Human brain mechanisms of pain perception and regulation in health and disease

Apkarian, A. Vania; Bushnell, M. Catherine; Treede, Rolf‐Detlef; Zubieta, Jon Kar

doi:10.1016/j.ejpain.2004.11.001

Cited by 2,636 publications

(2,453 citation statements)

References 243 publications

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“…Such distinctions are largely unhelpful to our patient selection as a gathering body of human functional neuroimaging and electrophysiological evidence confirms that chronic pain arises concomitantly with centrally mediated changes related to neuronal plasticity, regardless of etiology [61][62][63][64][65][66]. Thus, it can be assumed that chronic pain of organic origin following neural injury and refractory to medical treatment is largely central pain and thus neuropathic.…”

Section: Patient Selectionmentioning

confidence: 98%

Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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Deep brain stimulation (DBS) is a neurosurgical intervention the efficacy, safety, and utility of which are established in the treatment of Parkinson's disease. For the treatment of chronic, neuropathic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated with current standards of neuroimaging and stimulator technology over the last decade . We summarize the history, science, selection, assessment, surgery, programming, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and latterly rostral anterior cingulate cortex (Cg24) in 113 patients treated at 2 centers (John Radcliffe, Oxford, UK, and Hospital de São João, Porto, Portugal) over 13 years. Several experienced centers continue DBS for chronic pain, with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS under general anesthesia considered for whole or hemibody pain, or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.

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Section: Patient Selectionmentioning

confidence: 98%

Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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“…It is becoming more common to acquire multimodality neuroimaging data that include PET and fMRI, as well as other types of MR (and optical) outcomes (Apkarian et al, 2005;Catana et al, 2008;Dougherty et al, 2008;Herzog et al, 2011;Huppert et al, 2008;Newberg et al, 2005;Rabiner et al, 2011;Sperling et al, 2009;Tong et al, 2011). Combined fMRI and PET brain imaging will become even more commonplace with the increased availability of combined PET/MR imaging systems.…”

Section: Multimodality Imagingmentioning

confidence: 99%

Molecular Brain Imaging in the Multimodality Era

Price

2012

J Cereb Blood Flow Metab

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Multimodality molecular brain imaging encompasses in vivo visualization, evaluation, and measurement of cellular/molecular processes. Instrumentation and software developments over the past 30 years have fueled advancements in multimodality imaging platforms that enable acquisition of multiple complementary imaging outcomes by either combined sequential or simultaneous acquisition. This article provides a general overview of multimodality neuroimaging in the context of positron emission tomography as a molecular imaging tool and magnetic resonance imaging as a structural and functional imaging tool. Several image examples are provided and general challenges are discussed to exemplify complementary features of the modalities, as well as important strengths and weaknesses of combined assessments. Alzheimer's disease is highlighted, as this clinical area has been strongly impacted by multimodality neuroimaging findings that have improved understanding of the natural history of disease progression, early disease detection, and informed therapy evaluation.

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“…Here, this information is relayed through the spinal-thalamic tract, which is a key pathway for transmitting nociceptive information to the brain. The information is then processed in multiple supraspinal areas, including the thalamus, prefrontal cortex, the anterior cingulate cortex (ACC), the primary (S1) and secondary (S2) somatosensory cortices, and the insula [33,34].…”

Section: Neurophysiological Mechanisms Involved In Pain Perception Anmentioning

confidence: 99%

“…One site is the prefrontal cortex, which is thought to encode the cognitive aspects of both acute and chronic pain, including evaluating the meaning of pain and making executive decisions regarding how best to cope with pain [33]. Another site, the ACC, is related to the affective/emotional component of pain (i.e., suffering) [33,35] and the motivational-motor aspects of pain (e.g., preparing to do something about pain), including the initiation and facilitation of behavioral coping efforts [36,37]. The somatosensory cortices (S1 and S2) process sensory information about nociception, including location (e.g., left hand), severity, and identification (e.g., burn).…”

Section: Neurophysiological Mechanisms Involved In Pain Perception Anmentioning

confidence: 99%

Neurophysiology of pain and hypnosis for chronic pain

Dillworth

Mendoza

Jensen

2011

Behav. Med. Pract. Policy Res.

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In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available. KEYWORDSHypnosis, Hypnotic analgesia, Chronic pain, Neurophysiology, Hypnotic suggestions Chronic pain, defined as pain lasting longer than 6 months [1], is a complex experience that requires multifaceted approaches for both evaluation and treatment [1,2]. Chronic pain is considered to have an underlying biological basis, for which medications and physical treatments are commonly prescribed. Medical approaches for pain relief and management include pharmacological and surgical interventions as well as physical therapy. While nonsteroidal antiinflammatory drugs are commonly used to treat mild pain from inflammation, opioid analgesics are the mainstay of pharmacologic treatment of moderate to severe pain [2][3][4][5][6]. However, prolonged use of opioids may result in opioid tolerance and opioid-induced hyperalgesia, which is an increased sensitivity to pain. These problems, coupled with unpleasant medication side effects, may lead to discontinuation of treatment [7]. Depending on the patient's condition and cause of pain, surgery is typically considered for the treatment of chronic pain when it is deemed medically necessary or after other treatments have failed. These include intrathecal drug delivery [8], spinal cord stimulation [9], radiofrequency ablation [10], and chemical sympathectomy [11]. One concern is that even though surgical procedures can provide pain relief, they also may permanently damage the person's ability to perceive other sensations, such as light touch and temperature changes, and can cause different pain problems to occur.Medical approaches for pain reduction are only one element of an interdisciplinary approach, since gains in physical and social functioning are important goals as well [12]. Psychosocial and neuropsychological models of chronic pain show that pain treatment cannot focus solely on the sensation of pain itself (e.g., pain intensity) but must also consider the affective (e.g., emotional suffering), cognitive (e.g., beliefs about pain) and behavioral (e.g., inactivity) responses which also impact the overall experience of pain [13][14][15]. This idea has been further supported by research ev...

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Human brain mechanisms of pain perception and regulation in health and disease

Cited by 2,636 publications

References 243 publications

Neuropathic Pain and Deep Brain Stimulation

Neuropathic Pain and Deep Brain Stimulation

Molecular Brain Imaging in the Multimodality Era

Neurophysiology of pain and hypnosis for chronic pain

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