Investigation into the neural correlates of emotional augmentation of clinical pain

Schweinhardt, Petra; Kalk, Nicola J.; Wartolowska, Karolina; Chessell, Iain P.; Wordsworth, P; Tracey, Irene

doi:10.1016/j.neuroimage.2007.12.016

Cited by 145 publications

(92 citation statements)

References 54 publications

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“…The medial PFC appears to be an important site of supra-spinal pain facilitation. Rheumatoid arthritis patients were shown to activate the medial PFC exclusively in response to clinically relevant pain and not in disease-irrelevant pain (70). Interestingly, the magnitude of depressive symptoms of the largely not clinically depressed patients were positively related to the medial PFC activation.…”

Section: Do Chronic Pain Patients Have Altered Supraspinal Pain Modulmentioning

confidence: 92%

Pain imaging in health and disease — how far have we come?

Schweinhardt

Bushnell²

2010

J. Clin. Invest.

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191

145

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Since modern brain imaging of pain began 20 years ago, networks in the brain related to pain processing and those related to different types of pain modulation, including placebo, have been identified. Functional and anatomical connectivity of these circuits has begun to be analyzed. Imaging in patients suggests that chronic pain is associated with altered function and structural abnormalities in pain modulatory circuits. Moreover, biochemical alterations associated with chronic pain are being identified that provide information on cellular correlates as well as potential mechanisms of structural changes. Data from these brain imaging studies reinforce the idea that chronic pain leads to brain changes that could have functional significance.

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Section: Do Chronic Pain Patients Have Altered Supraspinal Pain Modulmentioning

confidence: 92%

Pain imaging in health and disease — how far have we come?

Schweinhardt

Bushnell²

2010

J. Clin. Invest.

Self Cite

191

145

View full text Add to dashboard Cite

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“…In humans, different subregions of the PFC have a role in acute pain; the medial prefrontal cortex (mPFC) was found to be involved in signaling the unpleasantness of pain (3); the anterior cingulate cortex mediates the affective component of pain responses (4) and the placebo effect (5); and anticipation of pain is positively correlated with activity in both the anterior cingulate and mPFC (6). Lending support to the hypothesis that chronic pain involves cortical reorganization, functional MRI (fMRI) studies in patients with complex region pain syndrome type I (CRPS-I) and back pain have shown that the patients' real-time rating of perceived intensity of spontaneous pain is associated with novel activity in mPFC (7,8) when compared with activity patterns that correlate with rating of acute pain stimuli. Additionally, studies in humans with CRPS-I and chronic back pain demonstrate impaired performance on emotional decisionmaking tasks such as the Iowa Gambling Task (9), which implies involvement of the mPFC.…”

mentioning

confidence: 99%

Morphological and functional reorganization of rat medial prefrontal cortex in neuropathic pain

Metz

Yau

Centeno

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

359

263

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Neuropathic pain is a chronic pain that results from lesion or dysfunction of the nervous system. Depression and cognitive decline are often coupled to chronic pain, suggesting the involvement of cortical areas associated with higher cognitive functions. We investigated layer 2/3 pyramidal neurons in acute slices of the contralateral medial prefrontal cortex (mPFC) in the rat spared nerve injury (SNI) model of neuropathic pain and found morphological and functional differences between the mPFC of SNI and sham-operated animals. Basal, but not apical, dendrites of neurons from SNI rats are longer and have more branches than their counterparts in sham-operated animals; spine density is also selectively increased in basal dendrites of neurons from SNI rats; the morphological changes are accompanied by increased contribution to synaptic currents of the NMDA component. Interestingly, the NMDA/AMPA ratio of the synaptic current elicited in mPFC neurons by afferent fiber stimulation shows linear correlation with the rats' tactile threshold in the injured (but not in the contralateral) paw. Our results not only provide evidence that neuropathic pain leads to rearrangement of the mPFC, which may help defining the cellular basis for cognitive impairments associated with chronic pain, but also show pain-associated morphological changes in the cortex at single neuron level.T he prefrontal cortex (PFC) is associated with high-order cognitive and emotional functions including attention, decision making, goal-directed behavior, and working memory (1, 2). In humans, different subregions of the PFC have a role in acute pain; the medial prefrontal cortex (mPFC) was found to be involved in signaling the unpleasantness of pain (3); the anterior cingulate cortex mediates the affective component of pain responses (4) and the placebo effect (5); and anticipation of pain is positively correlated with activity in both the anterior cingulate and mPFC (6). Lending support to the hypothesis that chronic pain involves cortical reorganization, functional MRI (fMRI) studies in patients with complex region pain syndrome type I (CRPS-I) and back pain have shown that the patients' real-time rating of perceived intensity of spontaneous pain is associated with novel activity in mPFC (7, 8) when compared with activity patterns that correlate with rating of acute pain stimuli. Additionally, studies in humans with CRPS-I and chronic back pain demonstrate impaired performance on emotional decisionmaking tasks such as the Iowa Gambling Task (9), which implies involvement of the mPFC. Indeed, the performance of CRPS-I patients resembles that of patients with frontal cortex lesions. In patients with chronic back pain, the extent of activation of the mPFC during spontaneous pain and the extent of emotional, cognitive impairment correlate with the intensity of the pain and the duration of the condition (7). Finally, magnetic resonance studies show that chronic pain is associated with decreased gray matter density in various PFC regions (10, 11). Thus, the e...

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“…In patients with rheumatoid arthritis, fMRI showed that depressive symptoms were related to the cerebral processing of joint pain in the medial prefrontal cortex without relation to joint inflammation [18]. This brain region seems to contribute to the maintenance and exacerbation of pain and might alter the effect of elimination of peripheral nociceptive input by RF denervation.…”

Section: Discussionmentioning

confidence: 99%

Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study

et al. 2011

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Background and aims Radiofrequency denervation (RF) of the lumbar facet joints has been shown to be effective in well-selected patients. However, long-term success varies between studies. We evaluated the influence of selected psychosocial and constitutional factors on the outcome of RF, expressed as the duration of pain relief. Methods This prospective observational study included 44 patients who received RF denervations at the University Hospital of Berne. Success was defined as at least 50% pain reduction 7-21 days, 6 months and 1 year after RF therapy. The Cox-regression analysis was performed to evaluate the influence of the following factors on the duration of success: age, sex, depression, work inability and previous surgery. Results Complete follow-up was available for 41 patients. The success rate 7-21 days after the denervation was 76%. It decreased to 32% at 6 months and to 22% at 1 year. The median success duration was 17 weeks (95% CI 10-26). The Cox-regression analysis showed a significant shorter duration of success for patients with depression (hazard ratio [HR] 2.97, 95% CI 1.32-6.65), previous surgery (HR 2.39, 95% CI 1.10-5.21) and number of treated joints (HR 1.95 for each increase in the number of joints, 95% CI 1.14-3.33). In bivariate analyses, only depression was kept to be significant.Conclusions Depression seems to be related with a short duration of success. Based on these findings, a comprehensive study is warranted to evaluate whether psychosocial factors have to be considered when recruiting patients for radiofrequency denervation.

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Investigation into the neural correlates of emotional augmentation of clinical pain

Cited by 145 publications

References 54 publications

Pain imaging in health and disease — how far have we come?

Pain imaging in health and disease — how far have we come?

Morphological and functional reorganization of rat medial prefrontal cortex in neuropathic pain

Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study

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