scholarly journals Prolonged tonic pain in healthy humans disrupts intrinsic brain networks implicated in pain modulation

2019 ◽  
Author(s):  
Timothy J. Meeker ◽  
Anne-Christine Schmid ◽  
Michael L. Keaser ◽  
Shariq A. Khan ◽  
Rao P. Gullapalli ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Brain Networks ◽  
Cingulate Cortex ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Healthy Humans ◽  
Chronic Pain Patients ◽  
Tonic Pain ◽  
Ongoing Pain ◽  
Pain Patients

AbstractNeural mechanisms of ongoing nociceptive processing in the human brain remain largely obscured by the dual challenge of accessing neural dynamics and safely applying sustained painful stimuli. Recently, pain-related neural processing has been measured using fMRI resting state functional connectivity (FC) in chronic pain patients. However, ongoing pain-related processing in normally pain-free humans remains incompletely understood. Therefore, differences between chronic pain patients and controls may be due to comorbidities with chronic pain. Decreased FC among regions of the descending pain modulation network (DPMN) are associated with presence and severity of chronic pain disorders. We aimed to determine if the presence of prolonged tonic pain would lead to disruption of the DPMN. High (10%) concentration topical capsaicin was combined with a warm thermode applied to the leg to create a flexible, prolonged tonic pain model to study the FC of brain networks in otherwise healthy, pain-free subjects in two separate cohorts (n=18; n=32). We contrasted seed-based FC during prolonged tonic pain with a pain-free passive task. In seed-based FC analysis prolonged tonic pain led to enhanced FC between the anterior middle cingulate cortex (aMCC) and the somatosensory leg representation. Additionally, FC was enhanced between the pregenual anterior cingulate cortex (pACC), right mediodorsal thalamus and the posterior parietal cortex bilaterally. Further, in the seed-driven PAG network, positive FC with the left DLPFC became negative FC during prolonged tonic pain. These data suggest that some altered DPMN FC findings in chronic pain could partially be explained by the presence of ongoing pain.

Thalamic Stimulation Activates The Anterior Cingulate Cortex in Chronic Pain Patients: A PET Study

NeuroImage ◽  
1998 ◽  
Vol 7 (4) ◽  
pp. S439 ◽  
Author(s):  
K.D. Davis ◽  
E. Taub ◽  
F. Duffner ◽  
A.M. Lozano ◽  
R.R. Tasker ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Anterior Cingulate Cortex ◽  
Cingulate Cortex ◽  
Anterior Cingulate ◽  
Thalamic Stimulation ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Distraction Analgesia in Chronic Pain Patients

2014 ◽  
Vol 121 (6) ◽  
pp. 1292-1301 ◽  
Author(s):  
Kristin L. Schreiber ◽  
Claudia Campbell ◽  
Marc O. Martel ◽  
Seth Greenbaum ◽  
Ajay D. Wasan ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Temporal Summation ◽  
Pain Catastrophizing ◽  
Pain Modulation ◽  
Analysis Of Covariance ◽  
Noxious Stimulation ◽  
Conditioned Pain Modulation ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Background: Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction. Methods: Chronic pain patients (n = 149) underwent psychometric and quantitative sensory testing, including assessment of the temporal summation of pain in the presence and absence of a distracting motor task. Results: A simple distraction task decreased temporal summation of pain overall, but, surprisingly, a greater distraction analgesia was observed in high catastrophizers. This enhanced distraction analgesia in high catastrophizers was not altered when controlling for current pain scores, depression, anxiety, or opioid use (analysis of covariance [ANCOVA]: F = 8.7, P < 0.005). Interestingly, the magnitude of distraction analgesia was inversely correlated with conditioned pain modulation (Pearson R = −0.23, P = 0.005). Conclusion: Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing’s pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.

scholarly journals Virtual Reality Based Passive and Active Distraction Methods for the Treatment of Chronic Pain

2021 ◽  
Author(s):  
Jiaheng Wang
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Daily Lives ◽  
Chronic Pain Patients ◽  
Different Types ◽  
Initial Injury ◽  
Physical Interactions ◽  
Ongoing Pain ◽  
Pain Patients

<p>Chronic pain is ongoing pain lasting for long periods after the initial injury or disease has healed. Chronic pain is difficult to treat and can affect the daily lives of patients. Distraction therapy is a proven way of relieving pain for patients by taking their attention away from the pain. Virtual reality is a platform for distraction therapy by immersing the user visually, aurally, and even somewhat physically in a virtual world detached from reality. There is little research done regarding the effects virtual reality's physical interactions have on pain management. This project aims to evaluate different types of virtual reality interactions for chronic pain patients to determine which is most effective for pain relief. The results found that physical and mental activities in virtual reality are equally effective as each other at reducing pain while the patients are engaged in the content, while the effects of observing relaxing content persists outside of virtual reality. These results inform the design of future virtual reality games targeted at pain management.</p>

Cingulotomy for Intractable Pain

2019 ◽  
pp. 141-148
Author(s):  
Patrick J. Hunt ◽  
Patrick J. Karas ◽  
Ashwin Viswanathan ◽  
Sameer A. Sheth
Keyword(s):  
Chronic Pain ◽  
Anterior Cingulate Cortex ◽  
Cingulate Cortex ◽  
Anterior Cingulate ◽  
Intractable Pain ◽  
Pharmacologic Treatment ◽  
Pain Patients

Chronic pain is a common and often debilitating condition. This pain can be intractable to pharmacologic treatment, thereby necessitating non-pharmacologic approaches. Here we review anterior cingulotomy as a surgical solution to intractable chronic pain, from assessment and planning through the procedure and aftercare. Ablating tissue within the anterior cingulate cortex may allow for the amelioration of the affective aspect of chronic pain. This is especially beneficial to patients with significant psychiatric components to their pain, patients who are unfit for neuromodulatory implants, and patients with terminal diagnoses. Anterior cingulotomy is irreversible and is less commonly used than reversible neuromodulatory approaches. However, anterior cingulotomy remains an important option for patients suffering from intractable chronic pain.

scholarly journals Virtual Reality Based Passive and Active Distraction Methods for the Treatment of Chronic Pain

2021 ◽  
Author(s):  
Jiaheng Wang
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Daily Lives ◽  
Chronic Pain Patients ◽  
Different Types ◽  
Initial Injury ◽  
Physical Interactions ◽  
Ongoing Pain ◽  
Pain Patients

<p>Chronic pain is ongoing pain lasting for long periods after the initial injury or disease has healed. Chronic pain is difficult to treat and can affect the daily lives of patients. Distraction therapy is a proven way of relieving pain for patients by taking their attention away from the pain. Virtual reality is a platform for distraction therapy by immersing the user visually, aurally, and even somewhat physically in a virtual world detached from reality. There is little research done regarding the effects virtual reality's physical interactions have on pain management. This project aims to evaluate different types of virtual reality interactions for chronic pain patients to determine which is most effective for pain relief. The results found that physical and mental activities in virtual reality are equally effective as each other at reducing pain while the patients are engaged in the content, while the effects of observing relaxing content persists outside of virtual reality. These results inform the design of future virtual reality games targeted at pain management.</p>

scholarly journals Prolonged tonic pain in healthy humans enhances functional connectivity of descending pain modulation networks involving the amygdala, periaqueductal gray and parabrachial nucleus to cortical sensory-discriminative areas

2021 ◽  
Author(s):  
Timothy J. Meeker ◽  
Anne-Christine Schmid ◽  
Michael L. Keaser ◽  
Shariq A. Khan ◽  
Rao P. Gullapalli ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Functional Connectivity ◽  
Pain Intensity ◽  
Cingulate Cortex ◽  
Periaqueductal Gray ◽  
Anterior Cingulate ◽  
Bold Signal ◽  
Experienced Pain ◽  
Tonic Pain ◽  
Parietal Lobule

AbstractIntroductionResting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC changes accompanying tonic pain in pain-free persons is rare. A brain network disrupted during chronic pain is a network we term the Descending Pain Modulatory Network (DPMN). Here, we evaluate the effect of tonic pain on FC of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN).MethodsIn 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. We used functional MRI to measure resting BOLD signal during pain-free rest where participants experienced warmth and tonic pain where participants experienced the same temperature thermode combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity with FC during both states. We hypothesized tonic pain would disrupt FC dyads within the DPMN. We used partial correlation to determine FC correlated with pain intensity and BOLD signal.ResultsOf hypothesized FC dyads, PAG and subgenual ACC was weakly disrupted during tonic pain (F=3.34; p=0.074; pain-free>pain d=0.25). sgACC-PAG FC became positively related to pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During tonic pain, FC of this connection was abolished (paired t=-3.17; p=0.0026). During pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During tonic pain, FC between left AMYG and right inferior temporal and superior frontal gyri negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC and right claustrum; left and right primary visual cortex; right middle temporal gyrus and right temporo-occipitoparietal junction. Finally, subsequent pain positively correlated with PAG FC and left cerebellum, left dorsolateral prefrontal, right posterior cingulate cortex and paracentral lobule, inferior parietal lobule, medial precuneus and PBN.ConclusionWe demonstrate 1) tonic pain weakly disrupts of sgACC-PAG FC; 2) sgACC-PAG tonic pain FC positively correlates with pain; 3) right PBN-PAG FC predicts subsequent pain and is abolished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which predict intensity of tonic pain. Our findings suggest specific connectivity patterns within the DPMN at rest predict experienced pain and are modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation and biomarkers to guide interventions.HighlightsParabrachial-periaqueductal gray (PAG) functional connectivity (FC) predicts painSubgenual anterior cingulate cortex-PAG FC correlates with pain during tonic painPAG- and amydalocortical networks at rest predict tonic pain intensityResting FC of PAG supports cortical targets of neuromodulation to control pain

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