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No Effect of a Single Session of Transcranial Direct Current Stimulation on Experimentally Induced Pain in Patients with Chronic Low Back Pain – An Exploratory Study
Kerstin Luedtke, Arne May, Tim P. Jürgens
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048857
Abstract: Transcranial direct current stimulation (tDCS) has been shown to modulate cortical excitability. A small number of studies suggested that tDCS modulates the response to experimental pain paradigms. No trials have been conducted to evaluate the response of patients already suffering from pain, to an additional experimental pain before and after tDCS. The present study investigated the effect of a single session of anodal, cathodal and sham stimulation (15 mins/1 mA) over the primary motor cortex on the perceived intensity of repeated noxious thermal and electrical stimuli and on elements of quantitative sensory testing (thermal pain and perception thresholds) applied to the right hand in 15 patients with chronic low back pain. The study was conducted in a double-blind sham-controlled and cross-over design. No significant alterations of pain ratings were found. Modalities of quantitative sensory testing remained equally unchanged. It is therefore hypothesized that a single 15 mins session of tDCS at 1 mA may not be sufficient to alter the perception of experimental pain and in patients with chronic pain. Further studies applying repetitive tDCS to patients with chronic pain are required to fully answer the question whether experimental pain perception may be influenced by tDCS over the motor cortex.
Changes in Gray Matter Induced by Learning—Revisited
Joenna Driemeyer, Janina Boyke, Christian Gaser, Christian Büchel, Arne May
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0002669
Abstract: Background Recently, activation-dependant structural brain plasticity in humans has been demonstrated in adults after three months of training a visio-motor skill. Learning three-ball cascade juggling was associated with a transient and highly selective increase in brain gray matter in the occipito-temporal cortex comprising the motion sensitive area hMT/V5 bilaterally. However, the exact time-scale of usage-dependant structural changes occur is still unknown. A better understanding of the temporal parameters may help to elucidate to what extent this type of cortical plasticity contributes to fast adapting cortical processes that may be relevant to learning. Principal Findings Using a 3 Tesla scanner and monitoring whole brain structure we repeated and extended our original study in 20 healthy adult volunteers, focussing on the temporal aspects of the structural changes and investigated whether these changes are performance or exercise dependant. The data confirmed our earlier observation using a mean effects analysis and in addition showed that learning to juggle can alter gray matter in the occipito-temporal cortex as early as after 7 days of training. Neither performance nor exercise alone could explain these changes. Conclusion We suggest that the qualitative change (i.e. learning of a new task) is more critical for the brain to change its structure than continued training of an already-learned task.
Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial
Kerstin Luedtke, Alison Rushton, Christine Wright, Tim P Juergens, Gerd Mueller, Arne May
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-290
Abstract: A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins) or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale) and disability (Oswestry Disability Index). Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function), Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36), as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up.This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back pain and whether it can further enhance the effects of a cognitive behavioural pain management programme. Trial registration: Current Controlled Trials ISRCTN89874874.A literature review [1] on the epidemiology and economic burden of non-specific chronic low back pain reported estimates of prevalence ranging from 6% to 11%. In a cross-sectional survey with 9267 respondents, average total back pain costs per patient per year in Germany have been reported as €1322 [2]. Chronic low back pain (CLBP) seems to account for the majority of these expenses, with annual direct costs of > €7000 per patie
Structural Brain Changes in Chronic Pain Reflect Probably Neither Damage Nor Atrophy
Rea Rodriguez-Raecke, Andreas Niemeier, Kristin Ihle, Wolfgang Ruether, Arne May
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0054475
Abstract: Chronic pain appears to be associated with brain gray matter reduction in areas ascribable to the transmission of pain. The morphological processes underlying these structural changes, probably following functional reorganisation and central plasticity in the brain, remain unclear. The pain in hip osteoarthritis is one of the few chronic pain syndromes which are principally curable. We investigated 20 patients with chronic pain due to unilateral coxarthrosis (mean age 63.25±9.46 (SD) years, 10 female) before hip joint endoprosthetic surgery (pain state) and monitored brain structural changes up to 1 year after surgery: 6–8 weeks, 12–18 weeks and 10–14 month when completely pain free. Patients with chronic pain due to unilateral coxarthrosis had significantly less gray matter compared to controls in the anterior cingulate cortex (ACC), insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex. These regions function as multi-integrative structures during the experience and the anticipation of pain. When the patients were pain free after recovery from endoprosthetic surgery, a gray matter increase in nearly the same areas was found. We also found a progressive increase of brain gray matter in the premotor cortex and the supplementary motor area (SMA). We conclude that gray matter abnormalities in chronic pain are not the cause, but secondary to the disease and are at least in part due to changes in motor function and bodily integration.
An Improved Model of Heat-Induced Hyperalgesia—Repetitive Phasic Heat Pain Causing Primary Hyperalgesia to Heat and Secondary Hyperalgesia to Pinprick and Light Touch
Tim P. Jürgens, Alexander Sawatzki, Florian Henrich, Walter Magerl, Arne May
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099507
Abstract: This study tested a modified experimental model of heat-induced hyperalgesia, which improves the efficacy to induce primary and secondary hyperalgesia and the efficacy-to-safety ratio reducing the risk of tissue damage seen in other heat pain models. Quantitative sensory testing was done in eighteen healthy volunteers before and after repetitive heat pain stimuli (60 stimuli of 48°C for 6 s) to assess the impact of repetitive heat on somatosensory function in conditioned skin (primary hyperalgesia area) and in adjacent skin (secondary hyperalgesia area) as compared to an unconditioned mirror image control site. Additionally, areas of flare and secondary hyperalgesia were mapped, and time course of hyperalgesia determined. After repetitive heat pain conditioning we found significant primary hyperalgesia to heat, and primary and secondary hyperalgesia to pinprick and to light touch (dynamic mechanical allodynia). Acetaminophen (800 mg) reduced pain to heat or pinpricks only marginally by 11% and 8%, respectively (n.s.), and had no effect on heat hyperalgesia. In contrast, the areas of flare (?31%) and in particular of secondary hyperalgesia (?59%) as well as the magnitude of hyperalgesia (?59%) were significantly reduced (all p<0.001). Thus, repetitive heat pain induces significant peripheral sensitization (primary hyperalgesia to heat) and central sensitization (punctate hyperalgesia and dynamic mechanical allodynia). These findings are relevant to further studies using this model of experimental heat pain as it combines pronounced peripheral and central sensitization, which makes a convenient model for combined pharmacological testing of analgesia and anti-hyperalgesia mechanisms related to thermal and mechanical input.
Towards dynamical network biomarkers in neuromodulation of episodic migraine
Markus A. Dahlem,Sebastian Rode,Arne May,Naoya Fujiwara,Yoshito Hirata,Kazuyuki Aihara,Jürgen Kurths
Quantitative Biology , 2013, DOI: 10.2478/s13380-013-0127-0
Abstract: Computational methods have complemented experimental and clinical neursciences and led to improvements in our understanding of the nervous systems in health and disease. In parallel, neuromodulation in form of electric and magnetic stimulation is gaining increasing acceptance in chronic and intractable diseases. In this paper, we firstly explore the relevant state of the art in fusion of both developments towards translational computational neuroscience. Then, we propose a strategy to employ the new theoretical concept of dynamical network biomarkers (DNB) in episodic manifestations of chronic disorders. In particular, as a first example, we introduce the use of computational models in migraine and illustrate on the basis of this example the potential of DNB as early-warning signals for neuromodulation in episodic migraine.
Understanding migraine using dynamical network biomarkers
Markus A. Dahlem,Jürgen Kurths,Michel D. Ferrari,Kazuyuki Aihara,Marten Scheffer,Arne May
Quantitative Biology , 2014,
Abstract: Background: Mathematical modeling approaches are becoming ever more established in clinical neuroscience. They provide insight that is key to understand complex interactions of network phenomena, in general, and interactions within the migraine generator network, in particular. Purpose: In this study, two recent modeling studies on migraine are set in the context of premonitory symptoms that are easy to confuse for trigger factors. This causality confusion is explained, if migraine attacks are initiated by a transition caused by a tipping point. Conclusion: We need to characterize the involved neuronal and autonomic subnetworks and their connections during all parts of the migraine cycle if we are ever to understand migraine. We predict that mathematical models have the potential to dismantle large and correlated fluctuations in such subnetworks as a dynamical network biomarker of migraine.
The Effect of Opioid Receptor Blockade on the Neural Processing of Thermal Stimuli
Eszter D. Schoell,Ulrike Bingel,Falk Eippert,Juliana Yacubian,Kerrin Christiansen,Hilke Andresen,Arne May,Christian Buechel
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012344
Abstract: The endogenous opioid system represents one of the principal systems in the modulation of pain. This has been demonstrated in studies of placebo analgesia and stress-induced analgesia, where anti-nociceptive activity triggered by pain itself or by cognitive states is blocked by opioid antagonists. The aim of this study was to characterize the effect of opioid receptor blockade on the physiological processing of painful thermal stimulation in the absence of cognitive manipulation. We therefore measured BOLD (blood oxygen level dependent) signal responses and intensity ratings to non-painful and painful thermal stimuli in a double-blind, cross-over design using the opioid receptor antagonist naloxone. On the behavioral level, we observed an increase in intensity ratings under naloxone due mainly to a difference in the non-painful stimuli. On the neural level, painful thermal stimulation was associated with a negative BOLD signal within the pregenual anterior cingulate cortex, and this deactivation was abolished by naloxone.
The Effects of European Austerity Programmes on Social Security Systems  [PDF]
Arne Heise, Hanna Lierse
Modern Economy (ME) , 2011, DOI: 10.4236/me.2011.24055
Abstract: The recent financial and economic crisis is intensifying the pressure for budget consolidation,increasing the likelihood of cuts in social services throughout Europe. One government after another is bringing forward a budget consolidation programme. Cuts are envisaged above all in social services and so the question arises of what effects this will have on welfare states in EU member countries and on Social Europe in general. In this study cuts in social systems are analysed and compared, both planned and already undertaken. Regardless of the different magnitudes of the austerity efforts and the policy fields concerned there can be no doubt that all austerity programmes are regressive in nature and that the option of raising incomes is being exercised far less frequently than spending cuts and this applies especially in the social realm.
A Normative Model for Regional University Network Collaboration in Education  [PDF]
Arne Jensen, Rickard Bergqvist
Creative Education (CE) , 2012, DOI: 10.4236/ce.2012.326156
Abstract: Increasing demand for more specialized courses and programme increases the need for universities to differentiate their educational offer and portfolio. Increasing the course portfolio combined with small student populations at the same time ensuring high quality is a difficult challenge for most universities given their budget limitation and the access they have to educators in the specialized disciplines within their own organization. Pooling, coordination and utilization of resources through the creation of network creation and university collaborations is one option for coping with this challenge. This paper develops a normative model for intraregional university network collaboration in education aiming at preparing students for work in a particular industry. The paper deals with network organization, principles of operation, course structure, course delivery, and supporting activities.
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