Resting state connectivity correlates with drug and placebo response in fibromyalgia patients
| Autor: | Eric Ichesco, Richard E. Harris, Scott Peltier, Tobias Schmidt-Wilcke, Johnson P. Hampson, Anson Kairys, Daniel J. Clauw, S. Harte |
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| Rok vydání: | 2014 |
| Předmět: |
Cyclopropanes
SNRI selective serotonin and norepinephrine reuptake inhibitor PAG periaqueductal gray Fibromyalgia Chronic pain lcsh:RC346-429 Placebos Functional connectivity 5-HT serotonin Brain Mapping Cross-Over Studies SNRI ACC anterior cingulate cortex fMRI Milnacipran Brain Middle Aged Magnetic Resonance Imaging medicine.anatomical_structure Neurology fMRI functional magnetic resonance imaging DLPFC dorsolateral prefrontal cortex MCC mid-cingulate cortex lcsh:R858-859.7 Female IC insular cortex IPL inferior parietal lobule Psychology Selective Serotonin Reuptake Inhibitors medicine.drug Adult Rest Cognitive Neuroscience FEW family wise error BPI brief pain inventory CNS central nervous system lcsh:Computer applications to medicine. Medical informatics Placebo Insular cortex Article MLN milnacipran Double-Blind Method medicine Humans Radiology Nuclear Medicine and imaging lcsh:Neurology. Diseases of the nervous system Anterior cingulate cortex Resting state fMRI TMS transcranial magnetic stimulation fcMRI functional connectivity magnetic resonance imaging medicine.disease PCC posterior cingulate cortex Dorsolateral prefrontal cortex SPM statistical parametric mapping DMN default mode network QST quantitative sensory testing Neurology (clinical) rs-fc resting state functional connectivity Neuroscience NE norepinephrine |
| Zdroj: | NeuroImage: Clinical, Vol 6, Iss C, Pp 252-261 (2014) NeuroImage : Clinical |
| ISSN: | 2213-1582 |
| DOI: | 10.1016/j.nicl.2014.09.007 |
| Popis: | Fibromyalgia is a chronic pain syndrome characterized by widespread pain, fatigue, and memory and mood disturbances. Despite advances in our understanding of the underlying pathophysiology, treatment is often challenging. New research indicates that changes in functional connectivity between brain regions, as can be measured by magnetic resonance imaging (fcMRI) of the resting state, may underlie the pathogenesis of this and other chronic pain states. As such, this parameter may be able to be used to monitor changes in brain function associated with pharmacological treatment, and might also be able to predict treatment response. We performed a resting state fcMRI trial using a randomized, placebo-controlled, cross-over design to investigate mechanisms of action of milnacipran (MLN), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), in fibromyalgia patients. Our aim was to identify functional connectivity patterns at baseline that would differentially predict treatment response to MLN as compared to placebo. Since preclinical studies of MLN suggest that this medication works by augmenting antinociceptive processes, we specifically investigated brain regions known to be involved in pain inhibition. 15 fibromyalgia patients completed the study, consisting of 6 weeks of drug and placebo intake (order counterbalanced) with an interspersed 2 week wash out period. As a main finding we report that reductions in clinical pain scores during MLN were associated with decreased functional connectivity between pro-nociceptive regions and antinociceptive pain regions at baseline, specifically between the rostral part of the anterior cingulate cortex (ACC) and the insular cortex (IC), as well as between the periaqueductal gray (PAG) and the IC: patients with lower preexisting functional connectivity had the greatest reduction in clinical pain. This pattern was not observed for the placebo period. However a more robust placebo response was associated with lower baseline functional connectivity between the ACC and the dorsolateral prefrontal cortex. This study indicates that ACC–IC connectivity might play a role in the mechanism of action of MLN, and perhaps more importantly fcMRI might be a useful tool to predict pharmacological treatment response. Highlights • Resting brain connectivity predicts clinical pain response to milnacipran. • Different brain connectivity patterns predicted response to placebo treatment. • Personalized analgesic therapy may be facilitated by brain imaging. |
| Databáze: | OpenAIRE |
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