Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography.

Derbyshire, Stuart; Jones, Anthony; Devani, Pooja; Friston, Karl J.; Feinmann, C; Harris, Malcolm; Pearce, Shirley; Watson, J. D. G.; Frackowiak, R. S. J.

doi:10.1136/jnnp.57.10.1166

Cited by 281 publications

(142 citation statements)

References 38 publications

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“…These results are also consistent with other functional imaging studies that have suggested augmented central pain processing in chronic pain conditions, including fibromyalgia (27,55), irritable bowel syndrome (26), cerebral infarction complicated by allodynia (56), and atypical facial pain (57). In the only previous study that used functional neuroimaging to assess patients with low back pain, Derbyshire et al used positron emission tomography to compare cerebral responses to heat stimulation in patients with CLBP and healthy control subjects (58).…”

Section: Augmented Pain Processing In Idiopathic Chronic Low Back Painsupporting

confidence: 84%

Evidence of augmented central pain processing in idiopathic chronic low back pain

Giesecke¹,

Gracely²,

Grant³

et al. 2004

Arthritis & Rheumatism

721

456

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Objective. For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n ‫؍‬ 11), patients with widespread pain (fibromyalgia; n ‫؍‬ 16), and healthy control subjects (n ‫؍‬ 11).Methods. Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site.Results. Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P ‫؍‬ 0.03) or the patients with fibromyalgia (3.5 kg) (P ‫؍‬ 0.006).When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups.Conclusion. At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.Chronic low back pain (CLBP) is one of the most common and expensive musculoskeletal disorders in developed countries (1,2). Back pain in general affects 70-85% of all people at some time in their lives, but 90% of affected individuals recover, typically within 12 weeks (3). Recovery after 12 weeks is slow and uncertain, and this subset of patients with CLBP accounts for major expenses in the health care and disability systems (2,4).Despite the magnitude of the problem, little is known about the precise cause of CLBP. There is often a mismatch between objectiv...

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Section: Augmented Pain Processing In Idiopathic Chronic Low Back Painsupporting

confidence: 84%

Evidence of augmented central pain processing in idiopathic chronic low back pain

Giesecke¹,

Gracely²,

Grant³

et al. 2004

Arthritis & Rheumatism

721

456

View full text Add to dashboard Cite

show abstract

“…In a study of older adults suffering from CLBP, Buckalew and colleagues [12] found a non-significant trend to decreased middle cingulate gyrus volumes in the patient group when compared with healthy controls. The results are supported by functional brain imaging studies that have revealed evidence for altered middle CC activity in different pain conditions [36][37][38] underlining the hypothesis that reduced MCC response is an adaptive cortical mechanism in acute pain that contributes to chronic pain development [12]. Nevertheless, we have to be careful interpreting these results with respect to chronic pain only.…”

Section: Discussionsupporting

confidence: 54%

Brain structural and psychometric alterations in chronic low back pain

et al. 2013

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Purpose Chronic low back pain (CLBP) is one of the most important pain disorders with increasing social and economic implications. Given that CLBP is a multidimensional process associated with comorbidities such as anxiety and depression, treatment of chronic low back pain is still a challenge. Advancement of in vivo brain imaging technologies has revealed increasing insights into the etiology and pathogenesis of chronic pain; however, the exact mechanisms of chronification of LBP remain still unclear. The purpose of the present study was to analyse the neurostructural alterations in CLBP and to evaluate the role of comorbidities and their neurostructural underpinnings.Methods In the present study we investigated a wellcharacterized group of 14 patients with CLBP and 14 healthy controls applying structural MRI and psychometric measures. Using an improved algorithm for brain normalization (DARTEL) we performed a voxel-based morphometry (VBM) approach. Correlation analyses were performed to evaluate the role of anxiety and depression in neurostructural alterations observed in CLBP. Results The psychometric measures revealed significantly higher scores on depression and anxiety in the patient population. VBM analysis showed significant decreases in grey matter density in areas associated with pain processing and modulation, i.e. the dorsolateral prefrontal cortex, the thalamus and the middle cingulate cortex. With respect to anxiety and depression scores, we did not observe any correlations to the structural data. Conclusions In the present study we found compelling evidence for alterations of grey matter architecture in CLBP in brain regions playing a major role in pain modulation and control. Our results fit the hypothesis of a ''brain signature'' in chronic pain conditions. The results of the psychometric assessment underline the importance of an interdisciplinary therapeutic approach including orthopedic, neurological and psychological evaluation and treatment.Keywords Chronic low back pain Á MRI Á Voxel based morphometry Á Dorsolateral prefrontal cortex Á Thalamus

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“…It has been demonstrated to be either activated in experimental pain Derbyshire et al 1994), traumatic nociceptive pain (Hsieh et al 1996b) and chronic neuropathic pain . A prominent activation has also been demonstrated in unpleasant itch (Hsieh et al 1994), a situation with no pain but where the urge to scratch invokes body coordination.…”

Section: (H) Posterior Parietal Cortexmentioning

confidence: 99%

Pain and functional imaging

Ingvar

1999

Phil. Trans. R. Soc. Lond. B

227

152

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Functional neuroimaging has fundamentally changed our knowledge about the cerebral representation of pain. For the ¢rst time it has been possible to delineate the functional anatomy of di¡erent aspects of pain in the medial and lateral pain systems in the brain. The rapid developments in imaging methods over the past years have led to a consensus in the description of the central pain responses between di¡erent studies and also to a de¢nition of a central pain matrix with specialized subfunctions in man. In the near future we will see studies where a systems perspective allows for a better understanding of the regulatory mechanisms in the higher-order frontal and parietal cortices. Also, pending the development of experimental paradigms, the functional anatomy of the emotional aspects of pain will become better known.

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Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography.

Cited by 281 publications

References 38 publications

Evidence of augmented central pain processing in idiopathic chronic low back pain

Evidence of augmented central pain processing in idiopathic chronic low back pain

Brain structural and psychometric alterations in chronic low back pain

Pain and functional imaging

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