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 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.

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.

The visual time analog scale: simple, novel measurement approach to assess pain in patients with chronic pain

2021 ◽  
Vol 11 (4) ◽  
pp. 357-368
Author(s):  
Akiko Okifuji ◽  
Reiko Mitsunaga ◽  
Yuri Kida ◽  
Gary W Donaldson
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Chronic Back Pain ◽  
Preliminary Evaluation ◽  
Numerical Pain Rating Scale ◽  
Chronic Pain Patients ◽  
Pain Patients ◽  
Pain Rating Scale ◽  
Measurement Approach

Aim: We conducted a preliminary evaluation of a newly developed, time-based visual time analog (VITA) scale for measuring pain in chronic pain patients. Materials & methods: 40 patients with chronic back pain rated their pain over four visits using numerical (pain) rating scale (NRS) and VITA assessing pain intensity by distributing the amount of time spent on ‘not aware of pain’ (blue), ‘aware of nothing but pain’ (red) and time in between (yellow). Results: The NRS scores were correlated with the VITA Red but not with VITA Blue. The psychometric analyses revealed that VITA achieved greater reliability and sensitivity than did NRS. Conclusion: The results provide preliminary support for VITA scale for assessing pain intensity in patients with chronic pain.

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.

F225 SEE WHAT YOU FEEL BEHIND: LOOKING AT THEIR OWN BACK REDUCES EXPERIMENTAL PAIN INTENSITY IN CHRONIC BACK PAIN PATIENTS

2011 ◽  
Vol 5 (S1) ◽  
pp. 132-132
Author(s):  
M. Diers ◽  
W. Zieglgänsberger ◽  
P. Yilmaz ◽  
R. Bekrater-Bodmann ◽  
J. Foell ◽  
...  
Keyword(s):  
Back Pain ◽  
Pain Intensity ◽  
Chronic Back Pain ◽  
Experimental Pain ◽  
Pain Patients

scholarly journals Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 353
Author(s):  
Sebastian Lukas König ◽  
Michal Prusak ◽  
Sibylle Pramhas ◽  
Marita Windpassinger
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Treatment Response ◽  
Rating Scale ◽  
Significant Proportion ◽  
Outpatient Setting ◽  
Baseline Visit ◽  
Wide Range ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.

scholarly journals Watching your pain site reduces pain intensity in chronic back pain patients

2015 ◽  
Vol 20 (4) ◽  
pp. 581-585 ◽  
Author(s):  
M. Diers ◽  
A. Löffler ◽  
W. Zieglgänsberger ◽  
J. Trojan
Keyword(s):  
Back Pain ◽  
Pain Intensity ◽  
Chronic Back Pain ◽  
Pain Site ◽  
Pain Patients

scholarly journals Psychological support of patients with chronic pain on multidisciplinary management

2020 ◽  
Vol 14 (4) ◽  
pp. 206-216
Author(s):  
Vladimir V. Khinovker ◽  
M. V. Alkina ◽  
P. A. Chernomurova ◽  
A. A. Gazenkampf
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Cognitive Behavioral Therapy ◽  
Pain Intensity ◽  
Chronic Back Pain ◽  
Behavioral Therapy ◽  
Self Regulation ◽  
Psychological Support ◽  
Support Program ◽  
Cognitive Behavioral

Background. Although pain has been studied extensively, its treatment remains an urgent problem. Pain can be caused by various factors, both at the physiological and psychological levels. Patients with chronic pain develop specific psychological problems. Viewing pain through the prism of a psychosocial approach involves the use and development of new psychotechnologies. Objective. This study aimed to explore the possibilities of improving the emotional state and reducing pain intensity in patients with chronic back pain using mindfulness and cognitive behavioral therapy techniques. Materials and methods. The study sample consisted of 30 patients with chronic back pain (20 women, 10 men) who were on outpatient treatment at a pain management center. Results and discussion. Based on the results of the analysis and generalization of literature sources, we prepared a psychological support program, including cognitive behavioral and mindfulness techniques. The program consisted of three blocks: diagnostics, exercises, and repeat diagnostics. Experimental data have shown the possibility and confirmed the effectiveness of reducing levels of depression, anxiety, and pain. Conclusions. Patients with chronic pain often present with varying levels of depression and anxiety symptoms and a reduced quality of life. A medical and psychological support program using mindfulness techniques and cognitive behavioral therapy positively influenced the level of anxiety, depression, and pain intensity. A medical and psychological support program helped patients learned methods of self-regulation and self-relaxation.

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