Brainstem pain-control circuitry connectivity in chronic neuropathic pain
MetadataShow full item record
Funding and Sponsorship
© 2018 the authors.
Preclinical investigations have suggested that altered functioning of brainstem pain-modulation circuits may be crucial for the maintenance of some chronic pain conditions. While some human psychophysical studies show that patients with chronic pain display altered pain-modulation efficacy, it remains unknown whether brainstem pain-modulation circuits are altered in individuals with chronic pain. The aim of the present investigation was to determine whether, in humans, chronic pain following nerve injury is associated with altered ongoing functioning of the brainstem descending modulation systems. Using resting-state functional magnetic resonance imaging, we found that male and female patients with chronic neuropathic orofacial pain show increased functional connectivity between the rostral ventromedial medulla (RVM) and other brainstem pain-modulatory regions, including the ventrolateral periaqueductal gray (vlPAG) and locus ceruleus (LC). We also identified an increase in RVM functional connectivity with the region that receives orofacial nociceptor afferents, the spinal trigeminal nucleus. In addition, the vlPAG and LC displayed increased functional connectivity strengths with higher brain regions, including the hippocampus, nucleus accumbens, and anterior cingulate cortex, in individuals with chronic pain. These data reveal that chronic pain is associated with altered ongoing functioning within the endogenous pain-modulation network. These changes may underlie enhanced descending facilitation of processing at the primary synapse, resulting in increased nociceptive transmission to higher brain centers. Further, our findings show that higher brain regions interact with the brainstem modulation system differently in chronic pain, possibly reflecting top–down engagement of the circuitry alongside altered reward processing in pain conditions.
Showing items related by title, author, creator and subject.
Marciszewski, K.K.; Meylakh, N.; Harrington, Flavia ; Mills, E.P.; Macefield, V.G.; Macey, P.M.; Henderson, L.A. (2018)© 2018 the authors. The neural mechanism responsible for migraine remains unclear. While an external trigger has been proposed to initiate a migraine, it has also been proposed that changes in brainstem function are ...
Fluctuating regional brainstem diffusion imaging measures of microstructure across the migraine cycleMarciszewski, K.K.; Meylakh, N.; Di Pietro, Flavia ; Macefield, V.G.; Macey, P.M.; Henderson, L.A. (2019)© 2019 Marciszewski et al. The neural mechanisms responsible for the initiation and expression of migraines remain unknown. Although there is growing evidence of changes in brainstem anatomy and function between attacks, ...
Altered regional cerebral blood flow and hypothalamic connectivity immediately prior to a migraine headacheMeylakh, N.; Marciszewski, K.K.; Di Pietro, Flavia ; Macefield, V.G.; Macey, P.M.; Henderson, L.A. (2020)© International Headache Society 2020. Background: There is evidence of altered resting hypothalamic activity patterns and connectivity prior to a migraine, however it remains unknown if these changes are driven by changes ...