Arthritic pain is processed in brain areas concerned with emotions and fear

Kulkarni, B; Bentley, Delia; Elliott, Richard M.; Julyan, P. J.; Boger, Emma; Watson, Alison; Boyle, Y; El‐Deredy, Wael; Jones, Anthony K.P.

doi:10.1002/art.22460

Cited by 189 publications

(161 citation statements)

References 44 publications

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“…Women had both lower sensation and pain thresholds than men after TKA [21]. Moreover, in a small study of only six men and six women with knee osteoarthritis, positron emission tomography imaging of the brain showed arthritic pain is processed in areas of the brain concerned with emotion and fear [15]. Certainly pain is complex and a detailed analysis of sex and gender differences in pain is beyond the scope of this article.…”

Section: Discussionmentioning

confidence: 91%

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

O’Connor

2011

Clinical Orthopaedics &Amp; Related Research

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Background As efforts continue to improve the results of TKA, the potential influence of sex and gender on longterm survival of implants, knee function, pain relief, and patient satisfaction remains relevant, particularly given the increased incidence of osteoarthritis of the knee in women and reports that women derive equal benefit from TKA. Questions/purposes This article reviews the literature pertinent to the question of whether long-term survival, knee function, pain relief, and patient satisfaction after TKA differ between men and women. Methods Large clinical series ([ 1000 patients) published in the last 10 years were identified in PubMed and reviewed. Results Men may be at higher risk of revision surgery than women. Sex/gender has been consistently shown to impact both function and pain relief both before and after TKA. Although women achieve at least the same degree of functional improvement as men, women have worse preoperative physical function and do not reach the same final level of physical function as men. Likewise women may have similar or even greater improvement in pain after arthroplasty than men but still have final pain scores that are less favorable. Conclusions Further research is required to understand the sex and gender differences contributing to implant survival, physical function, and pain relief after TKA.Strategies need to be developed to identify any patient who is at higher risk of implant failure, suboptimal postoperative function, and incomplete pain relief.

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Section: Discussionmentioning

confidence: 91%

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

O’Connor

2011

Clinical Orthopaedics &Amp; Related Research

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“…The results showed that arthritic pain was associated with increased activity in the cingulate cortex, the thalamus, and the amygdale; areas involved with the processing of the emotional aspects of pain. Indeed, the authors suggested in this study that new treatments for pain in arthritis should target central structures (33).…”

Section: Discussionmentioning

confidence: 98%

Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis

Imamura¹,

Imamura²,

Kaziyama³

et al. 2008

Arthritis & Rheumatism

277

253

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Objective. Refractory, disabling pain associated with knee osteoarthritis (OA) is usually treated with total knee replacement. However, pain in these patients might be associated with central nervous sensitization rather than peripheral inflammation and injury. We evaluated the presence of hyperalgesia in patients scheduled for a total knee replacement due to knee osteoarthritis with refractory pain, and we assessed the impact of pressure pain threshold measurements (PPT) on pain, disability, and quality of life of these patients. Methods. Sixty-two female patients were compared with 22 age-matched healthy controls without reported pain for the last year. PPT was measured at the lower extremities subcutaneous dermatomes, over the vastus medialis, adductor longus, rectus femoris, vastus lateralis, tibialis anterior, peroneus longus, iliacus, quadratus lumborum and popliteus muscles and at the supraspinous ligaments from L1-L5, over the L5-S1 and S1-S2 sacral areas and at the pes anserinus bursae and patellar tendon. Results. Patients with knee OA had significantly lower PPT over all evaluated structures versus healthy control subjects (P < 0.001). Lower PPT values were correlated with higher pain intensity, higher disability scores, and with poorer quality of life, except for the role-emotional and general health status. Combined PPT values over the patellar tendon, at the S2 subcutaneous dermatome and at the adductor longus muscle were the best predictors for visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index pain scores. Conclusion. Patients with pain due to osteoarthritis who were scheduled for total knee replacement showed hyperalgesia of nervous system origin that negatively impacted pain, knee functional capacity, and most aspects of quality of life.

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“…The enhanced activity in the anterior cingulate is interesting in light of its proposed role in pain affect (Vogt, 2005;Kulkarni et al, 2007). The subcallosal portion is anatomically and functionally connected with the medial orbitofrontal and ventral posterior cingulate cortices (Vogt et al, 2006;Margulies et al, 2007), which in turn can be involved in self-monitoring and judgment about one's own and other individuals' emotional states (Ochsner et al, 2004;Vogt, 2005).…”

Section: Brain Regions Involved In the Observation Of Unpleasant Stimulimentioning

confidence: 99%

Does It Look Painful or Disgusting? Ask Your Parietal and Cingulate Cortex

Benuzzi¹,

Lui²,

Duzzi³

et al. 2008

J. Neurosci.

141

109

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Looking at still images of body parts in situations that are likely to cause pain has been shown to be associated with activation in some brain areas involved in pain processing. Because pain involves both sensory components and negative affect, it is of interest to explore whether the visually evoked representations of pain and of other negative emotions overlap. By means of event-related functional magnetic resonance imaging, here we compare the brain areas recruited, in female volunteers, by the observation of painful, disgusting, or neutral stimuli delivered to one hand or foot. Several cortical foci were activated by the observation of both painful and disgusting video clips, including portions of the medial prefrontal cortex, anterior, mid-, and posterior cingulate cortex, left posterior insula, and right parietal operculum. Signal changes in perigenual cingulate and left anterior insula were linearly related to the perceived unpleasantness, when the individual differences in susceptibility to aversive stimuli were taken into account. Painful scenes selectively induced activation of left parietal foci, including the parietal operculum, the postcentral gyrus, and adjacent portions of the posterior parietal cortex. In contrast, brain foci specific for disgusting scenes were found in the posterior cingulate cortex. These data show both similarities and differences between the brain patterns of activity related to the observation of noxious or disgusting stimuli. Namely, the parietal cortex appears to be particularly involved in the recognition of noxious environmental stimuli, suggesting that areas involved in sensory aspects of pain are specifically triggered by observing noxious events.

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Arthritic pain is processed in brain areas concerned with emotions and fear

Cited by 189 publications

References 44 publications

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis

Does It Look Painful or Disgusting? Ask Your Parietal and Cingulate Cortex

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