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

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.

Adjustment to Chronic Pain in Back Pain Patients Classified According to the Motivational Stages of Chronic Pain Management

2006 ◽  
Vol 7 (6) ◽  
pp. 417-427 ◽  
Author(s):  
Stefanie Zenker ◽  
Michael Petraschka ◽  
Michael Schenk ◽  
Anett Reißhauer ◽  
Tanja Newie ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Management ◽  
Chronic Pain Management ◽  
Pain Patients

scholarly journals Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain

2006 ◽  
Vol 26 (47) ◽  
pp. 12165-12173 ◽  
Author(s):  
M. N. Baliki ◽  
D. R. Chialvo ◽  
P. Y. Geha ◽  
R. M. Levy ◽  
R. N. Harden ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Brain Activity ◽  
Spontaneous Fluctuations

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.

Dynamics of Pain: Fractal Dimension of Temporal Variability of Spontaneous Pain Differentiates Between Pain States

2006 ◽  
Vol 95 (2) ◽  
pp. 730-736 ◽  
Author(s):  
Jennifer M. Foss ◽  
A. Vania Apkarian ◽  
Dante R. Chialvo
Keyword(s):  
Chronic Pain ◽  
Fractal Dimension ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Brain Activity ◽  
Normal Subjects ◽  
Time Variability ◽  
Spontaneous Pain ◽  
Pain Ratings ◽  
Chronic Pain Conditions

Spontaneous pain is a common complaint in chronic pain conditions. However, its properties have not been explored. Here we study temporal properties of spontaneous pain. We examine time variability of fluctuations of spontaneous pain in patients suffering from chronic back pain and chronic postherpetic neuropathy and contrast properties of these ratings to normal subjects' ratings of either acute thermal painful stimuli or of imagined back pain. Subjects are instructed to continuously rate their subjective assessment of the intensity of pain over a 6- to 12-min period. We observe that the fluctuations of spontaneous pain do not possess stable mean or variance, implying that these time series can be better characterized by fractal analysis. To this end, we apply time and frequency domain techniques to characterize variability of pain ratings with a single parameter: fractal dimension, D. We demonstrate that the majority of ratings of spontaneous pain by the patients have fractal properties, namely they show a power law relationship between variability and time-scale length; D is distinct between types of chronic pain, and from ratings of thermal stimulation or of imagined pain; and there is a correspondence between D for pain ratings and D for brain activity, in chronic back pain patients using fMRI. These results show that measures of variability of spontaneous pain differentiate between chronic pain conditions, and thus may have mechanistic and clinical utility.

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