Northwestern University Feinberg School of Medicine Structural and
Northwestern University Feinberg School of Medicine Structural and Functional Brain Properties of Pain Perception in Health and Disease Pascal Tétreault, Ph. D Postdoctoral fellow A. Vania Apkarian lab May 29 th 2015
Outline 1. Acute pain vs chronic pain: distinct brain activity 2. Chronic pain: change in brain anatomy 3. Transition from acute to chronic pain: what is the role of the brain? 2
From acute to chronic pain Acute Weeks 3 Inflammatory 3 months Chronic > 6 months
Acute vs chronic pain Acute pain: Chronic pain: - Short duration - Long duration - Serve physiological function - No physiological use - Direct link to stimulus - Not linked to injury - Nociceptive - Emotions, limbic system - Spinothalamic tract - Nervous system-wide reorganization 4
Brain signature for acute pain Acute pain: Automated meta-analysis of 410 studies for The term « Pain » Neurosynth. org, Tal Yarkoni/Tor Wager lab 5
Brain signature for acute pain The pain matrix, is it specific? 6 Mouraux A. , 2011, Neuroimage. From Iannetti’s lab, UCL
Brain signature for acute pain The pain matrix, is it specific? 7 Mouraux A. , 2011, Neuroimage. From Iannetti’s lab, UCL
Brain signature for acute pain The Neurologic Pain Signature (NPS), from Tor Wager’s lab - Machine-learning methods 8 Wager T. , 2013, NEJM
Brain signature for acute pain The Neurologic Pain Signature (NPS), from Tor Wager’s lab 9 Wager T. , 2013, NEJM
Brain signature for acute pain - Hard to find specificity for pain - Is there even a pain matrix? -. . . 10
Brain signature for chronic pain Chronic pain: Automated meta-analysis of 75 studies for The term « Chronic Pain » Neurosynth. org, Tal Yarkoni/Tor Wager lab 11
Brain signature for chronic pain Brain activity for spontaneous pain in chronic pain patients 12 Apkarian’s lab data
Brain signature for chronic pain Brain activity for spontaneous and acute pain in chronic pain patients 13 Apkarian A. V. , Pain, 2011
Brain signature for chronic pain Brain activity for spontaneous and acute pain in chronic pain patients 14 Apkarian A. V. , Pain, 2011
Brain anatomy Chronic pain induce reorganization in gray matter anatomy 15
Chronic pain induce changes in brain anatomy Gray matter density (GMD) reorganization Chronic back pain (Apkarian et al 2004) Fibromyalgia (Kuchinad et al 2007) 16 CRPS (Geha et al 2008) Tension headache (Schmidt-Wilcke et al 2005)
Chronic pain induce changes in brain anatomy GMD reorganization 17
Chronic pain induce changes in brain anatomy GMD reorganization is reversible Treatment effect 18 Seminowicz D A et al. J. Neurosci. 2011
Chronic pain induce changes in brain anatomy GMD reorganization is reversible Gwilym et al. , 2010, Arthritis & Rheumatism 19
Chronic pain induce changes in brain anatomy GMD reorganization is reversible Treatment effect VS Z-fstat Response effect VS 20 2. 3 3. 5
Chronic pain induce changes in brain anatomy White matter impairment 21
Transition from acute to chronic 22
From acute to chronic pain Brain activity changes when pain becomes chronic From Neurosynth. org 23 Hashmi J. , Brain, 2013
From acute to chronic pain Brain activity changes when pain becomes chronic 24 Hashmi J. , Brain, 2013
From acute to chronic pain Brain activity changes when pain becomes chronic 25 Hashmi J. , Brain, 2013
From acute to chronic pain - Representation of chronic pain - From sensory to emotional networks -. . . 26
Take home messages 1. Different functional expression of acute and chronic pain • Chronic pain is NOT just the persistence of acute stimuli 2. Chronic pain induce structural impairments • Both at the level of GMD and white matter properties 3. Pain chronification shift brain representation from nociceptive to emotional circuits • Dynamic process, early intervention might be able to influence the trajectories 27
Tomorrow’s talk How can we use neuroimaging methods to improve future clinical decisions To be able to predict the behavioral outcome will influence personalized medicine 28
Acknowledgments A. Vania Apkarian Marwan N. Baliki Thomas J. Schnitzer Postdoctoral fellowship from: Étienne Vachon-Presseau Lejian Huang Funded by: Bogdan Petre All the Apkarian lab! 29 IIT from:
- Slides: 29