Functional resonance magnetic imaging (fMRI) in adolescents with idiopathic musculoskeletal pain: a paradigm of experimental pain

Abstract

BackgroundStudies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain.MethodsThe study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3±1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain.The two local Research Ethics Committees (Ethics Committee from Universidade Federal de São Paulo- Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten – Brazil, process number 1673, on October 19th, 2011) approved the study.ResultsThe idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm2 versus 4.45 kg/cm2, p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p = 0.0001; (p = 0.0007), middle gyrus (p = 0.01) and precuneus p = (0.02).ConclusionAdolescents with idiopathic musculoskeletal pain (IMP) tend to request higher brain function in cognitive-emotional areas when interpreting unpredictable sensory-perceptual situations. Therefore, it is assumed that this difference in pain processing in adolescents with IMP make the subjective experience of pain something more intense and unpleasant.

Stressful experiences in youth: “Set-up” for diminished resilience to chronic pain

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A Review of the Relationship among Self, Mind and Brain in Functional Magnetic Resonance Imaging Study: Tree-Pattern Image of Semantic Map in Human Brain Viewed from the Ultron-Logotron Theory

“…Reduction of chronic intractable cancer pain by surgical cingulotomy was reported by Bouckoms in 1989, and Pillay and Hassenbusch in 1992 (Davis et al, 1997). In adolescents with idiopathic musculoskeletal pain, the prefrontal cortex that is involved in the executive/emotional and pain-related system has abnormally increased sensitivity to pain stimulus, resulting in increased BOLD response and subjective experience of pain (Molina et al, 2017). Valet et al (2004) and Tracey (2008Tracey ( ) (2002 Tracey showed that the pain-related BOLD response in the prefrontal-cingulate areas to painful stimulation is modulated and reduced by distracting attention, resulting in reduction of pain perception (Bushnell & Apkarian, 2006).…”

“…When lesions of injury, degeneration, abnormal excitement, suppression or chemical drug effects are present at the sense organ, the peripheral nervous pathway, the spinal cord, the "prefrontal-rear system", ("PRS") and/or the prefrontal cortex would cause clinical disorders and diseases such as aphasia, blindness, hearing loss, depression, bipolar disorder, amnesia, schizophrenia, hallucination, Alzheimer's disease, general anesthesia, coma etc. (Sapolsky, 2004;Molina et al, 2017;Wikipedia, 2018).…”

A Pilot Study Examining Neural Response to Pain in Adolescents With and Without Chronic Pain

“…To our knowledge, only one study has investigated brain response to painful stimuli in adolescents with (n = 10) and without (n = 10) chronic pain. Findings revealed adolescents with chronic pain had lower brain activation in the thalamus, precentral gyrus, and prefrontal cortex (16). This study utilized a block design, with fixed intervals between stimuli, making it impossible to disentangle stimuli response from a pain anticipatory response, the latter of which may be indicative of an underlying pattern of neural deviation beyond what occurs during actual experiences of pain.…”