scholarly journals Intrinsic network activity reflects the ongoing experience of chronic pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pauline Jahn ◽  
Bettina Deak ◽  
Astrid Mayr ◽  
Anne Stankewitz ◽  
Daniel Keeser ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Chronic Migraine ◽  
Time Course ◽  
Chronic Back Pain ◽  
Cortical Network ◽  
Network Activity ◽  
Subjective Perception ◽  
Promising Tool ◽  
Pain Patients

AbstractAnalyses of intrinsic network activity have been instrumental in revealing cortical processes that are altered in chronic pain patients. In a novel approach, we aimed to elucidate how intrinsic functional networks evolve in regard to the fluctuating intensity of the experience of chronic pain. In a longitudinal study with 156 fMRI sessions, 20 chronic back pain patients and 20 chronic migraine patients were asked to continuously rate the intensity of their endogenous pain. We investigated the relationship between the fluctuation of intrinsic network activity with the time course of subjective pain ratings. For chronic back pain, we found increased cortical network activity for the salience network and a local pontine network, as well as decreased network activity in the anterior and posterior default mode network for higher pain intensities. Higher pain intensities in chronic migraine were accompanied with lower activity in a prefrontal cortical network. By taking the perspective of the individual, we focused on the variability of the subjective perception of pain, which include phases of relatively low pain and phases of relatively high pain. The present design of the assessment of ongoing endogenous pain can be a powerful and promising tool to assess the signature of a patient’s endogenous pain encoding.

The periaqueductal gray and descending pain modulation: why should we study them and what role do they play in chronic pain?

2015 ◽  
Vol 114 (4) ◽  
pp. 2080-2083 ◽  
Author(s):  
Kasey S. Hemington ◽  
Marie-Andrée Coulombe
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Functional Connectivity ◽  
Recent Literature ◽  
Chronic Back Pain ◽  
Periaqueductal Gray ◽  
Pain Modulation ◽  
Pain Research ◽  
Descending Pain Modulation ◽  
Pain Patients

In this Neuro Forum we discuss the significance of a recent study by Yu et al. ( Neuroimage Clin 6: 100–108, 2014). The authors examined functional connectivity of a key node of the descending pain modulation pathway, the periaqueductal gray (PAG), in chronic back pain patients. Altered PAG connectivity to pain-related regions was found; we place results within the context of recent literature and emphasize the importance of understanding the descending component of pain in pain research.

scholarly journals Loss of nucleus accumbens low-frequency fluctuations is a signature of chronic pain

2020 ◽  
Vol 117 (18) ◽  
pp. 10015-10023 ◽  
Author(s):  
Meena M. Makary ◽  
Pablo Polosecki ◽  
Guillermo A. Cecchi ◽  
Ivan E. DeAraujo ◽  
Daniel S. Barron ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Nucleus Accumbens ◽  
Chronic Low Back Pain ◽  
Chronic Back Pain ◽  
Chronic Phase ◽  
Anterior Cingulate ◽  
Low Back ◽  
Pain Patients

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.

scholarly journals Chronic Pain Patients Exhibit Individually Unique Cortical Signatures of Pain

2020 ◽  
Author(s):  
Astrid Mayr ◽  
Pauline Jahn ◽  
Anne Stankewitz ◽  
Bettina Deak ◽  
Anderson Winkler ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Chronic Back Pain ◽  
Anterior Insula ◽  
Individual Level ◽  
Intensity Changes ◽  
Complex Picture ◽  
The Individual ◽  
Pain Patients

AbstractWe investigated how the trajectory of pain patients’ ongoing and fluctuating pain is encoded in the brain. In repeated fMRI sessions, 20 chronic back pain patients and 20 chronic migraineurs were asked to continuously rate the intensity of their endogenous pain. Linear mixed effects models were used to disentangle cortical processes related to pain intensity and to pain intensity changes. We found that the intensity of pain in chronic back pain patients is encoded in the anterior insula, the frontal operculum, and the pons; the change of pain of chronic back pain and chronic migraine patients is mainly encoded in the anterior insula. At the individual level, we identified a more complex picture where each patient exhibited their own signature of endogenous pain encoding. The diversity of the individual cortical signatures of chronic pain encoding results adds to the understanding of chronic pain as a complex and multifaceted disease.

scholarly journals Individually Unique Dynamics of Cortical Connectivity Reflect the Ongoing Intensity of Chronic Pain

2021 ◽  
Author(s):  
Astrid Mayr ◽  
Pauline Jahn ◽  
Bettina Deak ◽  
Anne Stankewitz ◽  
Vasudev Devulapally ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Chronic Back Pain ◽  
Personalised Medicine ◽  
Brain Regions ◽  
Cortical Connectivity ◽  
Wide Range ◽  
The Individual ◽  
Pain Patients

Background. Chronic pain diseases are characterised by an ongoing and fluctuating endogenous pain, yet it remains to be elucidated how this is reflected by the dynamics of ongoing functional cortical connections. The present study addresses this disparity by taking the individual perspective of pain patients into account, which is the varying intensity of endogenous pain. Methods. To this end, we investigated the cortical encoding of 20 chronic back pain patients and 20 chronic migraineurs in four repeated fMRI sessions. During the recording, the patients were asked to continuously rate their pain intensity. A brain parcellation approach subdivided the whole brain into 408 regions. A 10 s sliding-window connectivity analysis computed the pair-wise and time-varying connectivity between all brain regions across the entire recording period. Linear mixed effects models were fitted for each pair of brain regions to explore the relationship between cortical connectivity and the observed trajectory of the patients' fluctuating endogenous pain. Results. Two pain processing entities were taken into account: pain intensity (high, middle, low pain) and the direction of pain intensity changes (rising vs. falling pain). Overall, we found that periods of high and increasing pain were predominantly related to low cortical connectivity. For chronic back pain this applies to the pain intensity-related connectivity for limbic and cingulate areas, and for the precuneus. The change of pain intensity was subserved by connections in left parietal opercular regions, right insular regions, as well as large parts of the parietal, cingular and motor cortices. The change of pain intensity direction in chronic migraine was reflected by decreasing connectivity between the anterior insular cortex and orbitofrontal areas, as well as between the PCC and frontal and ACC regions. Conclusions. Interestingly, the group results were not mirrored by the individual patterns of pain-related connectivity, which is suggested to deny the idea of a common neuronal core problem for chronic pain diseases. In a similar vein, our findings are supported by the experience of clinicians, who encounter patients with a unique composition of characteristics: personality traits, various combinations of symptoms, and a wide range of individual responses to treatment. The diversity of the individual cortical signatures of chronic pain encoding results adds to the understanding of chronic pain as a complex and multifaceted disease. The present findings support recent developments for more personalised medicine.

scholarly journals Functional Connectivity Alterations: Novel Therapy and Future Implications in Chronic Pain Management

2018 ◽  
Vol 1 (21;1) ◽  
pp. E207-E214 ◽  
Author(s):  
Dr. Stephen Thorp
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Management ◽  
Functional Connectivity ◽  
Diabetic Neuropathy ◽  
Chronic Back Pain ◽  
Brain Activity ◽  
Pain Syndrome ◽  
Pain Patients ◽  
The Brain

Background: Chronic pain is a major public health problem resulting in physical and emotional pain for individuals and families, loss of productivity, and an annual cost of billions of dollars. The lack of objective measures available to aid in diagnosis and evaluation of therapies for chronic pain continues to be a challenge for the clinician. Objectives: Functional magnetic resonance imaging (fMRI) is an imaging technique that can establish regional areas of interest and examine synchronous neuronal activity in functionally related but anatomically distinct regions of the brain, known as functional connectivity. Study Design: The present investigation examines changes in functional connectivity in 4 common pain syndromes: chronic back pain (CBP), fibromyalgia, diabetic neuropathy, and complex regional pain syndrome (CRPS). Setting: This is a review of the current understanding of functional connectivity. Methods: Utilizing functional imaging, patients with these conditions have been shown to have significant structural and functional differences when compared to healthy controls. Results: Functional connectivity, therefore, has the potential to assist in diagnostic classification of different pain conditions, predict individual responses to specific therapeutic interventions, and serve as a gateway for personalized medicine. Indirect activation of brain activity can be seen by the blood flow to the brain at specific sites, with chronic pain patients having increased brain activity. Limitations: The present investigation is limited in that few studies have examined this relatively new modality. Conclusions: Knowing and observing the brain’s activity as related to pain gives pain patients an opportunity to decrease pain-related brain activity and decrease severe chronic pain. This modality can be used along with interventional pain management techniques in order to provide optimum pain relief. Key words: Functional connectivity, fMRI, chronic pain, chronic back pain, fibromyalgia, diabetic neuropathy, chronic regional pain syndrome

scholarly journals Classification and characterisation of brain network changes in chronic back pain: a multicenter study

2017 ◽  
Author(s):  
Hiroaki Mano ◽  
Gopal Kotecha ◽  
Kenji Leibnitz ◽  
Takashi Matsubara ◽  
Aya Nakae ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Sensorimotor Cortex ◽  
Network Architecture ◽  
Cross Validation ◽  
Chronic Back Pain ◽  
Brain Network ◽  
Support Vector ◽  
Data Set ◽  
Pain Patients

AbstractChronic pain is a common and often disabling condition, and is thought to involve a combination of peripheral and central neurobiological factors. However, the extent and nature of changes in the brain is poorly understood. Here, we investigated brain network architecture using resting state fMRI data collected from chronic back pain patients in UK and Japan (41 patients, 56 controls). Using a machine learning approach (support vector machine), we found that brain network patterns reliably classified chronic pain patients in a third, independent open data set with an accuracy of 63%, whilst 68% was attained in cross validation of all data. We then developed a deep learning classifier using a conditional variational autoencoder, which also yield yielded 63% generalisation and 68% cross-validation accuracy. Given the existence of reliable network changes, we next studied the graph topology of the network, and found consistent evidence of hub disruption based on clustering and betweenness centrality of brain nodes in pain patients. To examine this in more detail, we developed a multislice modularity algorithm to identify a consensus pattern of modular reorganisation of brain nodes across the entire data set. This revealed evidence of significant changes in the modular identity of several brain regions, most notably including broad regions of bilateral sensorimotor cortex, subregions of which also contributed to classifier performance. These results provide evidence of consistent and characteristic brain network changes in chronic pain, and highlight extensive reorganisaton of the network architecture of sensorimotor cortex.

scholarly journals Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 327
Author(s):  
Dominique Josephine Dimmek ◽  
Christoph Korallus ◽  
Sabine Buyny ◽  
Gutenbrunner Christoph ◽  
Ralf Lichtinghagen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Immune Cells ◽  
Chronic Widespread Pain ◽  
Anxiety And Depression ◽  
Low Back ◽  
Widespread Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

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