Corticospinal excitability as a biomarker of myofascial pain syndrome

Thibaut, Aurore; Zeng, Dian; Caumo, Wolnei; Liu, Jianhua; Fregni, Felipe

doi:10.1097/pr9.0000000000000594

Cited by 24 publications

(16 citation statements)

References 74 publications

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“…Thus, assessing the underlying motor cortical excitability in patients with GWI related diffuse body pain including headaches, muscle, and joint pain can offer a new level of understanding in the illness and potentially provide guidance for therapeutic intervention for this patient population. While it is widely accepted that chronic pain states can be associated with impaired corticomotor excitability represented by a diminished supraspinal modulatory state from traumatic or non-traumatic causes 6 – 8 , 12 – 14 , to the authors’ best knowledge, no study has been conducted to assess the corticomotor excitability in patients with GWI related chronic diffuse body pain including headaches, joint, and muscle pain.…”

Section: Introductionmentioning

confidence: 99%

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

Lei

Kunnel

Metzger-Smith

et al. 2020

Sci Rep

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Chronic diffuse body pain is unequivocally highly prevalent in Veterans who served in the 1990–91 Persian Gulf War and diagnosed with Gulf War Illness (GWI). Diminished motor cortical excitability, as a measurement of increased resting motor threshold (RMT) with transcranial magnetic stimulation (TMS), is known to be associated with chronic pain conditions. This study compared RMT in Veterans with GWI related diffuse body pain including headache, muscle and joint pain with their military counterparts without GWI related diffuse body pain. Single pulse TMS was administered over the left motor cortex, using anatomical scans of each subject to guide the TMS coil, starting at 25% of maximum stimulator output (MSO) and increasing in steps of 2% until a motor response with a 50 µV peak to peak amplitude, defined as the RMT, was evoked at the contralateral flexor pollicis brevis muscle. RMT was then analyzed using Repeated Measures Analysis of Variance (RM-ANOVA). Veterans with GWI related chronic headaches and body pain (N = 20, all males) had a significantly (P < 0.001) higher average RMT (% ± SD) of 77.2% ± 16.7% compared to age and gender matched military controls (N = 20, all males), whose average was 55.6% ± 8.8%. Veterans with GWI related diffuse body pain demonstrated a state of diminished corticomotor excitability, suggesting a maladaptive supraspinal pain modulatory state. The impact of this observed supraspinal functional impairment on other GWI related symptoms and the potential use of TMS in rectifying this abnormality and providing relief for pain and co-morbid symptoms requires further investigation. Trial registration: This study was registered on January 25, 2017, on ClinicalTrials.gov with the identifier: NCT03030794. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03030794.

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Section: Introductionmentioning

confidence: 99%

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

Lei

Kunnel

Metzger-Smith

et al. 2020

Sci Rep

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“…While it is widely accepted that chronic pain states can be associated with impaired corticomotor excitability represented by a diminished supraspinal modulatory state from traumatic or non-traumatic causes. (5)(6)(7)(8)(9)(10) To the authors' best knowledge, no study has been conducted to assess the corticomotor excitability in patients with GWI related chronic headache and pain problems.…”

Section: Introductionmentioning

confidence: 99%

Diminished Corticomotor Excitability in Gulf War I Veterans with Chronic Pain Symptoms

Lei¹,

Kunnel²,

Metzger-Smith³

et al. 2020

Preprint

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Background: Diminished motor cortical excitability, as a measurement of increased resting motor threshold with transcranial magnetic stimulation (TMS), is known to be associated with chronic pain conditions. Over 175,000 veterans who were deployed to the Persian Gulf in 1990-91 suffer from an unexplained multisymptom illness termed Gulf War Illness (GWI) with chronic headaches and diffuse body pain as the most commonly reported symptoms. This study hypothesized that veterans with Gulf War Illness related pain exhibit diminished corticomotor excitability associated with chronic pain states and aimed to assess the resting motor threshold (RMT) at the primary motor cortex (M1) in veterans with GWI.Methods: Single pulse TMS was administered over the left motor cortex, using anatomical scans of each subject to guide the TMS coil, starting at 25% of maximum stimulator output (MSO) and increasing in steps of 2% until a motor response with a 50 µV peak to peak amplitude, defined as the RMT, was evoked at the flexor pollicis brevis muscle. RMT was then analyzed using Repeated Measures Analysis of Variance (RM-ANOVA).Results: Gulf War Veterans (GWV) with chronic headaches and body pain (N=20) had a significantly (P<0.001) higher average resting motor threshold (%± SD) of 77.2%±16.7% compared to age and gender matched GWV Controls (N=20), whose average was 55.6%±8.8%.Conclusion: This study demonstrated that a higher level of stimulation was required to evoke a motor response in veterans with GWI related pain. This diminished corticomotor excitability that suggests a reduced state of supraspinal pain modulatory function. Though further studies will be needed, TMS may provide a means of effectively rectifying this modulatory deficit.

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“…These changes in excitatory and inhibitory transmitter systems are confluent with a reduction in the descending inhibitory pathways ( Botelho et al, 2016 ; Thibaut et al, 2017 ; Thapa et al, 2018 ). As aforementioned, the dysfunction in the inhibitory corticospinal system involves several different mechanisms, such as the strength of the glutamatergic synapses or the weakening of synapses of the GABA-ergic system.…”

Section: Introductionmentioning

confidence: 99%

Insights About the Neuroplasticity State on the Effect of Intramuscular Electrical Stimulation in Pain and Disability Associated With Chronic Myofascial Pain Syndrome (MPS): A Double-Blind, Randomized, Sham-Controlled Trial

Botelho

Angoleri

Zortéa

et al. 2018

Front. Hum. Neurosci.

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Background: There is limited evidence concerning the effect of intramuscular electrical stimulation (EIMS) on the neural mechanisms of pain and disability associated with chronic Myofascial Pain Syndrome (MPS).Objectives: To provide new insights into the EIMS long-term effect on pain and disability related to chronic MPS (primary outcomes). To assess if the neuroplasticity state at baseline could predict the long-term impact of EIMS on disability due to MPS we examined the relationship between the serum brain-derived-neurotrophic-factor (BDNF) and by motor evoked potential (MEP). Also, we evaluated if the EIMS could improve the descending pain modulatory system (DPMS) and the cortical excitability measured by transcranial magnetic stimulation (TMS) parameters.Methods: We included 24 right-handed female with chronic MPS, 19–65 years old. They were randomically allocated to receive ten sessions of EIMS, 2 Hz at the cervical paraspinal region or a sham intervention (n = 12).Results: A mixed model analysis of variance revealed that EIMS decreased daily pain scores by -73.02% [95% confidence interval (CI) = -95.28 to -52.30] and disability due to pain -43.19 (95%CI, -57.23 to -29.39) at 3 months of follow up. The relative risk for using analgesics was 2.95 (95% CI, 1.36 to 6.30) in the sham group. In the EIMS and sham, the change on the Numerical Pain Scale (NPS0-10) throughout CPM-task was -2.04 (0.79) vs. -0.94 (1.18), respectively, (P = 0.01). EIMS reduced the MEP -28.79 (-53.44 to -4.15), while improved DPMS and intracortical inhibition. The MEP amplitude before treatment [(Beta = -0.61, (-0.58 to -0.26)] and a more significant change from pre- to post-treatment on serum BDNF) (Beta = 0.67; CI95% = 0.07 to 1.26) were predictors to EIMS effect on pain and disability due to pain.Conclusion: These findings suggest that a bottom–up effect induced by the EIMS reduced the analgesic use, improved pain, and disability due to chronic MPS. This effect might be mediated by an enhancing of corticospinal inhibition as seen by an increase in IC and a decrease in MEP amplitude. Likewise, the MEP amplitude before treatment and the changes induced by the EIMS in the serum BDNF predicted it’s long-term clinical impact on pain and disability due MPS.The trial is recorded in ClinicalTrials.gov: NCT02381171.

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Corticospinal excitability as a biomarker of myofascial pain syndrome

Abstract: Intracortical disinhibition, by means of decreased intracortical inhibition and increased intracortical facilitation, seems to be a reliable marker of chronic myofascial pain syndrome.

Cited by 24 publications

References 74 publications

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

Diminished Corticomotor Excitability in Gulf War I Veterans with Chronic Pain Symptoms

Insights About the Neuroplasticity State on the Effect of Intramuscular Electrical Stimulation in Pain and Disability Associated With Chronic Myofascial Pain Syndrome (MPS): A Double-Blind, Randomized, Sham-Controlled Trial

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