Abstract
Temporal summation of “second pain” (TSSP) or “windup” results from the summation
of C-fiber-evoked responses of dorsal-horn neurons. This phenomenon is dependent on
stimulus frequency (≥.33 Hz) and relevant to central sensitization and chronic pain.
Our previous neuroimaging studies characterized brain regions associated with TSSP
in normal control (NC) and fibromyalgia (FM) groups. During an fMRI scan, subjects
received sensitivity-adjusted repetitive heat pulses at .33 on the right foot. FM
subjects required significantly lower stimulus intensities than NC to achieve similar
TSSP and no significant group differences in the pain-related brain activity were
detected. In our current study, we asked whether the effective connectivity among
a set of TSSP-related brain regions identified in our previous work differs amongst
FM and NC groups. Structural equation modeling was used to characterize the effective
connectivity amongst a priori selected brain areas, including the thalamus, S1, S2,
posterior insula, and the anterior midcingulate cortex (aMCC) within the left and
right hemispheres. This analysis confirmed our a priori models of effective connectivity
among these regions mainly confirmed those hypothesized, yet some unpredicted connections
were additionally identified (thalamus to aMCC and aMCC to S1). While the models of
effective connectivity were not identical in the FM and NC groups, they were very
similar. Additionally, the TSSP related effective connectivity of right and left hemisphere
regions was very similar. These results provide evidence for significant overlap of
the fundamental brain mechanisms that process sensory and affective information related
to TSSP in NC and FM groups.
Perspective
Models of effective connectivity involving pain-related processes were estimated with
fMRI data from chronic pain and healthy populations. Models were estimated in both
hemispheres, and although similar, fibromyalgia was associated with unique models
of pain-related processes. Group differences involved the left hemisphere and S1,
S2, and posterior insula.
Key words
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Article info
Publication history
Accepted:
January 11,
2012
Received in revised form:
December 2,
2011
Received:
August 23,
2011
Footnotes
Supported by NIH Grants R01-NS-38767, R01-AR053541, and R01-AT001424, and supported in part by Clinical Research Center grant RR00082.
The authors have no financial or other relationships that pose a conflict of interest.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
