Greater integration across frontal networks and lower quality of life in youth with chronic pain
Poster No:
2515
Submission Type:
Abstract Submission
Authors:
Saül Pascual-Diaz1, Emma Biggs2, Marie-Eve Hoeppli3, Christopher King4,5,6, Nima Aghaeepour2, Martin Angst7, Brice Gaudilliere7, Jennifer Stinson8,9, Massieh Moayedi10,11, Robert Coghill12, Laura Simons2, Marina López-Solà1
Institutions:
1University of Barcelona, Barcelona, Spain, 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, 3CCHMC, Cincinnati, OH, 4Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 5Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 6Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 7Centre for the Study of Pain, University of Toronto, Toronto, Ontario, 8Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, 9The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada, 10Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Toronto, Ontario, 11Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada, 12Cincinnati Children's Hospital Medical Center, Cincinnati, OH
First Author:
Co-Author(s):
Emma Biggs
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Christopher King
Department of Pediatrics, University of Cincinnati|Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center|Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center
Cincinnati, OH|Cincinnati, OH|Cincinnati, OH
Department of Pediatrics, University of Cincinnati|Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center|Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center
Cincinnati, OH|Cincinnati, OH|Cincinnati, OH
Nima Aghaeepour
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Jennifer Stinson
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children|The Research Institute, The Hospital for Sick Children
Toronto, Ontario|Toronto, Ontario, Canada
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children|The Research Institute, The Hospital for Sick Children
Toronto, Ontario|Toronto, Ontario, Canada
Massieh Moayedi
Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto|Centre for the Study of Pain, University of Toronto
Toronto, Ontario|Toronto, Ontario, Canada
Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto|Centre for the Study of Pain, University of Toronto
Toronto, Ontario|Toronto, Ontario, Canada
Laura Simons
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University
Stanford, CA
Introduction:
Multisensory experiences significantly contribute to daily well-being, particularly in adolescents dealing with chronic musculoskeletal pain (CMP) [1]. Studies consistently demonstrate the correlation between hypersensitivity to multisensory stimulation and lower quality of life (QoL) in chronic pain patients, impacting school attendance and physical activity [2,3].
Connectivity between the Default Mode Network (DMN), Frontoparietal Network (FPN), and Ventral Attention (or Salience Network; VAN) during resting-state has been linked to chronic pain [4,5]. Abnormal integration between the DMN and the VAN has been observed in individuals with chronic pain, suggesting its relevance to the experience of clinical pain [6].
This study aimed to determine whether (i) integration across medial frontal cortical brain networks including the DMN, the VAN, and the FPN [7]; and (ii) brain activation during a multisensory task could predict QoL in youth with chronic pain. We hypothesized that greater activation in regions important for multisensory integration and cognitive/evaluative response to multisensory stimulation such as the medial and lateral aspects of the prefrontal cortex and networks converging in medial prefrontal regions would predict QoL.
Connectivity between the Default Mode Network (DMN), Frontoparietal Network (FPN), and Ventral Attention (or Salience Network; VAN) during resting-state has been linked to chronic pain [4,5]. Abnormal integration between the DMN and the VAN has been observed in individuals with chronic pain, suggesting its relevance to the experience of clinical pain [6].
This study aimed to determine whether (i) integration across medial frontal cortical brain networks including the DMN, the VAN, and the FPN [7]; and (ii) brain activation during a multisensory task could predict QoL in youth with chronic pain. We hypothesized that greater activation in regions important for multisensory integration and cognitive/evaluative response to multisensory stimulation such as the medial and lateral aspects of the prefrontal cortex and networks converging in medial prefrontal regions would predict QoL.
Methods:
We included 129 participants (110 females, aged 12 to 18, mean age=15.58, SD=1.57) with CMP from Stanford University; Cincinnati Children's Hospital, and Sick Kids Hospital in Toronto. We used an fMRI multisensory task [8] and measured self-reported QoL (Pediatric QoL of Life Inventory (PedsQL)). The fMRI task involved four trials of concurrent presentation of visual, auditory, and tactile-motor stimulation and alternating rest periods.
We preprocessed fMRI data to correct motion and noise using the CONN toolbox. GLMs identified voxels with significant activity changes during multisensory blocks compared to baseline, and we ran a voxel-wise regression to identify brain regions associated with the physical scale of PedsQL.
We computed connectivity matrices (controlling for task-related oscillations) for each subject during the multisensory task to obtain between-network integration values. Nodes corresponded to Brainnetome atlas regions overlapping with each brain network [7,9], with edges representing brain connectivity amongst between-network ROI pairs.
We preprocessed fMRI data to correct motion and noise using the CONN toolbox. GLMs identified voxels with significant activity changes during multisensory blocks compared to baseline, and we ran a voxel-wise regression to identify brain regions associated with the physical scale of PedsQL.
We computed connectivity matrices (controlling for task-related oscillations) for each subject during the multisensory task to obtain between-network integration values. Nodes corresponded to Brainnetome atlas regions overlapping with each brain network [7,9], with edges representing brain connectivity amongst between-network ROI pairs.
Results:
Augmented brain responses to non-painful multisensory stimulation in the rostral ACC predicted lower physical QoL (qFWEcluster-corrected=0.05, individual voxel p<.001). In females only, another cluster became significant in the dorsomedial prefrontal cortex (dmPFC) (qFWE=0.029). We ran bootstrap analyses (10000 permutations) revealing that the probability of obtaining the resulting clusters by chance was 0.09% (Fig 1).
Greater between-network connectivity (FPN, VAN and DM networks) predicted augmented responses in the rostral ACC during the multisensory task, which in turn predicted lower QoL. Importantly, for these network connectivity analyses we excluded regions from the Brainnetome atlas showing overlap (≥1 voxel) with the ACC and dmPFC activation clusters. We did not find a direct effect of connectivity on QoL (Fig 2).
Greater between-network connectivity (FPN, VAN and DM networks) predicted augmented responses in the rostral ACC during the multisensory task, which in turn predicted lower QoL. Importantly, for these network connectivity analyses we excluded regions from the Brainnetome atlas showing overlap (≥1 voxel) with the ACC and dmPFC activation clusters. We did not find a direct effect of connectivity on QoL (Fig 2).
·Figure 1
·Figure 2
Conclusions:
We observed a robust association between heightened task-evoked activation in the rostral ACC and dmPFC and lower physical QoL in adolescents with CMP. Our findings suggest that adolescents with CMP exhibiting increased activation in affective/regulation circuits during a non-painful, unpleasant sensory task tend to experience lower QoL, affecting their ability to perform physical activities in daily life. The findings were coupled with greater signal integration between cortical networks with important medial prefrontal representation (DMN, VAN, and FPN). The results highlight the association between aberrant multisensory processing (both in terms of augmented activation and between-networks signal integration) and reduced quality of life in youth with CMP.
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI)
Connectivity (eg. functional, effective, structural)
fMRI Connectivity and Network Modeling
Novel Imaging Acquisition Methods:
BOLD fMRI 2
Perception, Attention and Motor Behavior:
Perception: Pain and Visceral 1
Keywords:
FUNCTIONAL MRI
MRI
Pain
1|2Indicates the priority used for review
Provide references using author date format
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