We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Chronic pain-related remodeling of cerebral cortex – ‘pain memory’: a possible target for treatment of chronic pain

    Avigail Lithwick

    Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Faculty of Medicine, Jerusalem, Israel

    Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Faculty of Medicine, Jerusalem, Israel

    ,
    Shaya Lev

    Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Faculty of Medicine, Jerusalem, Israel

    Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Faculty of Medicine, Jerusalem, Israel

    &
    Alexander M Binshtok

    * Author for correspondence

    Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Faculty of Medicine, Jerusalem, Israel.

    Published Online:https://doi.org/10.2217/pmt.12.74

    SUMMARY Chronic pain is a major health problem worldwide, yet its management is nonspecific and often insufficient. In order to be able to alleviate chronic pain, it is crucial to understand the profound and comprehensive mechanisms by which chronic pain is triggered and processed in higher brain areas. Painful stimuli are processed by an intricate axis of peripheral and central components. Adding to the inherent complexity, the system is highly dynamic, undergoing constant plastic changes that often lead to perpetuation of pain. Given the key role that the cerebral cortex plays in sensory perception, understanding pain-related changes in cortical areas allocated to pain sensation is crucial. This review aims to summarize present research on pain-related plastic changes in the cerebral cortex.

    Papers of special note have been highlighted as: ▪ of interest

    References

    • Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur. J. Pain10,287–333 (2006).
    • Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J. Pain11(11),1230–1239 (2010).
    • Von Hehn CA, Baron R, Woolf CJ. Deconstructing the neuropathic pain phenotype to reveal neural mechanisms. Neuron73(4),638–652 (2012).
    • Serra J. Microneurography findings in fibromyalgia patients. Presented at: 14th World Congress of Pain. Milan, Italy (2012).
    • Strassman AM, Levy D. Response properties of dural nociceptors in relation to headache. J. Neurophysiol.95(3),1298–1306 (2006).
    • Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science288(5472),1765–1769 (2000).
    • Basbaum AI, Bautista DM, Scherrer GG, Julius D. Cellular and molecular mechanisms of pain. Cell139(2),267–284 (2009).
    • Binshtok AM. Mechanisms of nociceptive transduction and transmission: a machinery for pain sensation and tools for selective analgesia. Int. Rev. Neurobiol.97,143–177 (2011).
    • Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Ann. Rev. Neurosci.32,1–32 (2009).
    • 10  Hucho T, Levine JD. Signaling pathways in sensitization: toward a nociceptor cell biology. Neuron55(3),365–376 (2007).
    • 11  Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J. Pain10,895–926 (2009).
    • 12  Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur. J. Pain9(4),463–484 (2005).▪ Systematic review summarizing activation of brain areas in response to various pain states; the authors identified a brain network in response to acute pain.
    • 13  Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron55(3),377–391 (2007).
    • 14  Seifert F, Maihöfner C. Central mechanisms of experimental and chronic neuropathic pain: findings from functional imaging studies. Cell Mol. Life Sci.66(3),375–390 (2009).
    • 15  Treede RD, Kenshalo DR, Gracely RH, Jones AK. The cortical representation of pain. Pain79(2–3),105–111 (1999).
    • 16  Peyron R, Laurent B, García-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis. Neurophysiol. Clin.30(5),263–288 (2000).
    • 17  Jensen KB, Loitoile R, Kosek E et al. Patients with fibromyalgia display less functional connectivity in the brain’s pain inhibitory network. Mol. Pain8,32 (2012).
    • 18  Sprenger T, Valet M, Boecker H et al. Opioidergic activation in the medial pain system after heat pain. Pain122(1–2),63–67 (2006).
    • 19  Maihöfner C, Forster C, Birklein F, Neundörfer B, Handwerker HO. Brain processing during mechanical hyperalgesia in complex regional pain syndrome: a functional MRI study. Pain114(1–2),93–103 (2005).
    • 20  Iannetti GD, Hughes NP, Lee MC, Mouraux A. Determinants of laser-evoked EEG responses: pain perception or stimulus saliency? J. Neurophysiol.100(2),815–828 (2008).
    • 21  Legrain V, Iannetti GD, Plaghki L, Mouraux A. The pain matrix reloaded: a salience detection system for the body. Prog. Neurobiol.93(1),111–124 (2011).
    • 22  Wiech K, Lin CS, Brodersen KH, Bingel U, Ploner M, Tracey I. Anterior insula integrates information about salience into perceptual decisions about pain. J. Neurosci.30(48),16324–16331 (2010).
    • 23  Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum.46(5),1333–1343 (2002).
    • 24  Giesecke T, Gracely RH, Grant MA et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum.50(2),613–623 (2004).
    • 25  Becerra L, Morris S, Bazes S et al. Trigeminal neuropathic pain alters responses in CNS circuits to mechanical (brush) and thermal (cold and heat) stimuli. J. Neurosci.26(42),10646–10657 (2006).
    • 26  Maihöfner C, Handwerker HO, Birklein F. Functional imaging of allodynia in complex regional pain syndrome. Neurology66(5),711–717 (2006).
    • 27  Peyron R, Schneider F, Faillenot I et al. An fMRI study of cortical representation of mechanical allodynia in patients with neuropathic pain. Neurology63(10),1838–1846 (2004).
    • 28  Ducreux D, Attal N, Parker F, Bouhassira D. Mechanisms of central neuropathic pain: a combined psychophysical and fMRI study in syringomyelia. Brain129(Pt 4),963–976 (2006).
    • 29  Pleger B, Ragert P, Schwenkreis P et al. Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage32(2),503–510 (2006).
    • 30  Wrigley PJ, Press SR, Gustin SM et al. Neuropathic pain and primary somatosensory cortex reorganization following spinal cord injury. Pain141(1–2),52–59 (2009).
    • 31  Lotze M, Flor H, Grodd W, Larbig W, Birbaumer N. Phantom movements and pain. An fMRI study in upper limb amputees. Brain124(Pt 11),2268–2277 (2001).
    • 32  Baliki MN, Chialvo DR, Geha PY et al. Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. J. Neurosci.26(47),12165–12173 (2006).▪ The authors identified regions associated with spontaneous pain, and indicated a difference in activation location that was associated with a difference in type of pain, thus implicating a strong emotional component.
    • 33  Maciver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain131(Pt 8),2181–2191 (2008).▪ Demonstrated a cortical reorganization in individuals with phantom pain; following training using a mental imagery technique, a decrease in intensity of pain corresponded to the elimination of cortical reorganization, indicating plastic changes and the effectiveness of treatment.
    • 34  Wei F, Qiu CS, Kim SJ et al. Genetic elimination of behavioral sensitization in mice lacking calmodulin-stimulated adenylyl cyclases. Neuron36(4),713–726 (2002).
    • 35  Li XY, Ko HG, Chen T et al. Alleviating neuropathic pain hypersensitivity by inhibiting PKMzeta in the anterior cingulate cortex. Science330(6009),1400–1404 (2010).▪ Demonstrates that blockade of memory-related changes in anterior cingulate cortex decreased neuropathic injury-induced pain.
    • 36  Wager TD, Rilling JK, Smith EE et al. Placebo-induced changes in fMRI in the anticipation and experience of pain. Science303(5661),1162–1167 (2004).
    • 37  Petrovic P, Dietrich T, Fransson P, Andersson J, Carlsson K, Ingvar M. Placebo in emotional processing – induced expectations of anxiety relief activate a generalized modulatory network. Neuron46(6),957–969 (2005).
    • 38  Fields H. State-dependent opioid control of pain. Nat. Rev. Neurosci.5(7),565–575 (2004).
    • 39  Geha PY, Baliki MN, Chialvo DR, Harden RN, Paice JA, Apkarian AV. Brain activity for spontaneous pain of postherpetic neuralgia and its modulation by lidocaine patch therapy. Pain128(1–2),88–100 (2007).
    • 40  Parks EL, Geha PY, Baliki MN, Katz J, Schnitzer TJ, Apkarian AV. Brain activity for chronic knee osteoarthritis: dissociating evoked pain from spontaneous pain. Eur. J. Pain15(8), 843,e841–814 (2011).
    • 41  Baliki MN, Baria AT, Apkarian AV. The cortical rhythms of chronic back pain. J. Neurosci.31(39),13981–13990 (2011).
    • 42  Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat. Rev. Neurosci.3(8),655–666 (2002).
    • 43  Craig AD. How do you feel now? The anterior insula and human awareness. Nat. Rev. Neurosci.10(1),59–70 (2009).
    • 44  Craig AD, Chen K, Bandy D, Reiman EM. Thermosensory activation of insular cortex. Nat. Neurosci.3(2),184–190 (2000).
    • 45  Song GH, Venkatraman V, Ho KY, Chee MW, Yeoh KG, Wilder-Smith CH. Cortical effects of anticipation and endogenous modulation of visceral pain assessed by functional brain MRI in irritable bowel syndrome patients and healthy controls. Pain126(1–3),79–90 (2006).
    • 46  Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith CD. Empathy for pain involves the affective but not sensory components of pain. Science303,1157–1162 (2004).
    • 47  Baliki MN, Geha PY, Apkarian AV, Chialvo DR. Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. J. Neurosci.28(6),1398–1403 (2008).
    • 48  Apkarian AV, Sosa Y, Krauss BR et al. Chronic pain patients are impaired on an emotional decision-making task. Pain108(1–2),129–136 (2004).
    • 49  Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain152(3 Suppl.),S49–S64 (2011).
    • 50  Baliki MN, Schnitzer TJ, Bauer WR, Apkarian AV. Brain morphological signatures for chronic pain. PloS ONE6(10),e26010 (2011).▪ Authors demonstrated that the location and pattern of plastic changes of gray matter varies according to specific conditions of chronic pain.
    • 51  Dasilva AF, Becerra L, Pendse G, Chizh B, Tully S, Borsook D. Colocalized structural and functional changes in the cortex of patients with trigeminal neuropathic pain. PloS ONE3(10),e3396 (2008).
    • 52  Wartolowska K, Hough MG, Jenkinson M, Andersson J, Wordsworth BP, Tracey I. Structural changes of the brain in rheumatoid arthritis. Arthritis Rheum.64(2),371–379 (2012).
    • 53  Hofer SB, Mrsic-Flogel TD, Bonhoeffer T, Hubener M. Experience leaves a lasting structural trace in cortical circuits. Nature457(7227),313–317 (2009).
    • 54  Eto K, Wake H, Watanabe M et al. Inter-regional contribution of enhanced activity of the primary somatosensory cortex to the anterior cingulate cortex accelerates chronic pain behavior. J. Neurosci.31(21),7631–7636 (2011).▪ The authors demonstrated that the remodeling synaptic efficacy in the primary somatosensory cortex results in the modulation of activity in the anterior cingulate cortex, thus stressing the connective cortical nature, and its importance with regard to treatment of chronic pain.
    • 55  Kim SK, Kato G, Ishikawa T, Nabekura J.Phase-specific plasticity of synaptic structures in the somatosensory cortex of living mice during neuropathic pain. Mol. Pain7,87 (2011).
    • 56  Kim SK, Nabekura J. Rapid synaptic remodeling in the adult somatosensory cortex following peripheral nerve injury and its association with neuropathic pain. J. Neurosci.31(14),5477–5482 (2011).▪ Using time-lapse multiphoton microscopy of individual cortical dendrites, authors demonstrated that the synaptic organization following neuropathic nerve injury is similar to one observed during LTP. They also demonstrated that this process occurs at a faster pace than previously believed. Additionally, they stressed the importance of timing of treatment in preventing chronic pain.
    • 57  Bhatt DH, Zhang S, Gan WB. Dendritic spine dynamics. Ann. Rev. Physiol.71,261–282 (2009).
    • 58  Holtmaat A, Wilbrecht L, Knott GW, Welker E, Svoboda K. Experience-dependent and cell-type-specific spine growth in the neocortex. Nature441(7096),979–983 (2006).
    • 59  Yang G, Pan F, Gan WB. Stably maintained dendritic spines are associated with lifelong memories. Nature462(7275),920–924 (2009).
    • 60  Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV. The brain in chronic CRPS pain: abnormal gray–white matter interactions in emotional and autonomic regions. Neuron60(4),570–581 (2008).
    • 61  Ichesco E, Quintero A, Clauw DJ et al. Altered functional connectivity between the insula and the cingulate cortex in patients with temporomandibular disorder: a pilot study. Headache52(3),441–454 (2012).
    • 62  Baliki MN, Petre B, Torbey S et al. Corticostriatal functional connectivity predicts transition to chronic back pain. Nat. Neurosci.15(8),1117–1119 (2012).
    • 63  Napadow V, Kim J, Clauw DJ, Harris RE. Decreased intrinsic brain connectivity is associated with reduced clinical pain in fibromyalgia. Arthritis Rheum.64(7),2398–2403 (2012).
    • 64  Baliki MN, Geha PY, Apkarian AV, Chialvo DR. Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. J. Neurosci.28(6),1398–1403 (2008).
    • 65  Flor H, Denke C, Schaefer M, Grüsser S. Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet357(9270),1763–1764 (2001).
    • 66  Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen. Hosp. Psychiatry31(3),206–219 (2009).
    • 67  De Ridder D, De Mulder G, Menovsky T, Sunaert S, Kovacs S. Electrical stimulation of auditory and somatosensory cortices for treatment of tinnitus and pain. Prog. Brain Res.166,377–388 (2007).
    • 68  Feldman DE. Synaptic mechanisms for plasticity in neocortex. Ann. Rev. Neurosci.32,33–55 (2009).
    • 101  IASP taxonomy. International Association for the Study of Pain (2011). www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm (Accessed 3 September 2012)