scholarly journals The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies

2020 ◽  
Vol 9 (6) ◽  
pp. 1945 ◽  
Author(s):  
Rose M. Caston ◽  
Elliot H. Smith ◽  
Tyler S. Davis ◽  
John D. Rolston
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Electrical Stimulation ◽  
Brain Stimulation ◽  
Pain Perception ◽  
The United States ◽  
Anterior Cingulate ◽  
History Of ◽  
The Brain ◽  
Stimulation Of

Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain.

scholarly journals Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

2021 ◽  
Vol 11 (5) ◽  
pp. 639
Author(s):  
David Bergeron ◽  
Sami Obaid ◽  
Marie-Pierre Fournier-Gosselin ◽  
Alain Bouthillier ◽  
Dang Khoa Nguyen
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
High Frequency ◽  
Brain Lesion ◽  
Low Frequency ◽  
Posterior Insula ◽  
Deep Brain ◽  
Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

New Opportunities, the Brain Drain, and the Guptas

2019 ◽  
pp. 33-54
Author(s):  
Jennifer B. Saunders
Keyword(s):  
United States ◽  
Brain Drain ◽  
Extended Family ◽  
The United States ◽  
Social Community ◽  
The Family ◽  
Key Players ◽  
History Of ◽  
Race And Religion ◽  
The Brain

This chapter provides information about the significant contexts of the Hindu American community’s narrative performances. Reviewing reasons behind why people immigrate, it begins with general theories of immigration and then concentrates on the specific reasons why Indians left India during the period after 1947. The chapter then shifts its focus to the context in the United States as a receiving site for immigrants from India with particular attention to race and religion, two dominant themes in American immigration that have contributed to the Guptas’ experiences and the dynamics of their community-making activities. This leads to a discussion of the significance of religion for migrants in the United States before introducing the more specific religious context of the Guptas’ community. Finally, the chapter expands its lens to their transnational extended family with family trees, a description of their social community, and a specific history of key players in the family.

scholarly journals Manganese-enhanced MRI depicts a reduction in brain responses to nociception upon mTOR inhibition in chronic pain rats

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Myeounghoon Cha ◽  
Songyeon Choi ◽  
Kyeongmin Kim ◽  
Bae Hwan Lee
Keyword(s):  
Chronic Pain ◽  
Nerve Injury ◽  
Pain Perception ◽  
Imaging Techniques ◽  
Insular Cortex ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Related Area ◽  
Mtor Inhibition ◽  
The Brain

AbstractNeuropathic pain induced by a nerve injury can lead to chronic pain. Recent studies have reported hyperactive neural activities in the nociceptive-related area of the brain as a result of chronic pain. Although cerebral activities associated with hyperalgesia and allodynia in chronic pain models are difficult to represent with functional imaging techniques, advances in manganese (Mn)-enhanced magnetic resonance imaging (MEMRI) could facilitate the visualization of the activation of pain-specific neural responses in the cerebral cortex. In order to investigate the alleviation of pain nociception by mammalian target of rapamycin (mTOR) modulation, we observed cerebrocortical excitability changes and compared regional Mn2+ enhancement after mTOR inhibition. At day 7 after nerve injury, drugs were applied into the intracortical area, and drug (Vehicle, Torin1, and XL388) effects were compared within groups using MEMRI. Therein, signal intensities of the insular cortex (IC), primary somatosensory cortex of the hind limb region, motor cortex 1/2, and anterior cingulate cortex regions were significantly reduced after application of mTOR inhibitors (Torin1 and XL388). Furthermore, rostral-caudal analysis of the IC indicated that the rostral region of the IC was more strongly associated with pain perception than the caudal region. Our data suggest that MEMRI can depict pain-related signal changes in the brain and that mTOR inhibition is closely correlated with pain modulation in chronic pain rats.

scholarly journals Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Walter C. Prozialeck ◽  
Peter C. Lamar ◽  
Michael Krupp ◽  
Matthew Moon ◽  
Laura E. Phelps ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Southeast Asia ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Potential Harm ◽  
History Of ◽  
Chronic Pain Conditions

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

scholarly journals Musical Hallucinations in Chronic Pain: The Anterior Cingulate Cortex Regulates Internally Generated Percepts

2021 ◽  
Vol 12 ◽  
Author(s):  
Ashlyn Schmitgen ◽  
Jeremy Saal ◽  
Narayan Sankaran ◽  
Maansi Desai ◽  
Isabella Joseph ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Anterior Cingulate Cortex ◽  
Case Series ◽  
Cingulate Cortex ◽  
Brain Network ◽  
Anterior Cingulate ◽  
Functional Brain Network ◽  
Band Activity ◽  
Stimulation Of

The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.

Electrical stimulation of the brain in treatment of chronic pain

1985 ◽  
Vol 62 (3) ◽  
pp. 389-396 ◽  
Author(s):  
Ronald F. Young ◽  
Richard Kroening ◽  
Wayne Fulton ◽  
Robert A. Feldman ◽  
Israel Chambi
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Gray Matter ◽  
Pain Treatment ◽  
Psychiatric Evaluation ◽  
Content Type ◽  
The Brain ◽  
Fine Print ◽  
Stimulation Of

✓ Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

scholarly journals Manganese-enhanced MRI depicts a reduction in brain response to nociception upon mTOR inhibition in chronic pain rats

2020 ◽  
Author(s):  
Myeounghoon Cha ◽  
Songyeon Choi ◽  
Kyeongmin Kim ◽  
Bae Hwan Lee
Keyword(s):  
Chronic Pain ◽  
Nerve Injury ◽  
Pain Perception ◽  
Imaging Techniques ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Brain Response ◽  
Related Area ◽  
Mtor Inhibition ◽  
The Brain

Abstract Neuropathic pain induced by a nerve injury can lead to chronic pain. Recent studies have reported hyperactive neural activities in the nociceptive-related area of the brain as a result of chronic pain. Although cerebral activities associated with hyperalgesia and allodynia in chronic pain models are difficult to represent with functional imaging techniques, advances in manganese (Mn)-enhanced magnetic resonance imaging (MEMRI) could facilitate the visualization of the activation of pain-specific neural responses in the cerebral cortex. In order to investigate the alleviation of pain nociception by mammalian target of rapamycin (mTOR) modulation, we observed cerebrocortical excitability changes and compared regional Mn 2+ enhancement after mTOR inhibition. At day 7 after nerve injury, drugs were applied into the intracortical area, and drug (Vehicle, Torin1, and XL388) effects were compared within groups using MEMRI. Therein, signal intensities of the insular cortex (IC), primary somatosensory cortex of the hind limb region, motor cortex 1/2, and anterior cingulate cortex regions were significantly reduced after application of mTOR inhibitors (Torin1 and XL388). Furthermore, rostral-caudal analysis of the IC indicated that the rostral region of the IC was more strongly associated with pain perception than the caudal region. Our data suggest that MEMRI can depict pain-related signal changes in the brain and that mTOR inhibition is closely correlated with pain modulation in chronic pain rats.

Lever-Pressing Performance for Brain Stimulation on F-I and V-I Schedules in a Single-Lever Situation

1970 ◽  
Vol 26 (3) ◽  
pp. 699-706 ◽  
Author(s):  
Stephen Brown ◽  
Jay A. Trowill
Keyword(s):  
Electrical Stimulation ◽  
Brain Stimulation ◽  
Lever Press ◽  
Variable Interval ◽  
Fixed Interval ◽  
Schedule Of Reinforcement ◽  
Single Lever ◽  
Lever Pressing ◽  
The Brain ◽  
Stimulation Of

Rats were trained to lever press for electrical stimulation of the brain (ESB) and ultimately were assigned to either a fixed interval 1 min. (FI-1 min.) or a variable interval 1 min. (VI-1 min.) schedule of reinforcement. All Ss easily attained and maintained responding on the schedule to which they had been assigned. Patterns of responding during training and extinction were similar to those observed when conventional rewards, such as food or water, are used. Fixed-interval Ss demonstrated scalloped responding; variable-interval Ss demonstrated steady rates of responding. The implications of these results for understanding ESB as a reward are discussed.

scholarly journals Exploring the Role of Awe in Architecture as a Pain Disruptor- A Call for New Research

2020 ◽  
Author(s):  
Miram Hoffman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Perception ◽  
The United States ◽  
Management Tool ◽  
Opioid Overdose ◽  
Contributing Factors ◽  
Diverse Range ◽  
The Impact

Chronic pain is a widespread and complex phenomenon, driven by a diverse range of factors. Pain management has become a significant concern over the past several decades in the United States as controversy has grown surrounding the use of opioids for chronic pain management, the use of which has led to abuse and addiction. The Centers for Disease Control and Prevention (CDC) reports that 128 people die in the United States every day from an opioid overdose, whether obtained illicitly or by prescription. While opioids remain one of the frontline methods for pain management, their long term safety and efficacy has come under scrutiny. As with any complex systemic issue, there are many contributing factors to chronic pain and pain management. This paper proposes that the experience of awe – specifically elicited by design of the built environment – can serve as an innovative, non-pharmacological pain management tool. Awe is an emotional response to perceptually vast stimuli, precipitating accommodation or a shift in existing mental structures. The author hypothesizes that awe can be used as a form of the proven self-regulating pain management method known as reappraisal. Pain reappraisal is cognitive reframing of the context and meaning of pain, changing the value that pain is assigned and resulting in decreased pain perception. This paper explores the pertinent intersection of emotions, neuroscience, and the impact of the physical environment on our health and wellbeing. The intention of this paper is to call for a new line of research and does not attempt to address methods or results at this time.

Effects of Sodium Phenobarbital on Brain Stimulation Behavior, Behavioral Seizures, and EEG Seizure Activity

1978 ◽  
Vol 42 (3) ◽  
pp. 1007-1016 ◽  
Author(s):  
Sharon N. Schnare ◽  
Irmingard I. Lenzer
Keyword(s):  
Electrical Stimulation ◽  
Brain Stimulation ◽  
Seizure Activity ◽  
Sprague Dawley ◽  
Continuous Reinforcement ◽  
Sprague Dawley Rats ◽  
Sodium Phenobarbital ◽  
The Brain ◽  
Rate Of Response ◽  
Stimulation Of

The effects of sodium phenobarbital on (a) behavior reinforced by electrical stimulation of the brain, (b) behavioral seizures, and (c) EEG seizure activity were observed in seven male Sprague-Dawley rats. Rate of response on placebo day, over a 30-min. continuous reinforcement session, was compared to rate of response on drug day; an increase in response on the drug day over the placebo day was called a positive phenobarbital effect and a decrease a negative phenobarbital effect. For some animals the positive phenobarbital effect disappeared when the animal's rate of response was calculated for seizure-free time, i.e., when the time spent in seizure was subtracted from the 30-min. period. For other animals, however, the phenobarbital effect, whether positive or negative, was not directly related to time gained on the drug day compared to the placebo day. A new concept was advanced, that of seizure-proneness, measured by the number and duration of seizures and spike after-discharges. Significant correlations were found for seizure-proneness and phenobarbital effect.

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