Shellie Boudreau

The effects of intra-oral pain on motor cortex neuroplasticity associated with short-term novel tongue-protrusion training in humans

Abstract To determine if short‐term (15 min) training in a novel tongue‐task is associated with rapid neuroplasticity of the tongue primary motor area (MI) in the human cerebral cortex, and if intra‐oral tonic pain affects the tongue MI neuroplasticity and tongue‐task training performance. Nine healthy volunteers (7 men, 2 women, mean age 24 ± 1.1 years) participated in two cross‐over training sessions in which the application to the tongue of the algesic chemical capsaicin (1%) or vehicle cream was randomized. Prior to and again immediately after 15 min of training in a tongue‐protrusion task, transcranial magnetic stimulation (TMS) was applied to the MI in each session and motor evoked potentials (MEPs) were recorded in the tongue musculature and the first dorsal interosseous (FDI) muscle (as control). Neuroplasticity of the tongue MI, as reflected in a significantly enhanced TMS–MEP stimulus–response curve and reduced MEP threshold, was observed after the vehicle session but not after the capsaicin session. Subjects’ overall mean performance scores were significantly higher in the vehicle session than in the capsaicin session. MI neuroplasticity may rapidly occur in association with successful performance in novel tongue‐task training, but intra‐oral tonic pain interferes with these effects. These findings suggest that nociceptive input modulates MI neuroplasticity associated with novel motor training and may impair the ability to learn a new motor task.

The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders

The extent of cortical neuroplastic changes has been shown to be a key neurophysiological feature that correlates with the level of functional recovery. Therefore, rehabilitation efforts that attempt to maximize cortical reorganization provide the greatest potential for rehabilitation success. This paper reviews the evidence of cortical neuroplastic changes that have been shown to occur in association with experimental or chronic pain disorders. Further, the promising role of novel motor-skill training is discussed in order to best direct the clinician to optimize rehabilitation strategies for patients with musculoskeletal pain disorders.

The effects of training time, sensory loss and pain on human motor learning

This study determined, in humans, the effects of (i) the number of within-session task repetitions (72 or 144 over a period of 15 or 30 min, respectively) on the time course of motor learning in a long-term (seven consecutive daily motor-training sessions and a 1-week post-follow-up) novel tongue-task training regime and (ii) somatosensory manipulations (capsaicin-induced intra-oral pain or lidocaine-induced sensory loss of the tongue tip) on motor learning in a short-term (single motor-training session consisting of 72 within-session task repetitions over a period of 15 min) novel tongue-task training regime. Novel tongue-task training consisted of tracking a moving target box by generating a pre-set amount of tongue-protrusion force onto a force lever. Analysis of motor behaviour revealed (i) a higher within-session gain for the 30-min tongue-task training regime, but this difference did not differentially affect the time course of the overall motor performance or additional motor performance variables between the 15- and 30-min tongue-task training regimes in subsequent training sessions. (ii) somatosensory manipulations of the tongue tip reduced the gains in overall motor performance, and this reduced motor performance was mainly characterized by exaggerated undershoot errors and delayed reaction times for the lidocaine tongue-task training regime and exaggerated overshoot and undershoot errors as well as delayed reaction times for the capsaicin tongue-task training regime. It is concluded that extended within-session task repetitions do not facilitate additional long-term gains in overall motor performance and intra-oral sensory loss or pain hinders motor learning.

Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: A randomized controlled study

Although exercise can be effective for relief of neck pain, little is known about the effect of exercise on the neural control of neck muscles.

Digital Pain Drawings: Assessing Touch-screen Technology and 3D Body Schemas.

Objectives:To assess the consistency and level of agreement between pain drawings collected on (1) paper and a personal computer tablet; and (2) between a 2-dimensional (2D) line drawing and 3-dimensional (3D) body schema. Materials and Methods:Pain-free participants (N=24) recreated a premarked “pain” area from a 2D line drawing displayed on paper onto paper or tablet, and individuals with chronic neck pain (N=29) expressed their current pain on paper and tablet. A heterogeneous group (N=26) was recruited from cross-disciplinary pain clinic and expressed their pain on a 2D line drawing and a 3D body schema, as displayed on a tablet, and then completed an user-experience questionnaire. Results:Pain drawings showed moderate to high level of consistency and a high level of agreement for paper and tablet and between 2D line drawing and 3D body schema. A fixed bias (−1.0042, P<0.001) revealed that pain areas were drawn slightly smaller on paper than on tablet, and larger on the 2D than the 3D body schema (−0.6371, P=0.003), as recorded on a tablet. Over one-third of individuals with chronic pain preferred and/or believed that the 3D body schema enabled a more accurate record; 12 believed they were equal, and 3 preferred the 2D line drawing. Discussion:Pain drawings recorded with touch-screen technology provide equal reliability to paper but the size of the drawing slightly differs between the platforms. Although, 2D line drawings and 3D body schemas were similar in terms of consistency and reliability, it remains to be confirmed whether 3D body schemas increase the accuracy and precision of pain drawings.

Tip of the Tongue Selectivity and Motor Learning in the Palatal Area

This study assessed the ability of the tongue tip to accurately select intraoral targets embedded in an upper palatal tongue-computer interface, using 18 able-bodied volunteers. Four performance measures, based on modifications to Fittss Law, were determined for three different tongue-computer interface layouts. The layouts differed with respect to number and location of the targets in the palatal interface. Assessment of intraoral target selection speed and accuracy revealed that performance was indeed dependent on the location and distance between the targets. Performances were faster and more accurate for targets located farther away from the base of the tongue in comparison to posterior and medial targets. A regression model was built, which predicted intraoral target selection time based on target location and movement amplitude better than the predicted by using a standard Fittss Law model. A 30% improvement in the speed and accuracy over three daily practice sessions of 30 min emphasizes the remarkable motor learning abilities of the tongue musculature and provides further evidence that the tongue is useful for operating computer-interface technologies.

Localized pressure pain sensitivity is associated with lower activation of the semispinalis cervicis muscle in patients with chronic neck pain.

Objective:To investigate the relation between localized pressure pain sensitivity and the amplitude and specificity of semispinalis cervicis muscle activity in patients with chronic neck pain. Materials and Methods:Pressure pain detection thresholds (PPDTs) were measured over the C2-C3 and C5-C6 cervical zygapophyseal joints in 10 women with chronic neck pain and 9 healthy age-matched and sex-matched controls. Intramuscular electromyography (EMG) was acquired from the semispinalis cervicis at the levels of C2 and C5 during isometric circular contractions in the horizontal plane at 15 and 30 N, with continuous change in force direction in the range 0 to 360 degrees. The average rectified value and directional specificity of semispinalis cervicis muscle activity were computed and regression analyses were performed between measures of EMG and PPDT. Results:Patients showed significantly lower PPDT compared with controls (P<0.01). Patients also displayed lower EMG amplitude of the semispinalis cervicis at both spinal levels during the circular contractions (average across spinal levels, mean±SD: 129.01±58.99 and 126.83±58.78 µV for the 15- and 30-N contractions, respectively) compared with controls (158.69±66.27 and 187.64±87.82 µV; P<0.05). Furthermore, the directional specificity of semispinalis cervicis muscle was lower for the patients during the circular contractions (P<0.05). The PPDT (C2 and C5 pooled) was positively correlated to both, directional specificity (R2=0.22, P<0.05) and amplitude (R2=0.15, P<0.05) of the EMG. Discussion:In contrast to asymptomatic individuals, the semispinalis cervicis muscle displays reduced and less-defined EMG activity during a multidirectional isometric contraction in patients with chronic neck pain. The altered behavior of the semispinalis cervicis is weakly associated to pressure pain sensitivity.

Effects of periodontal afferent inputs on corticomotor excitability in humans

The aim of the present study was to determine in humans whether local anaesthesia (LA) or nociceptive stimulation of the periodontal ligaments affects the excitability of the face primary motor cortex (MI) related to the tongue and jaw muscles, as measured by transcranial magnetic stimulation (TMS). Twelve healthy volunteers (11 men, 1 woman, 25.3 +/- 4.2 years) participated in two 3-h sessions separated by 7 days. The LA carbocain or the nociceptive irritant capsaicin was randomly injected into the periodontal ligament of the lower right central incisor. In both sessions, TMS-motor evoked potential (MEP) stimulus-response curves and corticomotor maps were acquired for the tongue and masseter muscles before (baseline) and at 5, 30 and 60 min post-application of carbocain or capsaicin. Transcranial magnetic stimulation-MEP stimulus-response curves were also acquired at these time points for the first dorsal interosseous (FDI) as an internal control. Burning pain intensity and mechanical sensitivity ratings to a von Frey filament applied to the application site were recorded on an electronic visual analogue scale (VAS). All subjects reported a decreased mechanical sensitivity (anova: P = 0.004) in the LA session and a burning pain sensation (VAS peak pain: 6.4 +/- 1.0) in the capsaicin session. No significant changes in cortical excitability of the MI, as reflected by TMS-MEP stimulus-response curves or corticomotor maps for the tongue, masseter or FDI were found between baseline and post-injection for the LA (anovas: P > 0.22) or capsaicin (anovas: P > 0.16) sessions. These findings suggest that a transient loss or perturbation in periodontal afferent input to the brain from a single incisor is insufficient to cause changes in corticomotor excitability of the face MI, as measured by TMS in humans.

A Comparison of Oral Sensory Effects of Three TRPA1 Agonists in Young Adult Smokers and Non-smokers

This study profiled intra-oral somatosensory and vasomotor responses to three different transient receptor potential (TRP) channels, subfamily A, member 1 (TRPA1) agonists (menthol, nicotine, and cinnamaldehyde) in smoking and non-smoking young adults. Healthy non-smokers (N = 30) and otherwise healthy smokers (N = 25) participated in a randomized, double-blinded, cross-over study consisting of three experimental sessions in which they received menthol (30 mg), nicotine (4 mg), or cinnamaldehyde (25 mg) chewing gum. Throughout a standardized 10 min chewing regime, burning, cooling, and irritation intensities, and location were recorded. In addition, blood pressure, heart rate and intra-oral temperature were assessed before, during, and after chewing. Basal intra-oral temperature was lower in smokers (35.2°C ± 1.58) as compared to non-smokers (35.9°C ± 1.61) [F(1, 52) = 8.5, P = 0.005, post hoc, p = 0.005]. However, the increase in temperature, heart rate, and blood pressure in response to chewing menthol, nicotine, and cinnamaldehyde gums were similar between smokers and non-smokers. Although smoking status did not influence the intensity of burning, cooling, and irritation, smokers did report nicotine burn more often (92%) than non-smokers (63%) [χ(1, N=55)2 = 6.208, P = 0.013]. Reports of nicotine burn consistently occurred at the back of the throat and cinnamaldehyde burn on the tongue. The cooling sensation of menthol was more widely distributed in the mouth of non-smokers as compared to smokers. Smoking alters thermoregulation, somatosensory, and possibly TRPA1 receptor responsiveness and suggests that accumulated exposure of nicotine by way of cigarette smoke alters oral sensory and vasomotor sensitivity.

A test-retest reliability study of human experimental models of histaminergic and non-histaminergic itch

Numerous exploratory, proof-of-concept and interventional studies have used histaminergic and non-histaminergic human models of itch. However, no reliability studies for such surrogate models have been conducted. This study investigated the test-retest reliability for the response to histamine- and cowhage- (5, 15, 25 spiculae) induced itch in healthy volunteers. Cowhage spiculae were individually applied with tweezers and 1% histamine was applied with a skin prick test (SPT) lancet, both on the volar forearm. The intensity of itch was recorded on a visual analogue scale and self-reported area of itch was assessed 5 and 10 min after itch provocation. Reliability of the evoked itch (area under the curve and peak intensity) was assessed by the coefficient of variation (CV), intra-class correlation coefficient (ICC), and sample size estimation for parallel and cross-over designs. Cowhage (ICC = 0.57-0.77, CVbetween = 97%, CVwithin = 41%) and histamine: (ICC = 0.83-0.93, CVbetween = 97%, CVwithin = 20%) exhibited moderate-to-excellent intra-individual reliability and moderate inter-individual reliability for the itch intensity. For a test-retest observation period of one week, SPT-delivered histamine and application of cowhage-spiculae are reproducible human models of itch. The high inter-individual and low intra-individual variability suggests cross-over designed studies when applicable.