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Baliki MN, Vigotsky AD, Rached G, Jabakhanji R, Huang L, Branco P, Cong O, Griffith J, Wasan AD, Schnitzer TJ, Apkarian AV. Neuropsychology of chronic back pain managed with long-term opioid use. medRxiv 2024:2024.02.07.24302408. [PMID: 38370783 PMCID: PMC10871381 DOI: 10.1101/2024.02.07.24302408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Chronic pain is commonly treated with long-term opioids, but the neuropsychological outcomes associated with stable long-duration opioid use remain unclear. Here, we contrasted the psychological profiles, brain activity, and brain structure of 70 chronic back pain patients on opioids (CBP+O, average opioid exposure 6.2 years) with 70 patients managing their pain without opioids. CBP+O exhibited moderately worse psychological profiles and small differences in brain morphology. However, CBP+O had starkly different spontaneous brain activity, dominated by increased mesocorticolimbic and decreased dorsolateral-prefrontal activity, even after controlling for pain intensity and duration. These differences strongly reflected cortical opioid and serotonin receptor densities and mapped to two antagonistic resting-state circuits. The circuits' dynamics were explained by mesocorticolimbic activity and reflected negative affect. We reassessed a sub-group of CBP+O after they briefly abstained from taking opioids. Network dynamics, but not spontaneous activity, reflected exacerbated signs of withdrawal. Our results have implications for the management and tapering of opioids in chronic pain.
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Affiliation(s)
- Marwan N Baliki
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
- Shirley Ryan AbilityLab, Chicago, Illinois
| | - Andrew D Vigotsky
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Biomedical Engineering and Statistics & Data Science, Northwestern University, Chicago, Illinois
| | - Gaelle Rached
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
| | - Rami Jabakhanji
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
| | - Lejian Huang
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
| | - Paulo Branco
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
- Department of Anesthesia, Northwestern University, Chicago, Illinois
| | - Olivia Cong
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
| | - James Griffith
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Medical and Social Sciences, Northwestern University, Chicago, Illinois
| | - Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas J Schnitzer
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Anesthesia, Northwestern University, Chicago, Illinois
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
| | - A Vania Apkarian
- Center for Translational Pain Research, Northwestern University, Chicago, Illinois
- Department of Neuroscience, Northwestern University, Chicago, Illinois
- Department of Anesthesia, Northwestern University, Chicago, Illinois
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
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2
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Vigotsky AD, Cong O, Pinto CB, Barroso J, Perez J, Petersen KK, Arendt-Nielsen L, Hardt K, Manning D, Apkarian AV, Branco P. Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement. medRxiv 2024:2024.01.16.24301372. [PMID: 38293074 PMCID: PMC10827245 DOI: 10.1101/2024.01.16.24301372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.
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Affiliation(s)
- Andrew D. Vigotsky
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL. 60208, USA
| | - Olivia Cong
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Camila B Pinto
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Joana Barroso
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Jennifer Perez
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Kristian Kjaer Petersen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Material and Production, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Material and Production, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Kevin Hardt
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL. 60611, USA
| | - David Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL. 60611, USA
| | - A. Vania Apkarian
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Paulo Branco
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
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3
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Barroso J, Branco P, Pinto-Ramos J, Vigotsky AD, Reis AM, Schnitzer TJ, Galhardo V, Apkarian AV. Subcortical brain anatomy as a potential biomarker of persistent pain after total knee replacement in osteoarthritis. Pain 2023; 164:2306-2315. [PMID: 37463229 DOI: 10.1097/j.pain.0000000000002932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/14/2022] [Accepted: 04/02/2023] [Indexed: 07/20/2023]
Abstract
ABSTRACT The neural mechanisms for the persistence of pain after a technically successful arthroplasty in osteoarthritis (OA) remain minimally studied, and direct evidence of the brain as a predisposing factor for pain chronicity in this setting has not been investigated. We undertook this study as a first effort to identify presurgical brain and clinical markers of postarthroplasty pain in knee OA. Patients with knee OA (n = 81) awaiting total arthroplasty underwent clinical and psychological assessment and brain magnetic resonance imagining. Postoperative pain scores were measured at 6 months after surgery. Brain subcortical anatomic properties (volume and shape) and clinical indices were studied as determinants of postoperative pain. We show that presurgical subcortical volumes (bilateral amygdala, thalamus, and left hippocampus), together with shape deformations of the right anterior hippocampus and right amygdala, associate with pain persistence 6 months after surgery in OA. Longer pain duration, higher levels of presurgical anxiety, and the neuropathic character of pain were also prognostic of postsurgical pain outcome. Brain and clinical indices accounted for unique influences on postoperative pain. Our study demonstrates the presence of presurgical subcortical brain factors that relate to postsurgical persistence of OA pain. These preliminary results challenge the current dominant view that mechanisms of OA pain predominantly underlie local joint mechanisms, implying novel clinical management and treatment strategies.
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Affiliation(s)
- Joana Barroso
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
- Departments of Physical Medicine and Rehabilitation and
- Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Paulo Branco
- Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | | | - Andrew D Vigotsky
- Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL, United States
| | | | - Thomas J Schnitzer
- Departments of Physical Medicine and Rehabilitation and
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Departments of Rheumatology and
- Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Vasco Galhardo
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
| | - A Vania Apkarian
- Departments of Physical Medicine and Rehabilitation and
- Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
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4
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Branco P, Bosak N, Bielefeld J, Cong O, Granovsky Y, Kahn I, Yarnitsky D, Apkarian AV. Structural brain connectivity predicts early acute pain after mild traumatic brain injury. Pain 2023; 164:1312-1320. [PMID: 36355048 DOI: 10.1097/j.pain.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
ABSTRACT Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Noam Bosak
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olivia Cong
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yelena Granovsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Itamar Kahn
- Department of Neuroscience and Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States
| | - David Yarnitsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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5
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Branco P, Berger S, Abdullah T, Vachon-Presseau E, Cecchi G, Apkarian AV. Predicting placebo analgesia in patients with chronic pain using natural language processing: a preliminary validation study. Pain 2023; 164:1078-1086. [PMID: 36524810 PMCID: PMC10106359 DOI: 10.1097/j.pain.0000000000002808] [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: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Patients with chronic pain show large placebo effects in clinical trials, and inert pills can lead to clinically meaningful analgesia that can last from days to weeks. Whether the placebo response can be predicted reliably, and how to best predict it, is still unknown. We have shown previously that placebo responders can be identified through the language content of patients because they speak about their life, and their pain, after a placebo treatment. In this study, we examine whether these language properties are present before placebo treatment and are thus predictive of placebo response and whether a placebo prediction model can also dissociate between placebo and drug responders. We report the fine-tuning of a language model built based on a longitudinal treatment study where patients with chronic back pain received a placebo (study 1) and its validation on an independent study where patients received a placebo or drug (study 2). A model built on language features from an exit interview from study 1 was able to predict, a priori, the placebo response of patients in study 2 (area under the curve = 0.71). Furthermore, the model predicted as placebo responders exhibited an average of 30% pain relief from an inert pill, compared with 3% for those predicted as nonresponders. The model was not able to predict who responded to naproxen nor spontaneous recovery in a no-treatment arm, suggesting specificity of the prediction to placebo. Taken together, our initial findings suggest that placebo response is predictable using ecological and quick measures such as language use.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sara Berger
- Responsible and Inclusive Technology (Exploratory Sciences Division), IBM Research, Yorktown Heights, NY, United States
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - Taha Abdullah
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Etienne Vachon-Presseau
- Faculty of Dentistry and Department of Anesthesia, McGill University, Montréal, QC, Canada
- Alan Edwards Center for Research on Pain (AECRP), McGill University, Montréal, QC, Canada
| | - Guillermo Cecchi
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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6
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Wakaizumi K, Reckziegel D, Jabakhanji R, Apkarian AV, Baliki MN. Influence of exercise on pain is associated with resting-state functional connections: A cross-sectional functional brain imaging study. Neurobiology of Pain 2023; 13:100125. [PMID: 37025929 PMCID: PMC10070934 DOI: 10.1016/j.ynpai.2023.100125] [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] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/18/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
Exercise is associated with lower prevalence and severity of pain, and is widely recommended for pain management. However, the mechanisms the exercise effect on pain remain unclear. In this study, we examined the association of exercise with pain and aimed to identify its neurobiological mediators. We utilized a baseline data of a clinical trial for people with low back pain. Participants reported pain intensity and exercise habit, as well as pain-related psychological and emotional assessments. We also obtained brain imaging data using a resting-state functional MRI and performed mediation analyses to identify brain regions mediating the exercise effect on pain. Forty-five people with low back pain (mean pain intensity = 59.6 and mean duration = 9.9 weeks) were included in this study. Participants with an exercise habit (n = 29) showed significant less pain compared to those without an exercise habit (n = 16). Mediation analysis using resting-state functional connectivity identified the left thalamus, right amygdala, and medial prefrontal cortex as statistical mediators of the exercise effect on pain (indirect effect = -0.460, 95% confidence interval = -0.767 to -0.153). In conclusion, our findings suggest that brain function of the specific regions is probably a neuro-mechanism of exercise alleviating pain.
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Affiliation(s)
- Kenta Wakaizumi
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, USA
- Corresponding author at: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Diane Reckziegel
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Rami Jabakhanji
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - A. Vania Apkarian
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Marwan N. Baliki
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, USA
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7
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Pinto CB, Bielefeld J, Barroso J, Yip B, Huang L, Schnitzer T, Apkarian AV. Chronic pain domains and their relationship to personality, abilities, and brain networks. Pain 2023; 164:59-71. [PMID: 35612403 PMCID: PMC9582040 DOI: 10.1097/j.pain.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/23/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Chronic pain is a multidimensional pathological state. Recent evidence suggests that specific brain properties and patients' psychological and physical traits are distorted in chronic pain patients. However, the relationship between these alterations and pain dimensions remains poorly understood. Here, we first evaluated multiple dimensions of chronic pain by assessing a broad battery of pain-related questionnaire scores (23 outcomes) of 107 chronic low back pain patients and identified 3 distinct chronic pain domains: magnitude, affect & disability, and quality. Second, we investigated the pain domains relationship with measures of personality, social interaction, psychological traits, and ability traits (77 biopsychosocial & ability [biopsy&ab] outcomes). Pain magnitude (out-of-sample [OOS]
) is associated with emotional control, attention, and working memory, with higher pain scores showing lower capacity to regulate and adapt behaviorally. Pain affect & disability (OOS
associated with anxiety, catastrophizing and social relationships dysfunction. Pain quality did not relate significantly to biopsy&ab variables. Third, we mapped these 3 pain domains to brain functional connectivity. Pain magnitude mainly associated with the sensorimotor and the cingulo-opercular networks (OOS
). Pain affect & disability related to frontoparietal and default mode networks (OOS
. Pain quality integrated sensorimotor, auditory, and cingulo-opercular networks (OOS
). Mediation analysis could link functional connectivity and biopsy&ab models to respective pain domains. Our results provide a global overview of the complexity of chronic pain, showing how underlying distinct domains of the experience map to different biopsy&ab correlates and underlie unique brain network signatures.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joana Barroso
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Byron Yip
- Departments of Physical Medicine and Rehabilitation
| | - Lejian Huang
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Thomas Schnitzer
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
- Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
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8
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Yang L, Vigotsky AD, Wu B, Shen B, Yan Z, Apkarian AV, Huang L. Morphometric similarity networks discriminate patients with lumbar disc herniation from healthy controls and predict pain intensity. Front Netw Physiol 2022; 2:992662. [PMID: 36926079 PMCID: PMC10013053 DOI: 10.3389/fnetp.2022.992662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
We used a recently advanced technique, morphometric similarity (MS), in a large sample of lumbar disc herniation patients with chronic pain (LDH-CP) to examine morphometric features derived from multimodal MRI data. To do so, we evenly allocated 136 LDH-CPs to exploratory and validation groups with matched healthy controls (HC), randomly chosen from the pool of 157 HCs. We developed three MS-based models to discriminate LDH-CPs from HCs and to predict the pain intensity of LDH-CPs. In addition, we created analogous models using resting state functional connectivity (FC) to perform the above discrimination and prediction of pain, in addition to comparing the performance of FC- and MS-based models and investigating if an ensemble model, combining morphometric features and resting-state signals, could improve performance. We conclude that 1) MS-based models were able to discriminate LDH-CPs from HCs and the MS networks (MSN) model performed best; 2) MSN was able to predict the pain intensity of LDH-CPs; 3) FC networks constructed were able to discriminate LDH-CPs from HCs, but they could not predict pain intensity; and 4) the ensemble model neither improved discrimination nor pain prediction performance. Generally, MSN is sensitive enough to uncover brain morphology alterations associated with chronic pain and provides novel insights regarding the neuropathology of chronic pain.
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Affiliation(s)
- Lili Yang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Andrew D. Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL, United States
| | - Binbin Wu
- Department of Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bangli Shen
- Department of Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - A. Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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9
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Bao QY, Chang PC, Centeno MV, Farmer MA, Baliki M, Procissi D, Zhang W, Apkarian AV. Reversal of neuropathic pain is associated with corticostriatal functional reorganization after nerve repair in the spared nerve injury model. Pain 2022; 163:1929-1938. [PMID: 35082247 PMCID: PMC9309182 DOI: 10.1097/j.pain.0000000000002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/13/2021] [Indexed: 02/04/2023]
Abstract
ABSTRACT Following surgical repair after peripheral nerve injury, neuropathic pain diminishes in most patients but can persist in a small proportion of cases, the mechanism of which remains poorly understood. Based on the spared nerve injury (SNI), we developed a rat nerve repair (NR) model, where a delayed reconstruction of the SNI-injured nerves resulted in alleviating chronic pain-like behavior only in a subpopulation of rats. Multiple behavioral measures were assayed over 11-week presurgery and postsurgery periods (tactile allodynia, pain prick responses, sucrose preference, motor coordination, and cold allodynia) in SNI (n = 10), sham (n = 8), and NR (n = 12) rats. All rats also underwent resting-state functional magnetic resonance imaging under anesthesia at multiple time points postsurgery, and at 10 weeks, histology and retrograde labeling were used to calculate peripheral reinnervation. Behavioral measures indicated that at approximately 5 weeks postsurgery, the NR group separated to pain persisting (NR persisting, n = 5) and recovering (NR recovering, n = 7) groups. Counts of afferent nerves and dorsal root ganglion cells were not different between NR groups. Therefore, NR group differences could not be explained by peripheral reorganization. By contrast, large brain functional connectivity differences were observed between NR groups, where corticolimbic reorganization paralleled with pain recovery (repeated-measures analysis of variance, false discovery rate, P < 0.05), and functional connectivity between accumbens and medial frontal cortex was related both to tactile allodynia (nociception) and to sucrose preference (anhedonia) in the NR group. Our study highlights the importance of brain circuitry in the reversal of neuropathic pain as a natural pain-relieving mechanism. Further studies regarding the therapeutic potentials of these processes are warranted.
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Affiliation(s)
- Qi-Yuan Bao
- Department of Orthopaedics, Ruijin Hospital, Jiaotong University School of Medicine, Shanghai, China
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Pei-Ching Chang
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Maria Virginia Centeno
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Melissa A Farmer
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Marwan Baliki
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Pain Management Center, Chicago, IL, United States
| | - Daniel Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Weibin Zhang
- Department of Orthopaedics, Ruijin Hospital, Jiaotong University School of Medicine, Shanghai, China
| | - A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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10
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Vachon-Presseau E, Abdullah TB, Berger SE, Huang L, Griffith JW, Schnitzer TJ, Apkarian AV. Validating a biosignature-predicting placebo pill response in chronic pain in the settings of a randomized controlled trial. Pain 2022; 163:910-922. [PMID: 34433773 PMCID: PMC8863986 DOI: 10.1097/j.pain.0000000000002450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The objective of this study is to validate a placebo pill response predictive model-a biosignature-that classifies chronic pain patients into placebo responders (predicted-PTxResp) and nonresponders (predicted-PTxNonR) and test whether it can dissociate placebo and active treatment responses. The model, based on psychological and brain functional connectivity, was derived in our previous study and blindly applied to current trial participants. Ninety-four chronic low back pain (CLBP) patients were classified into predicted-PTxResp or predicted-PTxNonR and randomized into no treatment, placebo treatment, or naproxen treatment. To monitor analgesia, back pain intensity was collected twice a day: 3 weeks baseline, 6 weeks of treatment, and 3 weeks of washout. Eighty-nine CLBP patients were included in the intent-to-treat analyses and 77 CLBP patients in the per-protocol analyses. Both analyses showed similar results. At the group level, the predictive model performed remarkably well, dissociating the separate effect sizes of pure placebo response and pure active treatment response and demonstrating that these effects interacted additively. Pain relief was about 15% stronger in the predicted-PTxResp compared with the predicted-PTxNonR receiving either placebo or naproxen, and the predicted-PTxNonR successfully isolated the active drug effect. At a single subject level, the biosignature better predicted placebo nonresponders, with poor accuracy. One component of the biosignature (dorsolateral prefrontal cortex-precentral gyrus functional connectivity) could be generalized across 3 placebo studies and in 2 different cohorts-CLBP and osteoarthritis pain patients. This study shows that a biosignature can predict placebo response at a group level in the setting of a randomized controlled trial.
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Affiliation(s)
- Etienne Vachon-Presseau
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain (AECRP), McGill University, Montreal, QC, Canada
| | - Taha B. Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - Sara E. Berger
- Healthcare and Life Sciences Department, IBM Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY 10598, USA
| | - Lejian Huang
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - Thomas J. Schnitzer
- Departments of Internal Medicine and Rheumatology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
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11
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Tiwari SR, Vigotsky AD, Apkarian AV. On the Relationship Between Pain Variability and Relief in Randomized Clinical Trials. Front Pain Res 2022; 3:844309. [PMID: 35465296 PMCID: PMC9024103 DOI: 10.3389/fpain.2022.844309] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Previous research reports suggest greater baseline variability is associated with greater pain relief in those who receive a placebo. However, studies that evidence this association do not control for confounding effects from regression to the mean and natural history. In this report, we analyzed data from two randomized clinical trials (Placebo I and Placebo II, total N = 139) while adjusting for the effects of natural history and regression to the mean via a no treatment group. Results agree between the two placebo groups in each study: both placebo groups showed negligible semi-partial correlations between baseline variability and adjusted response [rsp (CI95%) = 0.22 (0.03, 0.42) and 0 (−0.07, 0.07) for Placebo I and II, respectively]. The no treatment group in Placebo I showed a negative correlation [−0.22 (−0.43, −0.02)], but the no treatment and drug groups in Placebo II's correlations were negligible [−0.02 (−0.08, 0.02) and 0.00 (−0.10, 0.12) for the no treatment and drug groups, respectively]. When modeled as a linear covariate, baseline pain variability accounted for <1% of the variance in post-intervention pain across both studies. Even after adjusting for baseline pain and natural history, the inability of baseline pain variability to account for substantial variance in pain response highlights that previous results concerning pain variability and treatment response may be inconsistent. Indeed, the relationship appears to be neither consistently specific nor sensitive to improvements in the placebo group. More work is needed to understand and establish the prognostic value of baseline pain variability—especially its placebo specificity and generalizability across patient populations.
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Affiliation(s)
- Siddharth R. Tiwari
- Illinois Mathematics and Science Academy, Aurora, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrew D. Vigotsky
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL, United States
| | - A. Vania Apkarian
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Neuroscience, Anesthesia, and Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: A. Vania Apkarian
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12
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Jabakhanji R, Vigotsky AD, Bielefeld J, Huang L, Baliki MN, Iannetti G, Apkarian AV. Limits of decoding mental states with fMRI. Cortex 2022; 149:101-122. [PMID: 35219121 PMCID: PMC9238276 DOI: 10.1016/j.cortex.2021.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
A growing number of studies claim to decode mental states using multi-voxel decoders of brain activity. It has been proposed that the fixed, fine-grained, multi-voxel patterns in these decoders are necessary for discriminating between and identifying mental states. Here, we present evidence that the efficacy of these decoders might be overstated. Across various tasks, decoder patterns were spatially imprecise, as decoder performance was unaffected by spatial smoothing; 90% redundant, as selecting a random 10% of a decoder's constituent voxels recovered full decoder performance; and performed similarly to brain activity maps used as decoders. We distinguish decoder performance in discriminating between mental states from performance in identifying a given mental state, and show that even when discrimination performance is adequate, identification can be poor. Finally, we demonstrate that simple and intuitive similarity metrics explain 91% and 62% of discrimination performance within- and across-subjects, respectively. These findings indicate that currently used across-subject decoders of mental states are superfluous and inappropriate for decision-making.
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Affiliation(s)
- Rami Jabakhanji
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Andrew D Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Marwan N Baliki
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Shirley Ryan AbilityLab, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Giandomenico Iannetti
- Division of Biosciences, University College London, London, UK; Neuroscience and Behaviour Laboratory, Italian Institute of Technology, Rome, Italy
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA.
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13
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Vigotsky AD, Tiwari SR, Griffith JW, Apkarian AV. What Is the Numerical Nature of Pain Relief? Front Pain Res (Lausanne) 2022; 2:756680. [PMID: 35295426 PMCID: PMC8915564 DOI: 10.3389/fpain.2021.756680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Pain relief, or a decrease in self-reported pain intensity, is frequently the primary outcome of pain clinical trials. Investigators commonly report pain relief in one of two ways: using raw units (additive) or using percentage units (multiplicative). However, additive and multiplicative scales have different assumptions and are incompatible with one another. In this work, we describe the assumptions and corollaries of additive and multiplicative models of pain relief to illuminate the issue from statistical and clinical perspectives. First, we explain the math underlying each model and illustrate these points using simulations, for which readers are assumed to have an understanding of linear regression. Next, we connect this math to clinical interpretations, stressing the importance of statistical models that accurately represent the underlying data; for example, how using percent pain relief can mislead clinicians if the data are actually additive. These theoretical discussions are supported by empirical data from four longitudinal studies of patients with subacute and chronic pain. Finally, we discuss self-reported pain intensity as a measurement construct, including its philosophical limitations and how clinical pain differs from acute pain measured during psychophysics experiments. This work has broad implications for clinical pain research, ranging from statistical modeling of trial data to the use of minimal clinically important differences and patient-clinician communication.
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Affiliation(s)
- Andrew D Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Siddharth R Tiwari
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Illinois Mathematics and Science Academy, Aurora, IL, United States
| | - James W Griffith
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Departments of Neuroscience, Anesthesia, and Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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14
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Uc A, Andersen DK, Apkarian AV, Bellin MD, Colloca L, Drewes AM, Dunbar EK, Forsmark CE, Goodman MT, Kapural L, Koob GF, Palermo TM, Pandol SJ, Pasricha P, Phillips AE, Piomelli D, Saloman JL, Schwarzenberg SJ, Singh VK, Sowa G, Strouse T, Treisman GJ, Windsor JA, Yadav D. Pancreatic Pain-Knowledge Gaps and Research Opportunities in Children and Adults: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2021; 50:906-915. [PMID: 34643606 PMCID: PMC10273134 DOI: 10.1097/mpa.0000000000001899] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on research gaps and opportunities in pancreatic pain. The event was held on July 21, 2021, and structured into 4 sessions: (1) pathophysiology; (2) biomarkers, mediators, and pharmacology of pain; (3) pain assessment; and (4) pain treatment challenges and opportunities. The current state of knowledge was reviewed; many knowledge gaps and research needs were identified that require further investigation. Common themes included the need to better understand the underlying mechanisms of pain in pancreatic diseases, the relationship of visceral neural pathways and central pain centers, the role of behavioral factors and disorders on the perception of pain, and differences in pain perception and processes in children when compared with adults. In addition, the role of genetic risk factors for pain and the mechanisms and role of placebos in pain treatment were discussed. Methods of pain assessment including quantitative sensory testing were examined, as well as the process of central sensitization of pain. Finally, newer approaches to pain management including cognitive behavioral therapy, nerve stimulation, experimental (nonopioid) drugs, and cannabinoid compounds were covered.
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Affiliation(s)
- Aliye Uc
- From the Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - A Vania Apkarian
- Departments of Physiology, Anesthesiology, Physical Medicine and Rehabilitation, and Center for Translational Pain Research, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Melena D Bellin
- Departments of Pediatrics and Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | | | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL
| | - Marc T Goodman
- Cancer Prevention and Control Program, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism and Intramural Research Program, National Institute on Drug, National Institutes of Health, Bethesda, MD
| | | | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA
| | - Pankaj Pasricha
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna E Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine
| | - Daniele Piomelli
- Departments of Anatomy and Neurobiology, Biological Chemistry, and Pharmacology, University of California, Irvine School of Medicine, Irvine, CA
| | - Jami L Saloman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine
| | - Sarah Jane Schwarzenberg
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gwendolyn Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas Strouse
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine
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15
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Reckziegel D, Abdullah T, Wu B, Wu B, Huang L, Schnitzer TJ, Apkarian AV. Hippocampus shape deformation: a potential diagnostic biomarker for chronic back pain in women. Pain 2021; 162:1457-1467. [PMID: 33181581 PMCID: PMC8049947 DOI: 10.1097/j.pain.0000000000002143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/29/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
ABSTRACT Sex differences in the quality and prevalence of chronic pain are manifold, with women generally presenting higher incidence and severity. Uncovering chronic pain-related sex differences inform neural mechanisms and may lead to novel treatment routes. In a multicenter morphological study (total n = 374), we investigated whether the shape of subcortical regions would reflect sex differences in back pain. Given the hormone-dependent functions of the hippocampus, and its role in the transition to chronic pain, this region constituted our primary candidate. We found that the anterior part of the left hippocampus (alHP) presented outer deformation in women with chronic back pain (CBP), identified in CBP in the United States (n = 77 women vs n = 78 men) and validated in a Chinese data set (n = 29 women vs n = 58 men with CBP, in contrast to n = 53 female and n = 43 male healthy controls). Next, we examined this region in subacute back pain who persisted with back pain a year later (SBPp; n = 18 women vs n = 18 men) and in a subgroup with persistent back pain for 3 years. Weeks after onset of back pain, there was no deformation within alHP, but at 1 and 3 years women exhibited a trend for outer deformation. The alHP partly overlapped with the subiculum and entorhinal cortex, whose functional connectivity, in healthy subjects, was associated with emotional and episodic memory related terms (Neurosynth, reverse inference). These findings suggest that in women the alHP undergoes anatomical changes with pain persistence, highlighting sexually dimorphic involvement of emotional and episodic memory-related circuitry with chronic pain.
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Affiliation(s)
- Diane Reckziegel
- Center for Chronic Pain and Drug Abuse, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Taha Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Touro College of Osteopathic Medicine, New York, USA
| | - Binbin Wu
- Department of Pain Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bo Wu
- Department of Information, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Lejian Huang
- Center for Chronic Pain and Drug Abuse, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Thomas J Schnitzer
- Center for Chronic Pain and Drug Abuse, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - A Vania Apkarian
- Center for Chronic Pain and Drug Abuse, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, USA
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16
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Ren W, Centeno MV, Wei X, Wickersham I, Martina M, Apkarian AV, Surmeier DJ. Adaptive alterations in the mesoaccumbal network after peripheral nerve injury. Pain 2021; 162:895-906. [PMID: 33021562 PMCID: PMC9272541 DOI: 10.1097/j.pain.0000000000002092] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 06/19/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023]
Abstract
ABSTRACT The nucleus accumbens (NAc) and the ventral tegmental area (VTA) are critical hubs in the brain circuitry controlling chronic pain. Yet, how these 2 regions interact to shape the chronic pain state is poorly understood. Our studies show that in mice, spared nerve injury (SNI) induced alterations in the functional connectome of D2-receptor expressing spiny projection neurons in the core region of the NAc-enhancing connections with prelimbic cortex and weakening them with basolateral amygdala. These changes, which were attributable in part to SNI-induced suppression of VTA dopaminergic signaling, were adaptive because mimicking them chemogenetically alleviated the anxiety and social withdrawal accompanying injury. By contrast, chemogenetic enhancement of activity in VTA dopaminergic neurons projecting to the medial shell of the NAc selectively suppressed tactile allodynia in SNI mice. These results suggest that SNI induces regionally specific alterations in VTA dopaminergic signaling in the NAc to promote environmental reengagement after injury. However, countervailing, homeostatic mechanisms limit these adaptive changes, potentially leading to the chronic pain state.
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Affiliation(s)
- Wenjie Ren
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
- Center of Excellence for Chronic Pain and Drug Abuse Research
| | - Maria Virginia Centeno
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
- Center of Excellence for Chronic Pain and Drug Abuse Research
| | - Xuhong Wei
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
| | - Ian Wickersham
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Marco Martina
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
- Center of Excellence for Chronic Pain and Drug Abuse Research
| | - A. Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
- Center of Excellence for Chronic Pain and Drug Abuse Research
| | - D. James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611
- Center of Excellence for Chronic Pain and Drug Abuse Research
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17
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Pinto CB, Bielefeld J, Jabakhanji R, Reckziegel D, Griffith JW, Apkarian AV. Neural and Genetic Bases for Human Ability Traits. Front Hum Neurosci 2021; 14:609170. [PMID: 33390920 PMCID: PMC7772246 DOI: 10.3389/fnhum.2020.609170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
The judgement of human ability is ubiquitous, from school admissions to job performance reviews. The exact make-up of ability traits, however, is often narrowly defined and lacks a comprehensive basis. We attempt to simplify the spectrum of human ability, similar to how five personality traits are widely believed to describe most personalities. Finding such a basis for human ability would be invaluable since neuropsychiatric disease diagnoses and symptom severity are commonly related to such differences in performance. Here, we identified four underlying ability traits within the National Institutes of Health Toolbox normative data (n = 1, 369): (1) Motor-endurance, (2) Emotional processing, (3) Executive and cognitive function, and (4) Social interaction. We used the Human Connectome Project young adult dataset (n = 778) to show that Motor-endurance and Executive and cognitive function were reliably associated with specific brain functional networks (r 2 = 0.305 ± 0.021), and the biological nature of these ability traits was also shown by calculating their heritability (31 and 49%, respectively) from twin data.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rami Jabakhanji
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Diane Reckziegel
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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18
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Yang L, Wu B, Fan L, Huang S, Vigotsky AD, Baliki MN, Yan Z, Apkarian AV, Huang L. Dissimilarity of functional connectivity uncovers the influence of participant's motion in functional magnetic resonance imaging studies. Hum Brain Mapp 2020; 42:713-723. [PMID: 33079467 PMCID: PMC7814752 DOI: 10.1002/hbm.25255] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 01/07/2023] Open
Abstract
Head motion is a major confounding factor impairing the quality of functional magnetic resonance imaging (fMRI) data. In particular, head motion can reduce analytical efficiency, and its effects are still present even after preprocessing. To examine the validity of motion removal and to evaluate the remaining effects of motion on the quality of the preprocessed fMRI data, a new metric of group quality control (QC), dissimilarity of functional connectivity, is introduced. Here, we investigate the association between head motion, represented by mean framewise displacement, and dissimilarity of functional connectivity by applying four preprocessing methods in two independent resting‐state fMRI datasets: one consisting of healthy participants (N = 167) scanned in a 3T GE‐Discovery 750 with longer TR (2.5 s), and the other of chronic back pain patients (N = 143) in a 3T Siemens Magnetom Prisma scanner with shorter TR (0.555 s). We found that dissimilarity of functional connectivity uncovers the influence of participant's motion, and this relationship is independent of population, scanner, and preprocessing method. The association between motion and dissimilarity of functional connectivity, and how the removal of high‐motion participants affects this association, is a new strategy for group‐level QC following preprocessing.
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Affiliation(s)
- Lili Yang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bo Wu
- Department of Information, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linyu Fan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shishi Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Andrew D Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, Illinois, USA
| | - Marwan N Baliki
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Management and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lejian Huang
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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19
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Mioton LM, Dumanian GA, Fracol ME, Apkarian AV, Valerio IL, Souza JM, Potter BK, Tintle SM, Nanos GP, Ertl WJ, Ko JH, Jordan SW. Benchmarking Residual Limb Pain and Phantom Limb Pain in Amputees through a Patient-reported Outcomes Survey. Plast Reconstr Surg Glob Open 2020; 8:e2977. [PMID: 32802669 PMCID: PMC7413780 DOI: 10.1097/gox.0000000000002977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
More than 75% of major limb amputees experience chronic pain; however, data on severity and experience of pain are inconsistent. Without a benchmark using quantitative patient-reported outcomes, it is difficult to critically assess the efficacy of novel treatment strategies. Our primary objective is to report quantitative pain parameters for a large sample of amputees using the validated Patient-reported Outcomes Measurement System (PROMIS). Secondarily, we hypothesize that certain patient factors will be associated with worse pain. METHODS PROMIS and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained from a cross-sectional survey of upper and lower extremity amputees recruited throughout North America via amputee clinics and websites. Demographics (gender, age, race, and education) and clinical information (cause, amputation level, and time since amputation) were collected. Regression modeling identified factors associated with worse pain scores (P < 0.05). RESULTS Seven hundred twenty-seven surveys were analyzed, in which 73.4% reported RLP and 70.4% reported PLP. Median residual PROMIS scores were 46.6 [interquartile range (IQR), 41-52] for RLP Intensity, 56.7 (IQR, 51-61) for RLP Behavior, and 55.9 (IQR, 41-63) for RLP Interference. Similar scores were calculated for PLP parameters: 46.8 (IQR, 41-54) for PLP Intensity, 56.2 (IQR, 50-61) for PLP Behavior, and 54.6 (IQR, 41-62) for PLP Interference. Female sex, lower education, trauma-related amputation, more proximal amputation, and closer to time of amputation increased odds of PLP. Female sex, lower education, and infection/ischemia-related amputation increased odds of RLP. CONCLUSION This survey-based analysis provides quantitative benchmark data regarding RLP and PLP in amputees with more granularity than has previously been reported.
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Affiliation(s)
- Lauren M. Mioton
- From the Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Gregory A. Dumanian
- From the Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Megan E. Fracol
- From the Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - A. Vania Apkarian
- The Department of Physiology, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Ian L. Valerio
- Department of Plastic Surgery, The Ohio State University, Columbus, Ohio
| | - Jason M. Souza
- The Division of Plastic Surgery and Department of Orthopedics, Uniformed Services University—Walter Reed National Military, Bethesda, Md
| | - Benjamin K. Potter
- The Division of Plastic Surgery and Department of Orthopedics, Uniformed Services University—Walter Reed National Military, Bethesda, Md
| | - Scott M. Tintle
- The Division of Plastic Surgery and Department of Orthopedics, Uniformed Services University—Walter Reed National Military, Bethesda, Md
| | - George P. Nanos
- The Division of Plastic Surgery and Department of Orthopedics, Uniformed Services University—Walter Reed National Military, Bethesda, Md
| | - William J. Ertl
- The Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, Okla
| | - Jason H. Ko
- From the Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Sumanas W. Jordan
- From the Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
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20
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Abstract
IMPORTANCE Opioid prescriptions for treatment of pain in emergency departments (EDs) are associated with long-term opioid use. The temporal pattern of opioid prescribing in the context of the opioid epidemic remains unknown. OBJECTIVE To examine the temporal pattern of opioid prescribing within an ED for varying pain conditions between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS A population-based, cross-sectional study was conducted at the ED of an urban academic medical center. All patients treated within that ED between January 1, 2009, and December 31, 2018, were included. MAIN OUTCOMES AND MEASURES The proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber. RESULTS Between 2009 and 2018, 556 176 patient encounters took place in the ED, with 70 218 unique opioid prescriptions ordered. A total of 316 632 patients (55.9%) were female, 45 070 (42.6%) were of white race, and 43 412 (40.6%) were privately insured; the median age group was 41 to 45 years. Yearly opioid prescriptions decreased by 66.3% (from 16.3 to 5.5 opioids per 100 encounters) between 2013 and 2018, with a yearly adjusted odds ratio (aOR) of 0.808 (95% CI, 0.802-0.814) compared with the prior year. In patients with musculoskeletal pain (back, joint, limb, and neck pain), opioid prescribing decreased by 71.1% (from 36.7 to 10.6 opioids per 100 encounters between 2013 and 2018; aOR, 0.758; 95% CI, 0.744-0.773). In patients with musculoskeletal trauma (fracture, sprain, contusion, and injury), opioid prescribing decreased by 58.0% (from 34.2 to 14.8 opioids per 100 encounters; aOR, 0.811; 95% CI, 0.797-0.824). In patients with nonmusculoskeletal pain (abdominal pain, kidney stone, respiratory distress, and pharyngitis) opioid prescribing decreased by 53.7% (from 20.1 to 9.3 opioids per 100 encounters; aOR, 0.850; 95% CI, 0.834-0.868). Between 2009 and 2018, patients who were black (aOR, 0.760; 95% CI, 0.741-0.779) and those who were Asian (aOR, 0.714; 95% CI, 0.665-0.764) had the lowest odds of receiving an opioid compared with other racial/ethnic groups. CONCLUSIONS AND RELEVANCE There was a substantial temporal decrease in the number of opioid prescriptions within this ED during the study period. This decrease was associated with substantial relative reductions in opioid prescribing for treatment of musculoskeletal pain compared with fractures and kidney stones.
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Affiliation(s)
- Ben C. Smith
- Medical Student, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew D. Vigotsky
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
- Department of Statistics, Northwestern University, Evanston, Illinois
| | - A. Vania Apkarian
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Thomas J. Schnitzer
- Anesthesiology and Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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21
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Barroso J, Wakaizumi K, Reckziegel D, Pinto-Ramos J, Schnitzer T, Galhardo V, Apkarian AV. Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement? PLoS One 2020; 15:e0222370. [PMID: 31914126 PMCID: PMC6948829 DOI: 10.1371/journal.pone.0222370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/22/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.
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MESH Headings
- Aged
- Arthroplasty, Replacement/adverse effects
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Female
- Humans
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain Management
- Pain Measurement/methods
- Pain, Postoperative/epidemiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/therapy
- Severity of Illness Index
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Affiliation(s)
- Joana Barroso
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde—i3S, Universidade do Porto, Porto, Portugal
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kenta Wakaizumi
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Shirley Ryan AbilityLab, Chicago, IL, United States of America
| | - Diane Reckziegel
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - João Pinto-Ramos
- Departamento de Medicina Física e de Reabilitação, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Thomas Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Vasco Galhardo
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde—i3S, Universidade do Porto, Porto, Portugal
| | - A. Vania Apkarian
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
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22
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Vachon-Presseau E, Berger SE, Abdullah TB, Griffith JW, Schnitzer TJ, Apkarian AV. Identification of traits and functional connectivity-based neurotraits of chronic pain. PLoS Biol 2019; 17:e3000349. [PMID: 31430270 PMCID: PMC6701751 DOI: 10.1371/journal.pbio.3000349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/12/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Psychological and personality factors, socioeconomic status, and brain properties all contribute to chronic pain but have essentially been studied independently. Here, we administered a broad battery of questionnaires to patients with chronic back pain (CBP) and collected repeated sessions of resting-state functional magnetic resonance imaging (fMRI) brain scans. Clustering and network analyses applied on the questionnaire data revealed four orthogonal dimensions accounting for 56% of the variance and defining chronic pain traits. Two of these traits-Pain-trait and Emote-trait-were associated with back pain characteristics and could be related to distinct distributed functional networks in a cross-validation procedure, identifying neurotraits. These neurotraits showed good reliability across four fMRI sessions acquired over five weeks. Further, traits and neurotraits all related to the income, emphasizing the importance of socioeconomic status within the personality space of chronic pain. Our approach is a first step in providing metrics aimed at unifying the psychology and the neurophysiology of chronic pain applicable across diverse clinical conditions.
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Affiliation(s)
- Etienne Vachon-Presseau
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Sara E. Berger
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Healthcare and Life Sciences Department, IBM Watson Research Center, Yorktown Heights, New York, United States of America
| | - Taha B. Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Thomas J. Schnitzer
- Departments of Internal Medicine and Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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23
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Pollema-Mays SL, Centeno MV, Chang Z, Apkarian AV, Martina M. Reduced ΔFosB expression in the rat nucleus accumbens has causal role in the neuropathic pain phenotype. Neurosci Lett 2018; 702:77-83. [PMID: 30503921 DOI: 10.1016/j.neulet.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The neuropathic pain phenotype is the consequence of functional and morphological reorganization of the PNS and CNS. This reorganization includes DRGs and the spinal cord, and extends to multiple supraspinal areas including the limbic and reward systems. Several recent papers show that acute manipulation of cortical and subcortical brain areas causally correlates with the cognitive, emotional and sensory components of neuropathic pain, yet mechanisms responsible for pain chronification remain largely unknown. Here we show that nucleus accumbens expression of ΔFos-B, a transcription factor that plays a critical role in addiction and in the brain response to stress, is reduced long term following peripheral neuropathic injury. Conversely, boosting ΔFos-B expression in the nucleus accumbens by viral transfection causes a significant and long-lasting improvement of the neuropathic allodynia. We suggest that ΔFos-B in the nucleus accumbens is a key modulator of long term gene expression leading to pain chronification.
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Affiliation(s)
- Sarah L Pollema-Mays
- Dept. of Physiology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611, United States
| | - Maria Virginia Centeno
- Dept. of Physiology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611, United States
| | - Zheng Chang
- Dept. of Physiology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611, United States
| | - A Vania Apkarian
- Dept. of Physiology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611, United States
| | - Marco Martina
- Dept. of Physiology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611, United States.
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24
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Abstract
This overview covers advances in mechanisms of chronic pain and their consequent clinical opportunities. Our research field is fractured into two separate camps: "peripheralists" and "centralists". While the strong position of the first group is the contention that mechanisms of chronic pain can be understood within the limits of afferent inputs and spinal cord circuitry, the second group insists that the rest of the brain plays a critical role. Here we attempt to conjoin these positions, across clinical pain conditions and animal studies, and demonstrate that the effort can lead to novel translational concepts.
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Affiliation(s)
- A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA; Department of Anesthesia, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
| | - Diane Reckziegel
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
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25
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Apkarian AV. Nociception, Pain, Consciousness, and Society: A Plea for Constrained Use of Pain-related Terminologies. J Pain 2018; 19:1253-1255. [PMID: 29890297 DOI: 10.1016/j.jpain.2018.05.010] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
Abstract
This focus article addresses the issue of the proper use of terminology in pain research. A review and some revisions of the definitions of pain and nociception in relation to consciousness are presented. From a behavioral viewpoint, it is argued that pain is a conscious assessment of the failure of the organism to protect the body from injury (actual or potential), whereas continuously ongoing subconscious/preconscious nociceptive processes protect the body from injuries. Thus pain perception/behavior requires the subjective ability to evaluate the environment and form coordinated responses. Yet, too often, our literature conflates the 2 concepts, resulting in a confusion that impacts on society. The issue is especially topical as the US Senate has been voting on a bill called the Pain-Capable Unborn Child Protection Act. The title of the bill itself does not make sense if we adhere to the strict definitions commonly accepted in our field. Thus this article concludes with a plea to properly constrain the narrative with which we describe our research and minimize potential abuse of the science of pain for political interests. Perspective:The focus article goes over the classic definitions of pain and nociception, incorporates novel concepts recently advanced as to their functional differentiation, and is a plea for our research and clinical society to adhere to the proper use of these terms to minimize misinterpretation by society at large.
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Affiliation(s)
- A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois..
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26
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Tétreault P, Baliki MN, Baria AT, Bauer WR, Schnitzer TJ, Apkarian AV. Inferring distinct mechanisms in the absence of subjective differences: Placebo and centrally acting analgesic underlie unique brain adaptations. Hum Brain Mapp 2018; 39:2210-2223. [PMID: 29417694 DOI: 10.1002/hbm.23999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/31/2022] Open
Abstract
Development and maintenance of chronic pain is associated with structural and functional brain reorganization. However, few studies have explored the impact of drug treatments on such changes. The extent to which long-term analgesia is related to brain adaptations and its effects on the reversibility of brain reorganization remain unclear. In a randomized placebo-controlled clinical trial, we contrasted pain relief (3-month treatment period), and anatomical (gray matter density [GMD], assessed by voxel-based morphometry) and functional connectivity (resting state fMRI nodal degree count [DC]) adaptations, in 39 knee osteoarthritis (OA) patients (22 females), randomized to duloxetine (DLX, 60 mg once daily) or placebo. Pain relief was equivalent between treatment types. However, distinct circuitry (GMD and DC) could explain pain relief in each group: up to 85% of variance for placebo analgesia and 49% of variance for DLX analgesia. No behavioral measures (collected at entry into the study) could independently explain observed analgesia. Identified circuitry were outside of nociceptive circuitry and minimally overlapped with OA-abnormal or placebo response predictive brain regions. Mediation analysis revealed that changes in GMD and DC can influence each other across remote brain regions to explain observed analgesia. Therefore, we can conclude that distinct brain mechanisms underlie DLX and placebo analgesia in OA. The results demonstrate that even in the absence of differences in subjective pain relief, pharmacological treatments can be differentiated from placebo based on objective brain biomarkers. This is a crucial step to untangling mechanisms and advancing personalized therapy approaches for chronic pain.
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Affiliation(s)
- Pascal Tétreault
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - Marwan N Baliki
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, 60611.,Shirley Ryan AbilityLab, Chicago, Illinois, 60611
| | - Alexis T Baria
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - William R Bauer
- Department of Neuroscience, University of Toledo, Toledo, Ohio, 43614-2598
| | - Thomas J Schnitzer
- Department of Rheumatology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611.,Anesthesiology Northwestern University, Feinberg School of Medicine, Chicago, Illinois, 60611
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27
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Berger SE, Vachon-Presseau É, Abdullah TB, Baria AT, Schnitzer TJ, Apkarian AV. Hippocampal morphology mediates biased memories of chronic pain. Neuroimage 2018; 166:86-98. [PMID: 29080714 PMCID: PMC5813825 DOI: 10.1016/j.neuroimage.2017.10.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 06/07/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 12/20/2022] Open
Abstract
Experiences and memories are often mismatched. While multiple studies have investigated psychological underpinnings of recall error with respect to emotional events, the neurobiological mechanisms underlying the divergence between experiences and memories remain relatively unexplored in the domain of chronic pain. Here we examined the discrepancy between experienced chronic low back pain (CBP) intensity (twice daily ratings) and remembered pain intensity (n = 48 subjects) relative to psychometric properties, hippocampus morphology, memory capabilities, and personality traits related to reward. 77% of CBP patients exaggerated remembered pain, which depended on their strongest experienced pain and their most recent mood rating. This bias persisted over nearly 1 year and was related to reward memory bias and loss aversion. Shape displacement of a specific region in the left posterior hippocampus mediated personality effects on pain memory bias, predicted pain memory bias in a validation CBP group (n = 21), and accounted for 55% of the variance of pain memory bias. In two independent groups (n = 20/group), morphology of this region was stable over time and unperturbed by the development of chronic pain. These results imply that a localized hippocampal circuit, and personality traits associated with reward processing, largely determine exaggeration of daily pain experiences in chronic pain patients.
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Affiliation(s)
- Sara E Berger
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA; Department of Healthcare and Life Sciences, IBM Thomas J. Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY 10598, USA
| | - Étienne Vachon-Presseau
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Taha B Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Alex T Baria
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Thomas J Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA; Department of Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA; Department of Anesthesia, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA.
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28
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Ruffle JK, Coen SJ, Giampietro V, Williams SC, Apkarian AV, Farmer AD, Aziz Q. Morphology of subcortical brain nuclei is associated with autonomic function in healthy humans. Hum Brain Mapp 2018; 39:381-392. [PMID: 29080228 PMCID: PMC6866383 DOI: 10.1002/hbm.23850] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/19/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022] Open
Abstract
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel syndrome and fibromyalgia. While the brain is a central hub for regulating autonomic function, the association between resting autonomic activity and subcortical morphology has not been comprehensively studied and thus was our aim. In 27 healthy subjects [14 male and 13 female; mean age 30 years (range 22-53 years)], we quantified resting ANS function using validated indices of cardiac sympathetic index (CSI) and parasympathetic cardiac vagal tone (CVT). High resolution structural magnetic resonance imaging scans were acquired, and differences in subcortical nuclei shape, that is, 'deformation', contingent on resting ANS activity were investigated. CSI positively correlated with outward deformation of the brainstem, right nucleus accumbens, right amygdala and bilateral pallidum (all thresholded to corrected P < 0.05). In contrast, parasympathetic CVT negatively correlated with inward deformation of the right amygdala and pallidum (all thresholded to corrected P < 0.05). Left and right putamen volume positively correlated with CVT (r = 0.62, P = 0.0047 and r = 0.59, P = 0.008, respectively), as did the brainstem (r = 0.46, P = 0.049). These data provide novel evidence that resting autonomic state is associated with differences in the shape and volume of subcortical nuclei. Thus, subcortical morphological brain differences in various disorders may partly be attributable to perturbation in autonomic function. Further work is warranted to investigate these findings in clinical populations. Hum Brain Mapp 39:381-392, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- James K. Ruffle
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
- Medical Acute Assessment Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, WhitechapelLondonE1 1BBUnited Kingdom
| | - Steven J. Coen
- Research Department of Clinical, Educational and Health PsychologyUniversity College London, Gower StreetLondonWC1E 6BTUnited Kingdom
| | - Vincent Giampietro
- Department of NeuroimagingKing's College London, Institute of Psychiatry, Psychology & NeuroscienceLondonSE5 8AFUnited Kingdom
| | - Steven C.R. Williams
- Department of NeuroimagingKing's College London, Institute of Psychiatry, Psychology & NeuroscienceLondonSE5 8AFUnited Kingdom
| | - A. Vania Apkarian
- Department of PhysiologyNorthwestern University, Feinberg School of MedicineChicagoIllinois60611
| | - Adam D. Farmer
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
- Department of GastroenterologyUniversity Hospitals Midlands NHS Trust, Stoke on TrentStaffordshireST4 6QGUnited Kingdom
| | - Qasim Aziz
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
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Baria AT, Centeno MV, Ghantous ME, Chang PC, Procissi D, Apkarian AV. BOLD temporal variability differentiates wakefulness from anesthesia-induced unconsciousness. J Neurophysiol 2017; 119:834-848. [PMID: 29212921 DOI: 10.1152/jn.00714.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Even though a number of findings, based on information content or information integration, are shown to define neural underpinnings characteristic of a conscious experience, the neurophysiological mechanism of consciousness is still poorly understood. Here, we investigated the brain activity and functional connectivity changes that occur in the isoflurane-anesthetized unconscious state in contrast to the awake state in rats (awake and/or anesthetized, n = 68 rats). We examined nine information measures previously shown to distinguish between conscious states: blood oxygen level-dependent (BOLD) variability, functional connectivity strength, modularity, weighted modularity, efficiency, clustering coefficient, small-worldness, and spatial and temporal Lempel-Ziv complexity measure. We also identified modular membership, seed-based network connectivity, and absolute and normalized power spectrums to assess the integrity of the BOLD functional networks between awake and anesthesia. fMRI BOLD variability and related absolute power were the only information measures significantly higher during the awake state compared with isoflurane anesthesia across animals, and with varying levels of anesthesia, after correcting for motion and respiration confounds. Thus, we conclude that, at least under the specific conditions examined here, global measures of information integration/sharing do not properly distinguish the anesthetized state from wakefulness, and heightened overall, global and local, BOLD variability is the most reliable determinant of conscious brain activity relative to isoflurane anesthesia. NEW & NOTEWORTHY Multiple metrics previously suggested to be able to distinguish between states of consciousness were compared, within and across rats in awake and isoflurane anesthesia-induced unconsciousness. All measures tested showed sensitivity to confounds, correcting for motion and for respiration changes due to anesthesia. Resting state local BOLD variability and the related absolute power were the only information measures that robustly differentiated wakefulness states. These results caution against the general applicability of global information measures in identifying levels of consciousness, thus challenging the popular concept that these measures reflect states of consciousness, and also pointing to local signal variability as a more reliable indicator of states of wakefulness.
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Affiliation(s)
- Alexis T Baria
- Department of Physiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Maria V Centeno
- Department of Physiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Mariam E Ghantous
- Department of Physiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Pei C Chang
- Department of Physiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Daniele Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,Department of Anesthesia, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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Affiliation(s)
- Pascal Tétreault
- Department of physiology, Northwestern University, Feinberg school of medicine, Chicago, Illinois, États-Unis
| | - A Vania Apkarian
- Department of physiology, Northwestern University, Feinberg school of medicine, Chicago, Illinois, États-Unis - Department of physical medicine and rehabilitation, Northwestern University, Feinberg school of medicine, Chicago, Illinois, États-Unis - Department of anesthesia, Northwestern University, Feinberg school of medicine, Chicago, Illinois, États-Unis
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Kutch JJ, Ichesco E, Hampson JP, Labus JS, Farmer MA, Martucci KT, Ness TJ, Deutsch G, Apkarian AV, Mackey SC, Klumpp DJ, Schaeffer AJ, Rodriguez LV, Kreder KJ, Buchwald D, Andriole GL, Lai HH, Mullins C, Kusek JW, Landis JR, Mayer EA, Clemens JQ, Clauw DJ, Harris RE. Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study. Pain 2017; 158:1979-1991. [PMID: 28692006 PMCID: PMC5964335 DOI: 10.1097/j.pain.0000000000001001] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Chronic pain is often measured with a severity score that overlooks its spatial distribution across the body. This widespread pain is believed to be a marker of centralization, a central nervous system process that decouples pain perception from nociceptive input. Here, we investigated whether centralization is manifested at the level of the brain using data from 1079 participants in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network (MAPP) study. Participants with a clinical diagnosis of urological chronic pelvic pain syndrome (UCPPS) were compared to pain-free controls and patients with fibromyalgia, the prototypical centralized pain disorder. Participants completed questionnaires capturing pain severity, function, and a body map of pain. A subset (UCPPS N = 110; fibromyalgia N = 23; healthy control N = 49) underwent functional and structural magnetic resonance imaging. Patients with UCPPS reported pain ranging from localized (pelvic) to widespread (throughout the body). Patients with widespread UCPPS displayed increased brain gray matter volume and functional connectivity involving sensorimotor and insular cortices (P < 0.05 corrected). These changes translated across disease diagnoses as identical outcomes were present in patients with fibromyalgia but not pain-free controls. Widespread pain was also associated with reduced physical and mental function independent of pain severity. Brain pathology in patients with centralized pain is related to pain distribution throughout the body. These patients may benefit from interventions targeting the central nervous system.
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Affiliation(s)
- Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Eric Ichesco
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Johnson P. Hampson
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer S. Labus
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melissa A. Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine T. Martucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Timothy J. Ness
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sean C. Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - David J. Klumpp
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony J. Schaeffer
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Karl J. Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Dedra Buchwald
- College of Medicine, Washington State University, Seattle, WA, USA
| | | | - H. Henry Lai
- Department of Urology, Washington University, Saint Louis, MO, USA
| | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - John W. Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - J. Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emeran A. Mayer
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Daniel J. Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E. Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
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Geha P, Yang Y, Estacion M, Schulman BR, Tokuno H, Apkarian AV, Dib-Hajj SD, Waxman SG. Pharmacotherapy for Pain in a Family With Inherited Erythromelalgia Guided by Genomic Analysis and Functional Profiling. JAMA Neurol 2017; 73:659-67. [PMID: 27088781 DOI: 10.1001/jamaneurol.2016.0389] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is a need for more effective pharmacotherapy for chronic pain, including pain in inherited erythromelalgia (IEM) in which gain-of-function mutations of sodium channel NaV1.7 make dorsal root ganglion (DRG) neurons hyperexcitable. OBJECTIVE To determine whether pain in IEM can be attenuated via pharmacotherapy guided by genomic analysis and functional profiling. DESIGN, SETTING, AND PARTICIPANTS Pain in 2 patients with IEM due to the NaV1.7 S241T mutation, predicted by structural modeling and functional analysis to be responsive to carbamazepine, was assessed in a double-blind, placebo-controlled study conducted from September 2014 to April 21, 2015. Functional magnetic resonance imaging assessed patterns of brain activity associated with pain during treatment with placebo or carbamazepine. Multielectrode array technology was used to assess the effect of carbamazepine on firing of DRG neurons carrying S241T mutant channels. MAIN OUTCOMES AND MEASURES Behavioral assessment of pain; functional magnetic resonance imaging; and assessment of firing in DRG neurons carrying S241T mutant channels. RESULTS This study included 2 patients from the same family with IEM and the S241T NaV1.7 mutation. We showed that, as predicted by molecular modeling, thermodynamic analysis, and functional profiling, carbamazepine attenuated pain in patients with IEM due to the S241T NaV1.7 mutation. Patient 1 reported a reduction in mean time in pain (TIP) per day during the 15-day maintenance period, from 424 minutes while taking placebo to 231.9 minutes while taking carbamazepine (400 mg/day), and a reduction in total TIP over the 15-day maintenance period, from 6360 minutes while taking placebo to 3015 minutes while taking carbamazepine. Patient 2 reported a reduction in mean TIP per day during the maintenance period, from 61 minutes while taking placebo to 9.1 minutes while taking carbamazepine (400 mg then 200 mg/day), and a reduction in total TIP, from 915 minutes while taking placebo over the 15-day maintenance period to 136 minutes while taking carbamazepine. Patient 1 reported a reduction of mean episode duration, from 615 minutes while taking placebo to 274.1 minutes while taking carbamazepine, while patient 2 reported a reduction of the mean episode duration from 91.5 minutes while taking placebo to 45.3 minutes while taking carbamazepine. Patient 1, who had a history of night awakenings from pain, reported 101 awakenings owing to pain while taking placebo during the maintenance period and 32 awakenings while taking carbamazepine. Attenuation of pain was paralleled by a shift in brain activity from valuation and pain areas to primary and secondary somatosensory, motor, and parietal attention areas. Firing of DRG neurons expressing the S241T NaV1.7 mutant channel in response to physiologically relevant thermal stimuli was reduced by carbamazepine. CONCLUSIONS AND RELEVANCE Our results demonstrate that pharmacotherapy guided by genomic analysis, molecular modeling, and functional profiling can attenuate neuropathic pain in patients carrying the S241T mutation.
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Affiliation(s)
- Paul Geha
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut2The John B. Pierce Laboratory, New Haven, Connecticut
| | - Yang Yang
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
| | - Mark Estacion
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
| | - Betsy R Schulman
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
| | - Hajime Tokuno
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Chicago, Illinois
| | - Sulayman D Dib-Hajj
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
| | - Stephen G Waxman
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut4Neurorehabilitation Research Center, Department of Neurology, Veterans Affairs Medical Center, West Haven, Connecticut
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Huang L, Kutch JJ, Ellingson BM, Martucci KT, Harris RE, Clauw DJ, Mackey S, Mayer EA, Schaeffer AJ, Apkarian AV, Farmer MA. Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study. Pain 2016; 157:2782-2791. [PMID: 27842046 PMCID: PMC5117992 DOI: 10.1097/j.pain.0000000000000703] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical phenotyping of urological chronic pelvic pain syndromes (UCPPSs) in men and women have focused on end organ abnormalities to identify putative clinical subtypes. Initial evidence of abnormal brain function and structure in male pelvic pain has necessitated large-scale, multisite investigations into potential UCPPS brain biomarkers. We present the first evidence of regional white matter (axonal) abnormalities in men and women with UCPPS, compared with positive (irritable bowel syndrome, IBS) and healthy controls. Epidemiological and neuroimaging data were collected from participants with UCPPS (n = 52), IBS (n = 39), and healthy sex- and age-matched controls (n = 61). White matter microstructure, measured as fractional anisotropy (FA), was examined by diffusion tensor imaging. Group differences in regional FA positively correlated with pain severity, including segments of the right corticospinal tract and right anterior thalamic radiation. Increased corticospinal FA was specific and sensitive to UCPPS, positively correlated with pain severity, and reflected sensory (not affective) features of pain. Reduced anterior thalamic radiation FA distinguished patients with IBS from those with UCPPS and controls, suggesting greater microstructural divergence from normal tract organization. Findings confirm that regional white matter abnormalities characterize UCPPS and can distinguish between visceral diagnoses, suggesting that regional axonal microstructure is either altered with ongoing pain or predisposes its development.
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Affiliation(s)
- Lejian Huang
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - Benjamin M. Ellingson
- Oppenheimer Center for Neurobiology of Stress and Pain, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Katherine T. Martucci
- Departments of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA
| | - Richard E. Harris
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Daniel J. Clauw
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Sean Mackey
- Departments of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA
| | - Emeran A. Mayer
- Oppenheimer Center for Neurobiology of Stress and Pain, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Anthony J. Schaeffer
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Departments of Surgery and Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Melissa A. Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Schnitzer TJ, Torbey S, Herrmann K, Kaushal G, Yeasted R, Vania Apkarian A. A randomized placebo-controlled pilot study of the efficacy and safety of D-cycloserine in people with chronic back pain. Mol Pain 2016; 12:12/0/1744806916678627. [PMID: 27852965 PMCID: PMC5117251 DOI: 10.1177/1744806916678627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few effective pharmacological treatment options exist for chronic back pain, the leading cause of disability in the US, and all are associated with significant adverse effects. OBJECTIVE To determine the efficacy and safety of D-cycloserine, a partial agonist to the N-methyl-D-aspartate receptor, in the treatment of chronic low back pain. METHODS A total of 41 participants with chronic back pain who met all inclusion and exclusion criteria were enrolled in a double-blind, placebo-controlled randomized pilot trial of D-cycloserine. Treatment was administered orally for six weeks at escalating daily doses of 100 mg, 200 mg, and 400 mg, each for two weeks. The primary outcome measure was back pain intensity using the Numeric Rating Scale (0-10). Secondary measures were back pain-related questionnaires: McGill Pain Questionnaire short form, painDETECT, PANAS, and BDI. The pre-specified analysis was a two-way repeated measures analysis of variance. RESULTS A treatment difference was observed between groups treated with D-cycloserine and placebo at six weeks of 1.05 ± 3.1 units on the Numeric Rating Scale, with an effect size of 0.4 and p = 0.14. This trend of better chronic back pain relief with D-cycloserine was also observed in the secondary measures. No safety issues were seen. CONCLUSION The difference in mean pain between the D-cycloserine and placebo groups did not reach statistical significance. However, a clinically meaningful effect size in the magnitude of pain relief was observed with a consistent pattern across multiple outcome measures with good safety, supporting further research into the effectiveness of D-cycloserine for chronic back pain.
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Affiliation(s)
- Thomas J Schnitzer
- Department of Physical Medicine and Rehabilitation and Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Souraya Torbey
- Department of Psychiatry, University of Virginia School of Medicine, VA, USA
| | - Kristi Herrmann
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gagan Kaushal
- Jefferson School of Pharmacy, Thomas Jefferson University, PA, USA
| | - Renita Yeasted
- Department of Physical Medicine and Rehabilitation and Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tétreault P, Mansour A, Vachon-Presseau E, Schnitzer TJ, Apkarian AV, Baliki MN. Brain Connectivity Predicts Placebo Response across Chronic Pain Clinical Trials. PLoS Biol 2016; 14:e1002570. [PMID: 27788130 PMCID: PMC5082893 DOI: 10.1371/journal.pbio.1002570] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/23/2016] [Indexed: 12/17/2022] Open
Abstract
Placebo response in the clinical trial setting is poorly understood and alleged to be driven by statistical confounds, and its biological underpinnings are questioned. Here we identified and validated that clinical placebo response is predictable from resting-state functional magnetic-resonance-imaging (fMRI) brain connectivity. This also led to discovering a brain region predicting active drug response and demonstrating the adverse effect of active drug interfering with placebo analgesia. Chronic knee osteoarthritis (OA) pain patients (n = 56) underwent pretreatment brain scans in two clinical trials. Study 1 (n = 17) was a 2-wk single-blinded placebo pill trial. Study 2 (n = 39) was a 3-mo double-blinded randomized trial comparing placebo pill to duloxetine. Study 3, which was conducted in additional knee OA pain patients (n = 42), was observational. fMRI-derived brain connectivity maps in study 1 were contrasted between placebo responders and nonresponders and compared to healthy controls (n = 20). Study 2 validated the primary biomarker and identified a brain region predicting drug response. In both studies, approximately half of the participants exhibited analgesia with placebo treatment. In study 1, right midfrontal gyrus connectivity best identified placebo responders. In study 2, the same measure identified placebo responders (95% correct) and predicted the magnitude of placebo's effectiveness. By subtracting away linearly modeled placebo analgesia from duloxetine response, we uncovered in 6/19 participants a tendency of duloxetine enhancing predicted placebo response, while in another 6/19, we uncovered a tendency for duloxetine to diminish it. Moreover, the approach led to discovering that right parahippocampus gyrus connectivity predicts drug analgesia after correcting for modeled placebo-related analgesia. Our evidence is consistent with clinical placebo response having biological underpinnings and shows that the method can also reveal that active treatment in some patients diminishes modeled placebo-related analgesia. Trial Registration ClinicalTrials.gov NCT02903238 ClinicalTrials.gov NCT01558700.
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Affiliation(s)
- Pascal Tétreault
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Ali Mansour
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Etienne Vachon-Presseau
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Thomas J. Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail: (AVA); (MNB)
| | - Marwan N. Baliki
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
- Rehabilitation Institution of Chicago, Chicago, Illinois, United States of America
- * E-mail: (AVA); (MNB)
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Mansour A, Baria AT, Tetreault P, Vachon-Presseau E, Chang PC, Huang L, Apkarian AV, Baliki MN. Global disruption of degree rank order: a hallmark of chronic pain. Sci Rep 2016; 6:34853. [PMID: 27725689 PMCID: PMC5057075 DOI: 10.1038/srep34853] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/21/2016] [Indexed: 12/18/2022] Open
Abstract
Chronic pain remains poorly understood; yet it is associated with the reorganization of the nervous system. Here, we demonstrate that a unitary global measure of functional connectivity, defined as the extent of degree rank order disruption, kD, identifies the chronic pain state. In contrast, local degree disruption differentiates between chronic pain conditions. We used resting-state functional MRI data to analyze the brain connectome at varying scales and densities. In three chronic pain conditions, we observe disrupted kD, in proportion to individuals' pain intensity, and associated with community membership disruption. Additionally, we observe regional degree changes, some of which were unique to each type of chronic pain. Subjects with recent onset of back pain exhibited emergence of kD only when the pain became chronic. Similarly, in neuropathic rats kD emerged weeks after injury, in proportion to pain-like behavior. Thus, we found comprehensive cross-species evidence for chronic pain being a state of global randomization of functional connectivity.
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Affiliation(s)
- Ali Mansour
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Alex T. Baria
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Pascal Tetreault
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Etienne Vachon-Presseau
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Pei-Ching Chang
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Lejian Huang
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60610, USA
| | - Marwan N. Baliki
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois 60611, USA
- Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA
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Vachon-Presseau E, Tétreault P, Petre B, Huang L, Berger SE, Torbey S, Baria AT, Mansour AR, Hashmi JA, Griffith JW, Comasco E, Schnitzer TJ, Baliki MN, Apkarian AV. Corticolimbic anatomical characteristics predetermine risk for chronic pain. Brain 2016; 139:1958-70. [PMID: 27190016 DOI: 10.1093/brain/aww100] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/16/2016] [Indexed: 12/21/2022] Open
Abstract
SEE TRACEY DOI101093/BRAIN/AWW147 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Mechanisms of chronic pain remain poorly understood. We tracked brain properties in subacute back pain patients longitudinally for 3 years as they either recovered from or transitioned to chronic pain. Whole-brain comparisons indicated corticolimbic, but not pain-related circuitry, white matter connections predisposed patients to chronic pain. Intra-corticolimbic white matter connectivity analysis identified three segregated communities: dorsal medial prefrontal cortex-amygdala-accumbens, ventral medial prefrontal cortex-amygdala, and orbitofrontal cortex-amygdala-hippocampus. Higher incidence of white matter and functional connections within the dorsal medial prefrontal cortex-amygdala-accumbens circuit, as well as smaller amygdala volume, represented independent risk factors, together accounting for 60% of the variance for pain persistence. Opioid gene polymorphisms and negative mood contributed indirectly through corticolimbic anatomical factors, to risk for chronic pain. Our results imply that persistence of chronic pain is predetermined by corticolimbic neuroanatomical factors.
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Affiliation(s)
- Etienne Vachon-Presseau
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Pascal Tétreault
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Bogdan Petre
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Lejian Huang
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Sara E Berger
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Souraya Torbey
- 2 Department of Psychiatry and Neurobehavioral Sciences, University of Virginia , 2955 Ivy Rd, Suite 210, Charlottesville, VA 22903, USA
| | - Alexis T Baria
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Ali R Mansour
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Javeria A Hashmi
- 3 Department of Anesthesia, Pain Management and Perioperative Medicine Dalhousie University, Halifax, NS, Canada B3H 4R2
| | - James W Griffith
- 4 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Erika Comasco
- 5 Department of Neuroscience, Science for Life Laboratory, Uppsala University, BMC, Pob 593, 75124, Uppsala, Sweden
| | - Thomas J Schnitzer
- 6 Northwestern University Feinberg School of Medicine, Departments of Physical Medicine and Rehabilitation and Internal Medicine/Rheumatology, 710 N. Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - Marwan N Baliki
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA 7 Rehabilitation Istitute of Chicago, 345 E Superior St, Chicago, IL 60611, USA
| | - A Vania Apkarian
- 1 Department of Physiology, Feinberg School of Medicine, Northwestern University 303 E. Chicago Ave., Chicago, IL 60611, USA
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Chang PC, Procissi D, Bao Q, Centeno MV, Baria A, Apkarian AV. Novel method for functional brain imaging in awake minimally restrained rats. J Neurophysiol 2016; 116:61-80. [PMID: 27052584 DOI: 10.1152/jn.01078.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/05/2016] [Indexed: 11/22/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) in rodents holds great promise for advancing our knowledge about human brain function. However, the use of anesthetics to immobilize rodents during fMRI experiments has restricted the type of questions that can be addressed using this technique. Here we describe an innovative procedure to train rats to be constrained without the need of any anesthesia during the whole procedure. We show that with 8-10 days of acclimation rats can be conscious and remain still during fMRI experiments under minimal stress. In addition, we provide fMRI results of conscious rodents in a variety of commonly used fMRI experimental paradigms, and we demonstrate the improved quality of these scans by comparing results when the same rodents were scanned under anesthesia. We confirm that the awake scanning procedure permits an improved evaluation of brain networks and brain response to external stimuli with minimal movement artifact. The present study further advances the field of fMRI in awake rodents, which provide more direct, forward and reverse, translational opportunities regarding brain functional correspondences between human and rodent research.
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Affiliation(s)
- Pei-Ching Chang
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Qiyuan Bao
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Maria Virginia Centeno
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alex Baria
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
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Vachon-Presseau E, Centeno MV, Ren W, Berger SE, Tétreault P, Ghantous M, Baria A, Farmer M, Baliki MN, Schnitzer TJ, Apkarian AV. The Emotional Brain as a Predictor and Amplifier of Chronic Pain. J Dent Res 2016; 95:605-12. [PMID: 26965423 DOI: 10.1177/0022034516638027] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [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: 01/19/2023] Open
Abstract
Human neuroimaging studies and complementary animal experiments now identify the gross elements of the brain involved in the chronification of pain. We briefly review these advances in relation to somatic and orofacial persistent pain conditions. First, we emphasize the importance of reverse translational research for understanding chronic pain-that is, the power of deriving hypotheses directly from human brain imaging of clinical conditions that can be invasively and mechanistically studied in animal models. We then review recent findings demonstrating the importance of the emotional brain (i.e., the corticolimbic system) in the modulation of acute pain and in the prediction and amplification of chronic pain, contrasting this evidence with recent findings regarding the role of central sensitization in pain chronification, especially for orofacial pain. We next elaborate on the corticolimbic circuitry and underlying mechanisms that determine the transition to chronic pain. Given this knowledge, we advance a new mechanistic definition of chronic pain and discuss the clinical implications of this new definition as well as novel therapeutic potentials suggested by these advances.
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Affiliation(s)
- E Vachon-Presseau
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M V Centeno
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Ren
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S E Berger
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - P Tétreault
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Ghantous
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A Baria
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Farmer
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M N Baliki
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - T J Schnitzer
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A V Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Abstract
Recent neuroimaging studies suggest that the brain adapts with pain, as well as imparts risk for developing chronic pain. Within this context, we revisit the concepts for nociception, acute and chronic pain, and negative moods relative to behavior selection. We redefine nociception as the mechanism protecting the organism from injury, while acute pain as failure of avoidant behavior, and a mesolimbic threshold process that gates the transformation of nociceptive activity to conscious pain. Adaptations in this threshold process are envisioned to be critical for development of chronic pain. We deconstruct chronic pain into four distinct phases, each with specific mechanisms, and outline current state of knowledge regarding these mechanisms: the limbic brain imparting risk, and the mesolimbic learning processes reorganizing the neocortex into a chronic pain state. Moreover, pain and negative moods are envisioned as a continuum of aversive behavioral learning, which enhance survival by protecting against threats.
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Affiliation(s)
- Marwan N Baliki
- Department of Physiology, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA.
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA; Department of Anesthesia, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA.
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Woodworth D, Mayer E, Leu K, Ashe-McNalley C, Naliboff BD, Labus JS, Tillisch K, Kutch JJ, Farmer MA, Apkarian AV, Johnson KA, Mackey SC, Ness TJ, Landis JR, Deutsch G, Harris RE, Clauw DJ, Mullins C, Ellingson BM. Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study. PLoS One 2015; 10:e0140250. [PMID: 26460744 PMCID: PMC4604194 DOI: 10.1371/journal.pone.0140250] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 02/16/2015] [Accepted: 09/23/2015] [Indexed: 12/27/2022] Open
Abstract
Studies have suggested chronic pain syndromes are associated with neural reorganization in specific regions associated with perception, processing, and integration of pain. Urological chronic pelvic pain syndrome (UCPPS) represents a collection of pain syndromes characterized by pelvic pain, namely Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), that are both poorly understood in their pathophysiology, and treated ineffectively. We hypothesized patients with UCPPS may have microstructural differences in the brain compared with healthy control subjects (HCs), as well as patients with irritable bowel syndrome (IBS), a common gastrointestinal pain disorder. In the current study we performed population-based voxel-wise DTI and super-resolution track density imaging (TDI) in a large, two-center sample of phenotyped patients from the multicenter cohort with UCPPS (N = 45), IBS (N = 39), and HCs (N = 56) as part of the MAPP Research Network. Compared with HCs, UCPPS patients had lower fractional anisotropy (FA), lower generalized anisotropy (GA), lower track density, and higher mean diffusivity (MD) in brain regions commonly associated with perception and integration of pain information. Results also showed significant differences in specific anatomical regions in UCPPS patients when compared with IBS patients, consistent with microstructural alterations specific to UCPPS. While IBS patients showed clear sex related differences in FA, MD, GA, and track density consistent with previous reports, few such differences were observed in UCPPS patients. Heat maps illustrating the correlation between specific regions of interest and various pain and urinary symptom scores showed clustering of significant associations along the cortico-basal ganglia-thalamic-cortical loop associated with pain integration, modulation, and perception. Together, results suggest patients with UCPPS have extensive microstructural differences within the brain, many specific to syndrome UCPPS versus IBS, that appear to be localized to regions associated with perception and integration of sensory information and pain modulation, and seem to be a consequence of longstanding pain.
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Affiliation(s)
- Davis Woodworth
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Emeran Mayer
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kevin Leu
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Cody Ashe-McNalley
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bruce D. Naliboff
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jennifer S. Labus
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kirsten Tillisch
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Melissa A. Farmer
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - Kevin A. Johnson
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Sean C. Mackey
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Timothy J. Ness
- Department of Anesthesiology, University of Alabama, Birmingham, Alabama, United States of America
| | - J. Richard Landis
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Georg Deutsch
- Department of Radiology, University of Alabama, Birmingham, Alabama, United States of America
| | - Richard E. Harris
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Daniel J. Clauw
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chris Mullins
- Division of Kidney, Urologic, and Hematologic Diseases; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health, Bethesda, Maryland, United States of America
| | - Benjamin M. Ellingson
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Kutch JJ, Yani MS, Asavasopon S, Kirages DJ, Rana M, Cosand L, Labus JS, Kilpatrick LA, Ashe-McNalley C, Farmer MA, Johnson KA, Ness TJ, Deutsch G, Harris RE, Apkarian AV, Clauw DJ, Mackey SC, Mullins C, Mayer EA. Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP: Research Network Neuroimaging Study. Neuroimage Clin 2015; 8:493-502. [PMID: 26106574 PMCID: PMC4474411 DOI: 10.1016/j.nicl.2015.05.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/25/2015] [Accepted: 05/29/2015] [Indexed: 01/27/2023]
Abstract
Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing. We studied men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). First resting state neuroimaging comparison CP/CPPS and healthy controls (HC) Motor cortex connectivity to insula distinguishes CP/CPPS from HC. Motor cortex connectivity to insula is among largest changes in CP/CPPS resting brain. Results provide additional evidence of motor network changes in chronic pain.
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Affiliation(s)
- Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Moheb S Yani
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel J Kirages
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Manku Rana
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Louise Cosand
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jennifer S Labus
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lisa A Kilpatrick
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cody Ashe-McNalley
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melissa A Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin A Johnson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Division of Pain Medicine, Stanford, CA, USA
| | - Timothy J Ness
- Departments of Radiology and Anesthesiology, Birmingham Medical Center, University of Alabama, Birmingham, AL, USA
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, Birmingham Medical Center, University of Alabama, Birmingham, AL, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Division of Pain Medicine, Stanford, CA, USA
| | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Emeran A Mayer
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Farmer MA, Huang L, Martucci K, Yang CC, Maravilla KR, Harris RE, Clauw DJ, Mackey S, Ellingson BM, Mayer EA, Schaeffer AJ, Apkarian AV. Brain White Matter Abnormalities in Female Interstitial Cystitis/Bladder Pain Syndrome: A MAPP Network Neuroimaging Study. J Urol 2015; 194:118-26. [PMID: 25711200 DOI: 10.1016/j.juro.2015.02.082] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Several chronic pain conditions may be distinguished by condition specific brain anatomical and functional abnormalities on imaging, which are suggestive of underlying disease processes. We present what is to our knowledge the first characterization of interstitial cystitis/bladder pain syndrome associated white matter (axonal) abnormalities based on multicenter neuroimaging from the MAPP Research Network. MATERIALS AND METHODS We assessed 34 women with interstitial cystitis/bladder pain syndrome and 32 healthy controls using questionnaires on pain, mood and daily function. White matter microstructure was evaluated by diffusion tensor imaging to model directional water flow along axons or fractional anisotropy. Regions correlating with clinical parameters were further examined for gender and syndrome dependence. RESULTS Women with interstitial cystitis/bladder pain syndrome showed numerous white matter abnormalities that correlated with pain severity, urinary symptoms and impaired quality of life. Interstitial cystitis/bladder pain syndrome was characterized by decreased fractional anisotropy in aspects of the right anterior thalamic radiation, the left forceps major and the right longitudinal fasciculus. Increased fractional anisotropy was detected in the right superior and bilateral inferior longitudinal fasciculi. CONCLUSIONS To our knowledge we report the first characterization of brain white matter abnormalities in women with interstitial cystitis/bladder pain syndrome. Regional decreases and increases in white matter integrity across multiple axonal tracts were associated with symptom severity. Given that white matter abnormalities closely correlated with hallmark symptoms of interstitial cystitis/bladder pain syndrome, including bladder pain and urinary symptoms, brain anatomical alterations suggest that there are neuropathological contributions to chronic urological pelvic pain.
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Affiliation(s)
- Melissa A Farmer
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lejian Huang
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Katherine Martucci
- Division of Pain Medicine, Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, Washington
| | | | - Richard E Harris
- Department of Anesthesiology and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Sean Mackey
- Division of Pain Medicine, Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Benjamin M Ellingson
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Anthony J Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery and Anesthesia, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Baliki MN, Chang PC, Baria AT, Centeno MV, Apkarian AV. CORRIGENDUM: Resting-state functional reorganization of the rat limbic system following neuropathic injury. Sci Rep 2015; 5:7603. [PMID: 25612839 PMCID: PMC4303879 DOI: 10.1038/srep07603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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45
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Berger SE, Baria AT, Baliki MN, Mansour A, Herrmann KM, Torbey S, Huang L, Parks EL, Schnizter TJ, Apkarian AV. Risky monetary behavior in chronic back pain is associated with altered modular connectivity of the nucleus accumbens. BMC Res Notes 2014; 7:739. [PMID: 25331931 PMCID: PMC4210520 DOI: 10.1186/1756-0500-7-739] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
Background The nucleus accumbens (NAc) has a well established role in reward processing. Yet, there is growing evidence showing that NAc function, and its connections to other parts of the brain, is also critically involved in the emergence of chronic back pain (CBP). Pain patients are known to perform abnormally in reward-related tasks, which suggests an intriguing link between pain, NAc connectivity, and reward behavior. In the present study, we compared performance on a gambling task (indicating willingness to risk losing money) between healthy pain-free controls (CON) and individuals with CBP. We then measured modular connectivity of each participants’ NAc with resting state functional MRI to investigate how connectivity accounts for reward behavior in the presence and absence of pain. Results We found gain sensitivity was significantly higher in CBP patients. These scores were significantly correlated to connectivity within the NAc module defined by CON subjects ( which had strong connections to the frontal cortex), but not within that defined by CBP patients ( which was more strongly connected to subcortical areas). An important part of our study was based on the precedence that a range of behaviors, from simple to complex, can be predicted from brain activity during rest. Thus, to corroborate our results we compared them closely to an independent study correlating the same connectivity metric to impulsive behaviors in healthy participants. We found that our CBP patients were highly similarin connectivity to this study’s highly-impulsive healthy subjects, strengthening the notion that there is an important link between the brain systems that support chronic pain and reward processing. Conclusions Our results support previous findings that chronic back pain is accompanied by altered connectivity of the NAc. This lends itself to riskier behavior in these patients, a finding which establishes a potential cognitive consequence or co-morbidity of long-term pain and provides a behavioral link to growing research showing that chronic pain is related to abnormal changes in the dopaminergic system.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, 300 E, Superior St, 60611 Chicago, IL, USA.
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Abstract
Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific view of pain, which has focused on encoding and representation of nociceptive signals. We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace, implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain. We briefly review the evidence generated to date for the proposed model and emphasize that the details of underlying mechanisms remain to be expounded.
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Affiliation(s)
- A R Mansour
- Department of Physiology, Surgery, and Rehabilitation Institute of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M A Farmer
- Department of Physiology, Surgery, and Rehabilitation Institute of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M N Baliki
- Department of Physiology, Surgery, and Rehabilitation Institute of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Vania Apkarian
- Department of Physiology, Surgery, and Rehabilitation Institute of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Department of Anesthesia, Surgery, and Rehabilitation Institute of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Baliki MN, Mansour AR, Baria AT, Apkarian AV. Functional reorganization of the default mode network across chronic pain conditions. PLoS One 2014; 9:e106133. [PMID: 25180885 PMCID: PMC4152156 DOI: 10.1371/journal.pone.0106133] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 08/01/2014] [Indexed: 11/24/2022] Open
Abstract
Chronic pain is associated with neuronal plasticity. Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA). We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN) exhibited deviations from healthy controls. All patient groups showed decreased connectivity of medial prefrontal cortex (MPFC) to the posterior constituents of the DMN, and increased connectivity to the insular cortex in proportion to the intensity of pain. Multiple DMN regions, especially the MPFC, exhibited increased high frequency oscillations, conjoined with decreased phase locking with parietal regions involved in processing attention. Both phase and frequency changes correlated to pain duration in OA and CBP patients. Thus chronic pain seems to reorganize the dynamics of the DMN and as such reflect the maladaptive physiology of different types of chronic pain.
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Affiliation(s)
- Marwan N. Baliki
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ali R. Mansour
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Alex T. Baria
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Anesthesia, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Rehabilitation Institute of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Kairys AE, Schmidt-Wilcke T, Puiu T, Ichesco E, Labus JS, Martucci K, Farmer MA, Ness TJ, Deutsch G, Mayer EA, Mackey S, Apkarian AV, Maravilla K, Clauw DJ, Harris RE. Increased brain gray matter in the primary somatosensory cortex is associated with increased pain and mood disturbance in patients with interstitial cystitis/painful bladder syndrome. J Urol 2014; 193:131-7. [PMID: 25132239 DOI: 10.1016/j.juro.2014.08.042] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Interstitial cystitis is a highly prevalent pain condition estimated to affect 3% to 6% of women in the United States. Emerging data suggest there are central neurobiological components to the etiology of this disease. We report the first brain structural imaging findings from the MAPP network with data on more than 300 participants. MATERIALS AND METHODS We used voxel based morphometry to determine whether human patients with chronic interstitial cystitis display changes in brain morphology compared to healthy controls. A total of 33 female patients with interstitial cystitis without comorbidities and 33 age and gender matched controls taken from the larger sample underwent structural magnetic resonance imaging at 5 MAPP sites across the United States. RESULTS Compared to controls, females with interstitial cystitis displayed significant increased gray matter volume in several regions of the brain including the right primary somatosensory cortex, the superior parietal lobule bilaterally and the right supplementary motor area. Gray matter volume in the right primary somatosensory cortex was associated with greater pain, mood (anxiety) and urological symptoms. We explored these correlations in a linear regression model, and found independent effects of these 3 measures on primary somatosensory cortex gray matter volume, namely clinical pain (McGill pain sensory total), a measure of urgency and anxiety (HADS). CONCLUSIONS These data support the notion that changes in somatosensory gray matter may have an important role in pain sensitivity as well as affective and sensory aspects of interstitial cystitis. Further studies are needed to confirm the generalizability of these findings to other pain conditions.
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Affiliation(s)
- Anson E Kairys
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | | | - Tudor Puiu
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Eric Ichesco
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan.
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Katherine Martucci
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Melissa A Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Timothy J Ness
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sean Mackey
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kenneth Maravilla
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel J Clauw
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Richard E Harris
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
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Pollema-Mays SL, Centeno MV, Apkarian AV, Martina M. Expression of DNA methyltransferases in adult dorsal root ganglia is cell-type specific and up regulated in a rodent model of neuropathic pain. Front Cell Neurosci 2014; 8:217. [PMID: 25152711 PMCID: PMC4126486 DOI: 10.3389/fncel.2014.00217] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 01/18/2014] [Accepted: 07/17/2014] [Indexed: 11/13/2022] Open
Abstract
Neuropathic pain is associated with hyperexcitability and intrinsic firing of dorsal root ganglia (DRG) neurons. These phenotypical changes can be long lasting, potentially spanning the entire life of animal models, and depend on altered expression of numerous proteins, including many ion channels. Yet, how DRGs maintain long-term changes in protein expression in neuropathic conditions remains unclear. DNA methylation is a well-known mechanism of epigenetic control of gene expression and is achieved by the action of three enzymes: DNA methyltransferase (DNMT) 1, 3a, and 3b, which have been studied primarily during development. We first performed immunohistochemical analysis to assess whether these enzymes are expressed in adult rat DRGs (L4–5) and found that DNMT1 is expressed in both glia and neurons, DNMT3a is preferentially expressed in glia and DNMT3b is preferentially expressed in neurons. A rat model of neuropathic pain was then used to determine whether nerve injury may induce epigenetic changes in DRGs at multiple time points after pain onset. Real-time RT PCR analysis revealed robust and time-dependent changes in DNMT transcript expression in ipsilateral DRGs from spared nerve injury (SNI) but not sham rats. Interestingly, DNMT3b transcript showed a robust upregulation that appeared already 1 week after surgery and persisted at 4 weeks (our endpoint); in contrast, DNMT1 and DNMT3a transcripts showed only moderate upregulation that was transient and did not appear until the second week. We suggest that DNMT regulation in adult DRGs may be a contributor to the pain phenotype and merits further study.
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Affiliation(s)
- Sarah L Pollema-Mays
- Department of Physiology, Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Maria V Centeno
- Department of Physiology, Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - A V Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Marco Martina
- Department of Physiology, Northwestern University Feinberg School of Medicine Chicago, IL, USA
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50
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Mutso AA, Petre B, Huang L, Baliki MN, Torbey S, Herrmann KM, Schnitzer TJ, Apkarian AV. Reorganization of hippocampal functional connectivity with transition to chronic back pain. J Neurophysiol 2013; 111:1065-76. [PMID: 24335219 DOI: 10.1152/jn.00611.2013] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [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: 12/20/2022] Open
Abstract
The hippocampus has been shown to undergo significant changes in rodent models of neuropathic pain; however, the role of the hippocampus in human chronic pain and its contribution to pain chronification have remained unexplored. Here we examine hippocampal processing during a simple visual attention task. We used functional MRI to identify intrinsic and extrinsic hippocampal functional connectivity (synchronous neural activity), comparing subacute back pain (SBP, back pain 1-4 mo) and chronic back pain (CBP, back pain >10 yr) patients to control (CON) subjects. Both groups showed more extensive hippocampal connectivity than CON subjects. We then examined the evolution of hippocampal connectivity longitudinally in SBP patients who recovered (SBPr, back pain decreased >20% in 1 yr) and those with persistent pain (SBPp). We found that SBPp and SBPr subjects have distinct changes in hippocampal-cortical connectivity over 1 yr; specifically, SBPp subjects showed large decreases in hippocampal connectivity with medial prefrontal cortex (HG-mPFC). Furthermore, in SBP patients the strength of HG-mPFC reflected variations in back pain over the year. These relationships were replicated when examined in a different task performed by SBP patients (rating fluctuations of back pain), indicating that functional connectivity of the hippocampus changes robustly in subacute pain and the nature of these changes depends on whether or not patients recover from SBP. The observed reorganization of processing within the hippocampus and between the hippocampus and the cortex seems to contribute to the transition from subacute to chronic pain and may also underlie learning and emotional abnormalities associated with chronic pain.
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Affiliation(s)
- Amelia A Mutso
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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