Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients

doi:10.1016/J.PAIN.2006.05.004

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Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients

Journal Article•DOI•

Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients

T. Schmidt-Wilcke¹, Elke Leinisch¹, S. Gänssbauer¹, Bogdan Draganski¹, Ulrich Bogdahn¹, Altmeppen J¹, Arne May¹, Arne May² - Show less +4 more•Institutions (2)

University of Regensburg¹, University of Hamburg²

01 Nov 2006-Pain (No longer published by Elsevier)-Vol. 125, Iss: 1, pp 89-97

TL;DR: The hypothesis that ongoing nociception is associated with cortical and subcortical reorganisation on a structural level, which may play an important role in the process of the chronification of pain, is supported.

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Abstract: Although chronic back pain is one of the most frequent reasons for permanent impairment in people under 65, the neurobiological mechanisms of chronification remain vague. Evidence suggests that cortical reorganisation, so-called functional plasticity, may play a role in chronic back pain patients. In the search for the structural counterpart of such functional changes in the CNS, we examined 18 patients suffering from chronic back pain with voxel-based morphometry and compared them to 18 sex and age matched healthy controls. We found a significant decrease of gray matter in the brainstem and the somatosensory cortex. Correlation analysis of pain unpleasantness and the intensity of pain on the day of scanning revealed a strong negative correlation (i.e. a decrease in gray matter with increasing unpleasantness/increasing intensity of pain) in these areas. Additionally, we found a significant increase in gray matter bilaterally in the basal ganglia and the left thalamus. These data support the hypothesis that ongoing nociception is associated with cortical and subcortical reorganisation on a structural level, which may play an important role in the process of the chronification of pain.

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Journal Article•DOI•

Cognitive and emotional control of pain and its disruption in chronic pain

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M. Catherine Bushnell¹, Marta Ceko¹, Lucie A. Low¹•Institutions (1)

National Institutes of Health¹

01 Jul 2013-Nature Reviews Neuroscience

TL;DR: The accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, is examined, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.

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Abstract: Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind-body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states - important components of mind-body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.

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1,359 citations

Journal Article•DOI•

The effect of pain on cognitive function: a review of clinical and preclinical research.

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Orla Moriarty¹, Brian E. McGuire¹, David P. Finn¹•Institutions (1)

National University of Ireland, Galway¹

01 Mar 2011-Progress in Neurobiology

TL;DR: The anatomical, neurochemical and molecular substrates common to both cognitive processing and supraspinal pain processing are described, and the evidence for their involvement in pain-related cognitive impairment is presented.

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801 citations

Journal Article•DOI•

Towards a theory of chronic pain

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A. Vania Apkarian¹, Marwan N. Baliki¹, Paul Geha¹•Institutions (1)

Northwestern University¹

01 Feb 2009-Progress in Neurobiology

TL;DR: A unified working model is outlined outlining the mechanism by which acute pain transitions into a chronic state, which incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronic pain conditions within a single model.

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713 citations

Cites result from "Affective components and intensity ..."

...This result has now been replicated in chronic back pain and other types of chronic pain conditions (Kuchinad et al., 2007; Schmidt-Wilcke et al., 2005, 2006)....
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Journal Article•DOI•

Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain

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A. Vania Apkarian¹, Javeria A. Hashmi¹, Marwan N. Baliki¹•Institutions (1)

Northwestern University¹

01 Mar 2011-Pain

TL;DR: A brain model for the transition of the human from acute to chronic pain is proposed by proposing a brain model that combines anatomical and functional reorganization of the brain in chronic pain.

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Abstract: We review recent advances in brain imaging in humans, concentrating on advances in our understanding of the human brain in clinical chronic pain. Understanding regarding anatomical and functional reorganization of the brain in chronic pain is emphasized. We conclude by proposing a brain model for the transition of the human from acute to chronic pain.

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612 citations

Cites background from "Affective components and intensity ..."

...changes in multiple clinical pain conditions: back pain [90], fibromyalgia [54,57,65,92], CRPS [40], knee osteoarthritis [87], irritable bowel syndrome [14,28], headaches [55,89,91,104], chronic vulvar pain [93], and in female individuals with menstrual pains [102], as well as in animal models of chronic pain [70,96]....
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Journal Article•DOI•

Chronic pain may change the structure of the brain

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Arne May¹•Institutions (1)

University of Hamburg¹

30 Jun 2008-Pain

TL;DR: The author suggests that the gray matter change observed in chronic pain patients are the consequence of frequent nociceptive input and should thus be reversible when pain is adequately treated.

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Abstract: Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and two types of frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbitofrontal cortex, the insula and dorsal pons. These regions function as multi-integrative structures during the experience and the anticipation of pain. As it seems that chronic pain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain. The author suggests that the gray matter change observed in chronic pain patients are the consequence of frequent nociceptive input and should thus be reversible when pain is adequately treated.

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583 citations

Cites background from "Affective components and intensity ..."

...decrease in gray matter) seen in the anterior cingulate cortex in migraine patients are similar to a decrease in this region in chronic back pain [67] and chronic phantom pain [15]....
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...However, this study also found an increase in thalamic gray matter and an additional decrease in the dorsolateral pons and the somatosensory cortex [67]....
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...back pain (n = 18) [67]; (lower row right) frequent migraine without...
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References

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Open Access

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Journal Article•DOI•

The CES-D Scale: A Self-Report Depression Scale for Research in the General Population

[...]

Lenore Sawyer Radloff¹•Institutions (1)

National Institutes of Health¹

01 Jun 1977-Applied Psychological Measurement

TL;DR: The CES-D scale as discussed by the authors is a short self-report scale designed to measure depressive symptomatology in the general population, which has been used in household interview surveys and in psychiatric settings.

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Abstract: The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.

...read moreread less

48,339 citations

"Affective components and intensity ..." refers methods in this paper

...The common depression scale (self-assessment scale) is the German version of the Center for Epidemiological Studies-Depression scale (CES-D; R) (Radloff, 1977)....
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Journal Article•DOI•

A rating scale for depression

[...]

Max Hamilton

01 Feb 1960-Journal of Neurology, Neurosurgery, and Psychiatry

TL;DR: The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.

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Abstract: Types of Rating Scale The value of this one, and its limitations, can best be considered against its background, so it is useful to consider the limitations of the various rating scales extant. They can be classified into four groups, the first of which has been devised for use on normal subjects. Patients suffering from mental disorders score very highly on some of the variables and these high scores serve as a measure of their illness. Such scales can be very useful, but have two defects: many symptoms are not found in normal persons; and less obviously, but more important, there is a qualitative difference between symptoms of mental illness and normal variations of behaviour. The difference between the two is not a philosophical problem but a biological one. There is always a loss of function in illness, with impaired efficiency. Self-rating scales are popular because they are easy to administer. Aside from the notorious unreliability of self-assessment, such scales are of little use for semiliterate patients and are no use for seriously ill patients who are unable to deal with them. Many rating scales for behaviour have been devised for assessing the social adjustment of patients and their behaviour in the hospital ward. They are very useful for their purpose but give little or no information about symptoms. Finally, a number of scales have been devised specifically for rating symptoms of mental illness. They cover the whole range of symptoms, but such all-inclusiveness has its disadvantages. In the first place, it is extremely difficult to differentiate some symptoms, e.g., apathy, retardation, stupor. These three look alike, but they are quite different and appear in different settings. Other symptoms are difficult to define, except in terms of their settings, e.g., mild agitation and derealization. A more serious difficulty lies in the fallacy of naming. For example, the term "delusions" covers schizophrenic, depressive, hypochrondriacal, and paranoid delusions. They are all quite different and should be clearly distinguished. Another difficulty may be summarized by saying that the weights given to symptoms should not be linear. Thus, in schizophrenia, the amount of anxiety is of no importance, whereas in anxiety states it is fundamental. Again, a schizophrenic patient who has delusions is not necessarily worse than one who has not, but a depressive patient who has, is much worse. Finally, although rating scales are not used for making a diagnosis, they should have some relation to it. Thus the schizophrenic patients should have a high score on schizophrenia and comparatively small scores on other syndromes. In practice, this does not occur. The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type. It is used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The interviewer may, and should, use all information available to help him with his interview and in making the final assessment. The scale has undergone a number of changes since it was first tried out, and although there is room for further improvement, it will be found efficient and simple in use. It has been found to be of great practical value in assessing results of treatment.

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29,488 citations

"Affective components and intensity ..." refers methods in this paper

...The tests included the following assessments of pain and depression: the pain experience scale (SES) (Geissner, 1995), present pain intensity using a Numerical Rating Scale (NRS) (De Conno et al., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment depression scale (ADS) (Hautzinger, 1993)....
[...]
..., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment depression scale (ADS) (Hautzinger, 1993)....
[...]
...…(SES) (Geissner, 1995), present pain intensity using a Numerical Rating Scale (NRS) (De Conno et al., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment…...
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Journal Article•DOI•

A new depression scale designed to be sensitive to change.

[...]

Stuart Montgomery, Marie Åsberg¹•Institutions (1)

Royal College of Psychiatrists¹

01 Apr 1979-British Journal of Psychiatry

TL;DR: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described, and its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change.

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Abstract: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

...read moreread less

11,923 citations

"Affective components and intensity ..." refers methods in this paper

...The tests included the following assessments of pain and depression: the pain experience scale (SES) (Geissner, 1995), present pain intensity using a Numerical Rating Scale (NRS) (De Conno et al., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment depression scale (ADS) (Hautzinger, 1993)....
[...]
..., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment depression scale (ADS) (Hautzinger, 1993)....
[...]
...…using a Numerical Rating Scale (NRS) (De Conno et al., 1994), the Hamilton Depression Scale (HAMD) (Hamilton, 1960) and the Montgomery-Asperg Depression Scale (MADRS) (Montgomery and Asberg, 1979) as external assessment scales, and a self-assessment depression scale (ADS) (Hautzinger, 1993)....
[...]

Journal Article•DOI•

Voxel-Based Morphometry—The Methods

[...]

John Ashburner¹, Karl J. Friston¹•Institutions (1)

Queen's University¹

01 Jun 2000-NeuroImage

TL;DR: In this paper, the authors describe the steps involved in VBM, with particular emphasis on segmenting gray matter from MR images with non-uniformity artifact and provide evaluations of the assumptions that underpin the method, including the accuracy of the segmentation and the assumptions made about the statistical distribution of the data.

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8,049 citations

"Affective components and intensity ..." refers methods in this paper

...VBM is based on high-resolution structural 3D-MR-images, registered in common stereotactic space, and designed to seek significant regional differences by applying voxel-wise statistics in the context of Gaussian random fields (Friston et al., 1999; Ashburner and Friston, 2000)....
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...Preprocessing of the data involved spatial normalization (Ashburner and Friston, 1997, 1999), gray matter segmentation (Ashburner and Friston, 1997) and spatial smoothing with a Gaussian kernel (Ashburner and Friston, 2000)....
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Journal Article•DOI•

The McGill Pain Questionnaire: major properties and scoring methods.

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Ronald Melzack¹•Institutions (1)

McGill University¹

01 Sep 1975-Pain

TL;DR: The McGill Pain Questionnaire as discussed by the authors consists of three major classes of word descriptors (sensory, affective and evaluative) that are used by patients to specify subjective pain experience.

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Abstract: The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically. This paper describes the procedures for administration of the questionnaire and the various measures that can be derived from it. The 3 major measures are: (1) the pain rating index, based on two types of numerical values that can be assigned to each word descriptor, (2) the number of words chosen; and (3) the present pain intensity based on a 1-5 intensity scale. Correlation coefficients among these measures, based on data obtained with 297 patients suffering several kinds of pain, are presented. In addition, an experimental study which utilized the questionnaire is analyzed in order to describe the nature of the information that is obtained. The data, taken together, indicate that the McGill Pain Questionnaire provides quantitative information that can be treated statistically, and is sufficiently sensitive to detect differences among different methods to relieve pain.

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6,007 citations