Collapse
Affiliation(s)
- Lisa Aziz-Zadeh
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA 90089-2520, USA.
| | | | | | | |
Collapse
|