Neurochemical changes in patients with chronic low back pain detected by proton magnetic resonance spectroscopy: A systematic review

Zhao, Xiaoli; Xu, Maosheng; Jorgenson, Kristen; Kong, Jian

doi:10.1016/j.nicl.2016.11.006

Cited by 54 publications

(34 citation statements)

References 48 publications

(119 reference statements)

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“…Furthermore, quantitative sensory testing has demonstrated widespread hyperalgesia, allodynia, and impaired endogenous analgesia in individuals with chronic pelvic pain, including UCPPS, ( As-Sanie et al, 2016 , Clauw et al, 1997 , Grinberg et al, 2017 , Iacovides et al, 2015 , Ness et al, 2014 , Ness et al, 2005 , Powell-Boone et al, 2005 , Slater et al, 2015 , Stratton et al, 2015 ), which also strongly suggest involvement of the central nervous system. Altered levels of brain metabolites have been observed in chronic pain patients with endometriosis ( As-Sanie et al, 2016 ) and in other non-pelvic pain conditions ( Aguila et al, 2016 , Cao et al, 2016 , Chang et al, 2013 , Fayed et al, 2010 , Feraco et al, 2011 , Foerster et al, 2012 , Grachev et al, 2000 , Harris and Clauw, 2012 , Harris et al, 2013 , Harris et al, 2009 , Harris et al, 2008 , Ito et al, 2017 , Petrou et al, 2008 , Petrou et al, 2012 , Reckziegel et al, 2016 , Valdes et al, 2010 , Widerstrom-Noga et al, 2013 , Zhao et al, 2017 ), but the present study is the first to test for these factors in UCPPS.…”

Section: Discussionmentioning

confidence: 77%

“…1 . The ACC and insula were chosen for their well-described role in both acute and chronic pain ( Bliss et al, 2016 ), and previous findings from our lab and others showing altered metabolites in these regions in chronic pain patients ( As-Sanie et al, 2016 , Cagnoli et al, 2013 , Cao et al, 2016 , Feraco et al, 2011 , Foerster et al, 2012 , Harris et al, 2013 , Harris et al, 2009 , Harris et al, 2008 , Ito et al, 2017 , Petrou et al, 2008 , Petrou et al, 2012 , Reckziegel et al, 2016 , Valdes et al, 2010 , Widerstrom-Noga et al, 2013 , Zhao et al, 2017 ). The occipital cortex was selected as a control region.…”

Section: Methodsmentioning

confidence: 99%

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Relationships between brain metabolite levels, functional connectivity, and negative mood in urologic chronic pelvic pain syndrome patients compared to controls: A MAPP research network study

Harper

Ichesco

Schrepf

et al. 2018

NeuroImage: Clinical

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Until recently, the predominant pathology of chronic pelvic pain conditions was thought to reside in the peripheral tissues. However, mounting evidence from neuroimaging studies suggests an important role of the central nervous system in the pathogenesis of these conditions. In the present cross-sectional study, proton magnetic resonance spectroscopy (1H-MRS) of the brain was conducted in female patients with urologic chronic pelvic pain syndrome (UCPPS) to determine if they exhibit abnormal concentrations of brain metabolites (e.g. those indicative of heightened excitatory tone) in regions involved in the processing and modulation of pain, including the anterior cingulate cortex (ACC) and the anterior and posterior insular cortices. Compared to a group of age-matched healthy subjects, there were significantly higher levels of choline (p = 0.006, uncorrected) in the ACC of UCPPS patients. ACC choline levels were therefore compared with the region's resting functional connectivity to the rest of the brain. Higher choline was associated with greater ACC-to-limbic system connectivity in UCPPS patients, contrasted with lower connectivity in controls (i.e. an interaction). In patients, ACC choline levels were also positively correlated with negative mood. ACC γ-aminobutyric acid (GABA) levels were lower in UCPPS patients compared with controls (p = 0.02, uncorrected), but this did not meet statistical correction for the 4 separate regional comparisons of metabolites. These results are the first to uncover abnormal GABA and choline levels in the brain of UCPPS patients compared to controls. Low GABA levels have been identified in other pain syndromes and might contribute to CNS hyper-excitability in these conditions. The relationships between increased ACC choline levels, ACC-to-limbic connectivity, and negative mood in UCPPS patients suggest that this metabolite could be related to the affective symptomatology of this syndrome.

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Section: Discussionmentioning

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Relationships between brain metabolite levels, functional connectivity, and negative mood in urologic chronic pelvic pain syndrome patients compared to controls: A MAPP research network study

Harper

Ichesco

Schrepf

et al. 2018

NeuroImage: Clinical

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“…The sensory motor integration of proprioceptive inputs coming from the moving hand, could further interfere with the laser stimuli and reinforce the inhibition they could exert on the metabolism of the motor cortical areas. Recent studies on metabolic changes of cortical areas measured by proton magnetic resonance spectroscopy in patients with chronic low back pain, indicated alteration in the biochemical profile of several cortical areas, including the motor cortex [54]. In sum, the general tone of motor cortex activation is lower in FM patients as compared to controls, especially during fast movement.…”

Section: Reduced Motor Performance and Motor Cortical Areas Activatiomentioning

confidence: 95%

Mutual interaction between motor cortex activation and pain in fibromyalgia: EEG-fNIRS study

et al. 2020

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Background Experimental and clinical studies suggested an analgesic effect on chronic pain by motor cortex activation. The present study explored the complex mechanisms of interaction between motor and pain during performing the slow and fast finger tapping task alone and in concomitant with nociceptive laser stimulation. Method The participants were 38 patients with fibromyalgia (FM) and 21 healthy subjects. We used a simultaneous multimodal method of laser-evoked potentials and functional near-infrared spectroscopy to investigate metabolic and electrical changes during the finger tapping task and concomitant noxious laser stimulation. Functional near-infrared spectroscopy is a portable and optical method to detect cortical metabolic changes. Laser-evoked potentials are a suitable tool to study the nociceptive pathways function. Results We found a reduced tone of cortical motor areas in patients with FM compared to controls, especially during the fast finger tapping task. FM patients presented a slow motor performance in all the experimental conditions, requesting rapid movements. The amplitude of laser evoked potentials was different between patients and controls, in each experimental condition, as patients showed smaller evoked responses compared to controls. Concurrent phasic pain stimulation had a low effect on motor cortex metabolism in both groups nor motor activity changed laser evoked responses in a relevant way. There were no correlations between Functional Near-Infrared Spectroscopy (FNIRS) and clinical features in FM patients.

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“…An advanced MRS method, MEscherGArwood Point RESolved Spectroscopy (MEGA-PRESS) ( Mescher et al, 1998 ; Puts and Edden, 2012 ) may be used to detect GABA levels in the healthy brain and compare them to levels in various pain and emotional disorders ( Gao et al, 2013 ; Plante et al, 2012 ; Zunhammer et al, 2016 ). 1 H-MRS studies have revealed altered levels of cerebral neurotransmitters in various chronic pain conditions, such as fibromyalgia ( Foerster et al, 2012 ), chronic back pain ( Sharma et al, 2011 ; Zhao et al, 2017 ), and neuropathic pain ( Widerstrom-Noga et al, 2013 ). Recently, we reviewed ( Lv et al, 2017 ) the brain changes of CD detected by fMRI and MRS, and observed CD spectrum analysis of metabolites were commonly used in vitro, serum, urine, excreta and tissue samples.…”

Section: Introductionmentioning

confidence: 99%

Neurotransmitter alterations in the anterior cingulate cortex in Crohn's disease patients with abdominal pain: A preliminary MR spectroscopy study

Song

Tang

et al. 2018

NeuroImage: Clinical

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PurposeCrohn's disease (CD) has been known to cause both abdominal pain alongside functional and structural alterations in the central nervous system (CNS) in affected patients. This study seeks to determine the alternations of metabolites in the bilateral anterior cingulate cortex (ACC) of CD patients with abdominal pain by using proton magnetic resonance spectroscopy (1H-MRS) to further explore the neural mechanism.MethodsSixteen CD patients with abdominal pain and 13 CD patients without abdominal pain, were recruited alongside 20 healthy controls (HCs) for this study. Clinical evaluations, including the 0–10 Visual Analogue Scale (VAS) of pain, Hospital Anxiety and Depression Scale (HADS) and Crohn's Disease Activity Index (CDAI), were evaluated prior to MR scanning. This study selected the bilateral ACC as the region of interest (ROI). The metabolites of the bilateral ACC were quantitatively analyzed by LCModel and Gannet. A independent sample t-test and one-way analysis of variance (ANOVA) were performed for statistical analysis. Spearman correlation analyses were performed to examine the relationship between the metabolite levels and clinical evaluations.ResultsThe results indicated that CD patients with abdominal pain exhibited significantly higher levels of Glutamate (Glu)/(creatine + phosphocreatine, total creatine, tCr) over CD patients without abdominal pain, and HCs (p = 0.003, 0.009, respectively) in the bilateral ACC. The level of (Glutamate + Glutamine, Glx)/tCr of pain CD group was higher than non-pain CD group (p = 0.022). Moreover, within the pain CD group, Glu/tCr and Glx/tCr levels correlated strongly with the VAS scores of pain (ρ = 0.86, 0.59 respectively, p < 0.05). Meanwhile, the results indicates that CD patients with abdominal pain have significantly lower levels of γ-aminobutyric acid plus (GABA+)/tCr (p = 0.002) than HCs. To some extent, CDAI demonstrated a trend of negative correlation with GABA+/tCr levels (p = 0.088, ρ = −0.60).ConclusionThe neural mechanism of CD patients with abdominal pain in pain processing is tightly associated with neurochemical metabolites. An imbalance in Glu and GABA may play a key role in abdominal pain processing for patients with CD. This mechanism of pain may associate with the intestinal microbiota on the brain-gut axis.

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Neurochemical changes in patients with chronic low back pain detected by proton magnetic resonance spectroscopy: A systematic review

Cited by 54 publications

References 48 publications

Relationships between brain metabolite levels, functional connectivity, and negative mood in urologic chronic pelvic pain syndrome patients compared to controls: A MAPP research network study

Relationships between brain metabolite levels, functional connectivity, and negative mood in urologic chronic pelvic pain syndrome patients compared to controls: A MAPP research network study

Mutual interaction between motor cortex activation and pain in fibromyalgia: EEG-fNIRS study

Neurotransmitter alterations in the anterior cingulate cortex in Crohn's disease patients with abdominal pain: A preliminary MR spectroscopy study

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