William R. Bauer

The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions

Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.

Brain Morphological Signatures for Chronic Pain

Chronic pain can be understood not only as an altered functional state, but also as a consequence of neuronal plasticity. Here we use in vivo structural MRI to compare global, local, and architectural changes in gray matter properties in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA), relative to healthy controls. We find that different chronic pain types exhibit unique anatomical ‘brain signatures’. Only the CBP group showed altered whole-brain gray matter volume, while regional gray matter density was distinct for each group. Voxel-wise comparison of gray matter density showed that the impact on the extent of chronicity of pain was localized to a common set of regions across all conditions. When gray matter density was examined for large regions approximating Brodmann areas, it exhibited unique large-scale distributed networks for each group. We derived a barcode, summarized by a single index of within-subject co-variation of gray matter density, which enabled classification of individual brains to their conditions with high accuracy. This index also enabled calculating time constants and asymptotic amplitudes for an exponential increase in brain re-organization with pain chronicity, and showed that brain reorganization with pain chronicity was 6 times slower and twice as large in CBP in comparison to CRPS. The results show an exuberance of brain anatomical reorganization peculiar to each condition and as such reflecting the unique maladaptive physiology of different types of chronic pain.

Postnatal blockade of cortical activity by tetrodotoxin does not disrupt the formation of vibrissa-related patterns in the rat's somatosensory cortex.

Neuronal activity has been shown to influence pattern formation in the visual system. In the present study, we determined whether or not this was also true in the somatosensory system by silencing the primary somatosensory cortex of rats with tetrodotoxin (TTX) for the first 7-11 days of life. Application of TTX during this period did not prevent the formation of the normal vibrissa-related pattern in S-I as visualized by either staining cortical sections for cytochrome oxidase, demonstration of the pattern with an antibody directed against serotonin, or labelling of thalamocortical axons with the carbocyanine dye, Di-I. These results indicate that neither peripherally evoked nor spontaneous activity are required for qualitatively normal pattern formation in the rats primary somatosensory cortex.

Effects of postnatal blockade of cortical activity with tetrodotoxin upon lesion-induced reorganization of vibrissae-related patterns in the somatosensory cortex of rat

Previous studies have shown that postnatal blockade of thalamocortical activity with either tetrodotoxin (TTX) or the NMDA receptor antagonist DL-2-amino-5-phosphonovalerate (APV) does not prevent the formation of vibrissae-related patterns. In the present study, blockade of cortical activity with TTX was combined with ablation of a row of vibrissae follicles or transection of the infraorbital nerve (ION, the trigeminal nerve branch that supplies the vibrissae follicles) to determine whether the cortical reorganization that follows these lesions in otherwise untreated animals was dependent upon neuronal activity that could be blocked with TTX. The results demonstrated that cortical TTX implants had no quantitative or qualitative effects upon the cortical reorganization that followed either vibrissae follicle cauterization or ION transection.

Effects of Postnatal Blockade of Cortical Activity with Tetrodotoxin upon the Development and Plasticity of Vibrissa-Related Patterns in the Somatosensory Cortex of Hamsters

Several previous studies have shown that postnatal blockade of thalamocortical activity with either tetrodotoxin (TTX) or the N-methyl-D-aspartate (NMDA) receptor antagonist D,L-2-amino-5-phosphonovalerate (APV) does not prevent the formation of vibrissa-related patterns in the primary somatosensory cortex of rats. One limitation of these studies is that this pattern forms very shortly after birth in rats, and there may be only a very limited time over which it may be influenced by activity blockade. In the present study, the effect of activity blockade was evaluated in a more altricial rodent, the hamster. The present study showed that a pattern of thalamocortical afferents corresponding to the vibrissae is not observed until the fourth postnatal day in hamsters. Nevertheless, application of TTX-impregnated implants to the cortices of newborn hamsters had no qualitative or quantitative effect upon vibrissa-related patterns in the primary somatosensory cortices of these animals. Moreover, TTX implants did not prevent the changes in patterns that followed cauterization of a row of vibrissa follicles.

Involvement of serotonin 2A receptors in the analgesic effect of tramadol in mono-arthritic rats.

The analgesic effects of tramadol are considered to be mediated by both the opioid system and the serotonergic system. This study investigated the involvement of a subtype of serotonin receptors, 5-hydroxytryptamine (5-HT)2A receptor, in the analgesic effect of tramadol. The intraperitoneal (i.p.) injection of tramadol reduced the paw withdrawal latency (PWL) to radiant heat testing in mono-arthritic rats. The antagonistic effect of i.p. ketanserin (a 5-HT2A receptor antagonist) on tramadol analgesia was observed. The expression of the 5-HT2A receptor mRNA in the nucleus of raphe magnus (NRM), ventrolateral periaqueductal gray (vlPAG) and spinal dorsal horn of mono-arthritic rats after a ten-day treatment with tramadol was measured with in situ hybridization. Either single injections or 10 days of tramadol treatment dose-dependently elevated PWL of arthritic rats while ketanserin could partially antagonize the tramadol analgesic effect. Expression of the 5-HT2A receptor mRNA in NRM, ipsilateral vlPAG, and the ipsilateral spinal dorsal horn of arthritic rats was significantly increased after tramadol treatment. These results suggest that 5-HT2A receptors are involved in the analgesic effect of tramadol. This study provides evidence for involvement of 5-HT2A receptors in the tramadol analgesia of inflammatory pain. The increase in this receptor mRNA in the chronic study may contribute to the sustaining effect of tramadol long-term treatments in clinical practice.

Longitudinal MRI evaluations of human global cortical thickness over minutes to weeks

Magnetic resonance imaging (MRI) was used to evaluate within-subject variability in global mean cortical thickness over test-retest intervals of minutes-weeks in five healthy adults. Within-subject measures of global mean thickness were consistent over these intervals. Test-retest assessments of absolute thickness differences and percent thickness differences indicated variations of, respectively, < or =0.05-0.06 mm and < or =+/-1.9-2.3%. There have been few evaluations of normal within-subject variations in cortical thickness. The present results suggest that within-subject variability in global mean cortical thickness can be low over test-retest intervals of minutes-weeks, and that longitudinal scans can establish useful baseline estimates of variability from which to assess changes due to injury, disease, or other experiences.

Profiles of Precentral and Postcentral Cortical Mean Thicknesses in Individual Subjects over Acute and Subacute Time-Scales

Human precentral and postcentral cortical areas interact to generate sensorimotor functions. Recent imaging work suggests that pre- and postcentral cortical thicknesses of an individual vary over time-scales of years and decades due to aging, disease, and other factors. In contrast, there is little understanding of how thicknesses of these areas vary in an individual over time-scales of minutes and weeks. This study used longitudinal magnetic resonance imaging (MRI) and computational morphometry approaches in 5 healthy subjects to assess how mean thicknesses, and intra- and interhemispheric relationships in mean thicknesses, of these areas vary in an individual subject over minutes and weeks. Within each individual, absolute differences in thicknesses over these times were small and similar in the precentral (mean = 0.02-0.04 mm) and postcentral (mean = 0.03-0.05 mm) areas. Each individual also had a consistent intrahemispheric disparity and interhemispheric asymmetrical or symmetrical relationship in thicknesses of these areas over these times. The results provide new understanding of within-individual cortical thickness variability in these areas and raise the possibility that longitudinal thickness profiling can provide a baseline definition of short time-scale thickness variability that can be used to detect acute and subacute changes in pre- and postcentral thicknesses at an individual subject level.

Case series evidence for changed interhemispheric relationships in cortical structure in some amputees

Limb amputation and related changes in body feelings are associated with cortical functional reorganization that is reflected by increased interhemispheric asymmetry of body maps in the postcentral somatosensory cortex (PCS). As a pilot test to determine if limb amputation affects interhemispheric symmetry in PCS structure, we used MRI and computational morphometry to examine interhemispheric relationships of PCS thicknesses in a case series of eight lower limb amputees compared with 11 control subjects. As a further control, the same relationships were compared in the lateral occipital visual cortex (LOV) which, by nature of its visual connectivity, would be expected to be less related to amputation. The PCS thicknesses in the left and right hemispheres were positively related in control subjects, but not in amputees. The range of the PCS interhemispheric thickness differences (ID) in amputees was larger than the range in control subjects, and four of eight amputees had PCS ID that were at or above the maximal control subject ID. In contrast, LOV thicknesses in the two hemispheres were positively related and LOV ID ranges were similar in both amputees and control subjects. The results from this case series suggest the hypothesis that amputation alters PCS interhemispheric thickness relationships in some amputees. Further tests of this hypothesis would be useful to determine whether changes in structural symmetry contribute to known post-amputation alterations in PCS functional map symmetry and body feeling.

Early Changes in Cortical Emotion Processing Circuits after Mild Traumatic Brain Injury from Motor Vehicle Collision

Mild traumatic brain injury (mTBI) patients frequently experience emotion dysregulation symptoms, including post-traumatic stress. Although mTBI likely affects cortical activation and structure, resulting in cognitive symptoms after mTBI, early effects of mTBI on cortical emotion processing circuits have rarely been examined. To assess early mTBI effects on cortical functional and structural components of emotion processing, we assessed cortical activation to fearful faces within the first 2 weeks after motor vehicle collision (MVC) in survivors who did and did not experience mTBI. We also examined the thicknesses of cortical regions with altered activation. MVC survivors with mTBI (n = 21) had significantly less activation in left superior parietal gyrus (SPG) (-5.9, -81.8, 33.8; p = 10-3.623), left medial orbitofrontal gyrus (mOFG) (-4.7, 36.1, -19.3; p = 10-3.231), and left and right lateral orbitofrontal gyri (lOFG) (left: -16.0, 41.4, -16.6; p = 10-2.573; right: 18.7, 22.7, -17.7; p = 10-2.764) than MVC survivors without mTBI (n = 23). SPG activation in mTBI survivors within 2 weeks after MVC was negatively correlated with subsequent post-traumatic stress symptom severity at 3 months (r = -0.68, p = 0.03). Finally, the SPG region was thinner in the mTBI survivors than in the non-mTBI survivors (F = 11.07, p = 0.002). These results suggest that early differences in activation and structure in cortical emotion processing circuits in trauma survivors who sustain mTBI may contribute to the development of emotion-related symptoms.