Reduced anterior cingulate grey matter volume in painful hand osteoarthritis

Abstract

ObjectiveIncreasing evidence supports the role of central sensitisation in osteoarthritis (OA) pain. In this study, we used neuroimaging to compare pain-processing regions of the brain in participants with and without hand OA. We then assessed for volumetric changes in these brain regions following treatment with centrally acting analgesics.MethodsParticipants with hand OA (n = 28) underwent T1-weighted MRI of the brain before and after 12 weeks of treatment with pregabalin, duloxetine or placebo. Grey matter volume in the anterior cingulate cortex (ACC), insular cortex and thalamus was compared to non-OA control subjects (n = 11) using FreeSurfer regional volumetric analysis and voxel-based morphometry, and evaluated for differences pre- and post-treatment.ResultsRelative to non-OA controls, hand OA participants had areas of reduced grey matter volume in the ACC at baseline (p = 0.007). Regional volumetric differences in the ACC persisted after 13 weeks’ treatment with pregabalin or duloxetine (p = 0.004) with no significant differences between treatment cohorts, despite improvements in NRS pain scores for pregabalin (p = 0.005) and duloxetine (p = 0.050). The ACC grey matter changes persisted despite a significant improvement in pain in the pregabalin and duloxetine groups vs. placebo. No structural differences were observed in the insular cortex or thalamus at baseline or following treatment.ConclusionOur study found evidence of reduced ACC grey matter volume in participants with hand arthritis that persisted after treatment with centrally acting analgesics pregabalin and duloxetine, respectively. The sustained changes observed in the ACC in our study could reflect the relatively short duration of treatment, or that the differences observed are irreversible volume changes due to chronic pain that are established over time.Electronic supplementary materialThe online version of this article (10.1007/s00296-018-4085-2) contains supplementary material, which is available to authorized users.

Neuroinflammatory Remodeling of the Anterior Cingulate Cortex as a Key Driver of Mood Disorders in Gastrointestinal Disease and Disorders

“…When subjects with IBD-Crohn's were analyzed as subgroups with and without the presence of abdominal pain, those with abdominal pain had reduced GM in the ACC compared to those without abdominal pain, and the GM volume of the ACC was negatively correlated with daily pain scores among IBD-Crohn's subjects (151). These results suggest that reduced GM volume of the ACC is associated with chronic pain, a finding supported by studies on other diseases characterized by chronic pain including osteoarthritis (188), neuropathic pain (189), and fibromyalgia (190).…”

The Recovery of Cognitive and Affective Deficiencies Linked with Chronic Osteoarthritis Pain and Implicated Pathways by Slow-Releasing Hydrogen Sulfide Treatment

“…The anterior cingulate cortex is a region involved in executive, attention, and decisionmaking processes [52]. Previous studies have reported a direct association between the presence of chronic pain and linked memory loss in this area [39,53,54]. In our pain model, an increased expression of PI3K was observed in the anterior cingulate cortex, which was only reversed by GYY4137 treatment.…”

“…Thus, we evaluated the effects of the systemic administration of two slow-releasing H 2 S donors, a natural garlic bioactive component (diallyl disulfide, DADS) and a synthetic compound (morpholin-4-ium 4-methoxyphenyl (morpholino) phosphinodithioate, GYY4137), on nociceptive, grip strength, and memory deficits, as well as on the anxiodepressive symptoms provoked by the intra-articular administration of monosodium acetate (MIA). To examine the probable pathways involved in these actions, we analyzed their effects on the amygdala, periaqueductal gray matter, infralimbic cortex, and anterior cingulate cortex, all of which are highly involved in the modulation of nociception, memory, and emotional disorders [37][38][39][40].…”

Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

“…Several imaging studies have reported increased neuronal activity of the ACC during acute pain stimulation or conditions of persistent pain [ 64 ]. Russell et al compared the volume of gray matter in the ACC between 28 patients with hand osteoarthritis and 11 non-osteoarthritis control subjects by analyzing T1-weighted MRIs of the brain [ 65 ]. They found that the gray matter volume in the ACC of patients with hand osteoarthritis was significantly reduced when compared to subjects without osteoarthritis.…”