Pain catastrophizing is associated with the Val66Met polymorphism of the brainderived neurotrophic factor in fibromyalgia

Background: Fibromyalgia (FM) is a musculoskeletal chronic pain syndrome that impacts negatively patient’s daily lives. Its pathogenesis is characterized by a complex relationship between biological and psychosocial factors not fully understood yet. Pain catastrophizing is associated with FM and is an important predictor of outcomes. This study aimed to answer two questions: (i) whether the allele and genotype frequencies of BDNF Val66Met (rs6265) polymorphism differs between FM patients and healthy controls (HC); and (ii) if the BDNF Val66Met polymorphism is a factor that predicts pain catastrophizing in FM. Methods: In a cross-sectional design, 108 FM patients and 108 HC were included. FM patients responded to the Brazilian Portuguese version of the Pain Catastrophizing Scale (BP-PCS) to assess pain catastrophizing, as well as other validated tools for anxiety (The State-Trait Anxiety Inventory - STAI), depression (Beck Depression Inventory II – BDI-II) and functional aspects (Fibromyalgia Impact Questionnaire - FIQ; Central Sensitization Inventory validated and adapted for Brazilian population - CSI-BP; Pittsburgh Sleep Quality Index - PSQI; and Resilience Scale). All subjects were genotyped for the BDNF Val66Met polymorphism. Results: Val allele was significantly more frequent in FM patients compared to the control group (p < 0.05). Also, FM patients with Val/Val genotype showed more pain catastrophizing thoughts, and this genotype was significantly associated with magnification and rumination dimensions of BP-PCS (p < 0.05). Furthermore, there were significant differences in levels of anxiety and symptoms of depression, years of education, and the functional situation between the FM and control groups. Conclusions: The findings show an association of BDNF Val66Met polymorphism with pain catastrophizing in FM, which opens new avenues to comprehend the interplay between molecular genetic characteristics and neuroplasticity mechanisms underpinning FM

Functional connectivity response to acute pain assessed by fNIRS is associated with BDNF genotype in fibromyalgia : an exploratory study

Fibromyalgia is a heterogenous primary pain syndrome whose severity has been associated with descending pain modulatory system (DPMS) function and functional connectivity (FC) between pain processing areas. The brain-derived neurotrophic factor (BDNF) Val66Met single nucleotide polymorphism has been linked to vulnerability to chronic pain. In this cross-sectional imaging genetics study, we investigated fbromyalgia, the relationship between BDNF Val66Met heterozygous genotypes (Val/Met), and the functional connectivity (FC) response pattern to acute pain stimulus in the motor (MC) and prefrontal (PFC) cortex assessed by near-infrared spectroscopy (fNIRS) before and after a cold pressor test utilizing water (0–1 °C). Also, we assessed the relationship between this genotype with the DPMS function and quality of life. We included 42 women (Val/ Val = 30; Val/Met = 12) with fbromyalgia, ages 18–65. The MANCOVA comparing Val/Met to Val/Val genotypes showed higher ΔFC between left(l)-PFC—l-MC (β= 0.357, p = 0.048), l-PFC—right(r)-PFC (β= 0.249, p = 0.012), l-PFC—r-MC (β= 0.226, p = 0.022), and l-MC—r-PFC (β= 0.260, p = 0.016). Val/Met genotypes showed higher efciency of the DPMS and lower disability due to pain. Here we show that fbromyalgia patients carrying the Val/Met BDNF genotype presented an increased ΔFC across MC and PFC in response to acute pain associated with diferences in acute pain perception and fbromyalgia symptoms

Are Pain Polymorphisms Associated with the Risk and Phenotype of Post-COVID Pain in Previously Hospitalized COVID-19 Survivors?

Objective: To investigate the association of different, selected pain polymorphisms with the presence of de novo long-COVID pain symptoms and to analyze the association between these polymorphisms with clinical, sensory-related, cognitive and psychological variables in COVID-19 survivors. Methods: Two hundred and ninety-three (n = 293, 49.5% female, mean age: 55.6 ± 12.9 years) previously hospitalized COVID-19 survivors participated. Three genotypes of the following single nucleotide polymorphisms (SNPs) were obtained from non-stimulated saliva: OPRM1 (rs1799971), COMT (rs4680), BDNF (rs6265), and HTR1B (rs6296) by polymerase chain reactions in all participants. Further, clinical (intensity/duration of pain), sensory-related (sensitization-associated symptoms, neuropathic pain features), psychological (anxiety or depressive levels, sleep quality), and cognitive (catastrophizing, kinesiophobia) variables were collected in those COVID-19 survivors suffering from post-COVID pain. Analyses were carried out to associate clinical features with genotype. Results: Participants were assessed 17.8 ± 5.2 months after hospitalization. One hundred and seventeen (39.9%) experienced post-COVID pain (particularly of musculoskeletal origin). The distributions of the genotype variants of any SNP were not significantly different between COVID-19 survivors with and without long-term post-COVID pain (all, p > 0.178). No differences in sensitization-associated symptoms, neuropathic pain features, catastrophizing, kinesiophobia levels, anxiety and depressive levels or sleep quality according to the genotype variant in any SNPs were found. No effect of gender was identified. Conclusion: The four SNPs generally associated with pain did not appear to predispose to the development of de novo long-COVID pain symptoms in previously hospitalized COVID-19 survivors. The SNPs were not involved in the phenotypic features of post-COVID pain either

Transcranial direct current stimulation to improve the dysfunction of descending pain modulatory system related to opioids in chronic non-cancer pain : an integrative review of neurobiology and meta-analysis

Background: Opioid long-term therapy can produce tolerance, opioid-induced hyperalgesia (OIH), and it induces dysfunction in pain descending pain inhibitory system (DPIS). Objectives: This integrative review with meta-analysis aimed: (i) To discuss the potential mechanisms involved in analgesic tolerance and opioid-induced hyperalgesia (OIH). (ii) To examine how the opioid can affect the function of DPIS. (ii) To show evidence about the tDCS as an approach to treat acute and chronic pain. (iii) To discuss the effect of tDCS on DPIS and how it can counter-regulate the OIH. (iv) To draw perspectives for the future about the tDCS effects as an approach to improve the dysfunction in the DPIS in chronic non-cancer pain. Methods: Relevant published randomized clinical trials (RCT) comparing active (irrespective of the stimulation protocol) to sham tDCS for treating chronic non-cancer pain were identified, and risk of bias was assessed. We searched trials in PubMed, EMBASE and Cochrane trials databases. tDCS protocols accepted were application in areas of the primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), or occipital area. Results: Fifty-nine studies were fully reviewed, and 24 with moderate to the high-quality methodology were included. tDCS improved chronic pain with a moderate effect size [pooled standardized mean difference; −0.66; 95% confidence interval (CI) −0.91 to −0.41]. On average, active protocols led to 27.26% less pain at the end of treatment compared to sham [95% CI; 15.89–32.90%]. Protocol varied in terms of anodal or cathodal stimulation, areas of stimulation (M1 and DLPFC the most common), number of sessions (from 5 to 20) and current intensity (from 1 to 2mA). The time of application was 20min in 92% of protocols. Conclusion: In comparison with sham stimulation, tDCS demonstrated a superior effect in reducing chronic pain conditions. They give perspectives that the top-down neuromodulator effects of tDCS are a promising approach to improve management in refractory chronic not-cancer related pain and to enhance dysfunctional neuronal circuitries involved in the DPIS and other pain dimensions and improve pain control with a therapeutic opioid-free. However, further studies are needed to determine individualized protocols according to a biopsychosocial perspective

Elevated highly sensitive C-reactive protein in fibromyalgia associates with symptom severity

Objectives. Fibromyalgia (FM), a common pain syndrome, is thought to be a non-inflammatory, nociplastic condition, but evidence implicating neuroinflammation has been increasing. Systemic inflammation may be associated with more severe symptoms in some FM patients. We studied healthy controls and FM patients with and without systemic inflammation detectable using high-sensitivity CRP (hsCRP) measurement. Methods. We measured hsCRP levels and gathered clinical and questionnaire data [including the Fibromyalgia Impact Questionnaire (FIQ)] from 40 female FM patients and 30 age-matched healthy women. An hsCRP level >3 mg/l was considered elevated. Results. FM patients had significantly higher mean hsCRP levels than controls, explained by overweight and lower leisure-time physical activity. Eight FM patients had elevated hsCRP levels and 29 had normal hsCRP levels. Levels of hsCRP were significantly correlated with FIQ scores. Patients with elevated hsCRP had higher FIQ scores, with worse physical functioning and greater pain and were less likely to be employed than patients with normal hsCRP. These patient groups did not differ by blood count, liver function or lipid profiles, nor by education, psychological measures, sleep disturbance, smoking or comorbidities. Conclusion. Some FM patients have elevated hsCRP, mostly due to overweight and physical inactivity. They have worse symptoms and their ability to work is impaired. Measurement of hsCRP may help to identify FM patients in greatest need of interventions supporting working ability.Peer reviewe

Prédisposition génétique à la chronicité des symptômes post-commotionnels à la suite d'un traumatisme crânio-cérébral léger

La prévalence des troubles du sommeil et de douleur chronique est élevée chez le patient ayant subi un traumatisme crânien cérébral léger (TCCL). L’interaction entre ces plaintes est suggérée chez les patients avec un TCCL mais son étiologie reste encore peu connue. Les résultats de recherche présentés dans le premier article de cette thèse suggèrent que les patients avec un TCCL qui souffrent de douleur ont une modification des ondes cérébrales durant leur sommeil, ce qui pourrait expliquer en partie comment les deux symptômes interagissent. De plus, la douleur, surtout si associée à des troubles de l’humeur, semble jouer un rôle majeur dans la persistance des symptômes post-commotionnels. Le deuxième article de cette thèse décrit une exacerbation des symptômes post-commotionnels chez le patient ayant eu un TCCL et souffrant de douleur. La persistance ou l’apparition de la douleur chronique à long terme serait prédite par le polymorphisme val66met du gène brain-derived neurotrophic factor (BDNF). Une étude subséquente, présentée dans le troisième article, nous a permis d’approfondir les bases génétiques et cellulaires du rôle du BDNF dans la persistance des symptômes post-commotionnels. Des polymorphismes fréquents dans le gène BDNF ont révélé des variantes liées au mauvais pronostic suite à un TCCL. De plus, l’analyse de cellules extraites de patients ayant subi un TCCL démontrent que l’expression de la protéine BDNF peut être modifiée chez le patient de génotype met66 et ayant subi un TCCL, lui conférant ainsi un rôle neuroprotecteur potentiel. En résumé, nous avons tenté de démontrer dans cette thèse que la douleur suite à un TCCL joue un rôle important dans les perturbations du sommeil et dans la persistance des symptômes post-commotionnels. Une prédisposition génétique pourrait contribuer à expliquer le mauvais pronostic et la chronicité des symptômes post-commotionnels suite à un TCCL.Mild traumatic brain injury (MTBI) is a major public health concern as patients are left, amongst other symptoms, with sleep complaints and chronic pain. An interaction between these symptoms is suggested. For instance, a night of poor sleep is usually followed by hypersensitivity to pain and chronic pain always leads to sleep complaints. This interaction is suggested following an MTBI, however, data sustaining that hypothesis are still lacking. Data from the first article suggest that pain and other post-concussion symptoms are correlated with sleep-wake disturbances post-MTBI. MTBI patients with pain have more rapid electroencephalographic (EEG) waves during sleep than those without pain. This may suggest that there is an intrinsic physiological relationship between the two complaints. Moreover, pain seems to play an important role in the persistence of post-concussive symptoms. The second article of this thesis describes and details the exacerbation of post-concussive symptoms in the presence of pain following MTBI. The val66met polymorphism in the Brain-derived neurotrophic factor (BDNF) gene is an important predisposing factor for chronic pain. Lastly, a subsequent study, presented in the third article details the genetic and cellular basis of the role of BDNF in the persistence of post-concussive symptoms. Common polymorphisms in the BDNF genes were genotyped and revealed variants related to post-concussive symptoms following MTBI. Moreover, protein expression studies in lymphoblast cells of MTBI patients showed a modified expression of BDNF with the met genotype that might be neuroprotective. In summary, this thesis first shows that pain contributes to sleep-wake disturbances following MTBI and that the chronicity of post-concussive symptoms, including chronic pain, may be dependent on polymorphisms in the BDNF gene

Prediction and causal inference in the transition from acute to chronic low back pain

The overarching aim of this thesis was to enhance our understanding of the neurobiological risk factors associated with the transition from acute to chronic Low back pain (LBP). To achieve this aim, the Understanding persistent Pain Where it ResiDes (UPWaRD) study was conducted. In this thesis, six chapters describe the background, methods, and results of the UPWaRD study. Chapter 2 describes the protocol, published ‘a priori’ for developing a multivariable prediction model, including candidate predictors selected from the neurobiological (e.g. sensorimotor cortical excitability assessed by sensory and motor evoked potentials, Brain Derived Neurotrophic Factor [BDNF] genotype), psychological (e.g. depression and anxiety), symptom-related (e.g. LBP history) and demographic domains. Chapter 3 builds on the study protocol in the form of a cohort profile, describing baseline characteristics of 120 people experiencing an acute LBP episode and 57 pain-free control participants that form the UPWaRD cohort. Chapter 4 reports the results of the multivariable prediction model developed in 120 people experiencing acute LBP. To further understand the importance of these prognostic factors we developed a causal model of chronic LBP using directed acyclic graphs. The methodology and statistical analysis plan for drawing causal inferences, thus transparently reporting our causal assumptions, are reported in Chapter 5. Chapter 6 then provides the first evidence that low sensory cortex excitability during an acute LBP episode is a causal mechanism underpinning the development of chronic LBP. Finally, in Chapter 7, we report the results of a proteomic analysis, using hydrophobic interaction chromatography and electrospray ionization tandem mass spectrometry. Taken together this thesis makes an extensive and original contribution to our understanding of neurobiological risk factors involved in the transition from acute to chronic LBP. Not only is the inclusion of neurobiological prognostic factors in multivariable clinical prediction models a promising direction for future research that aims to identify people at high risk of poor outcome, but low sensory cortex excitability during acute LBP may be a promising causal mechanism that future treatments could target during acute LBP in the hope of expediting recovery and preventing the development of chronic LBP. Further, this thesis provides some of the earliest evidence to suggest sex-specific differential expression of proteins, measured from human serum, contributes to recovery status at three-month follow-up. This work provides foundational evidence for future research exploring strategies targeting distinct immune system processes in males and females that may interfere with the transition from acute to chronic LBP

Motor cortex excitability and BDNF levels in chronic musculoskeletal pain according to structural pathology

The central sensitization syndrome (CSS) encompasses disorders with overlapping symptoms in a structural pathology spectrum ranging from persistent nociception [e.g., osteoarthritis (OA)] to an absence of tissue injuries such as the one presented in fibromyalgia (FM) and myofascial pain syndrome (MPS). First, we hypothesized that these syndromes present differences in their cortical excitability parameters assessed by transcranial magnetic stimulation (TMS), namely motor evoked potential (MEP), cortical silent period (CSP), short intracortical inhibition (SICI) and short intracortical facilitation (SICF). Second, considering that the presence of tissue injury could be detected by serum neurotrophins, we hypothesized that the spectrum of structural pathology (i.e., from persistent nociception like in OA, to the absence of tissue injury like in FM and MPS), could be detected by differential efficiency of their descending pain inhibitory system, as assessed by the conditioned pain modulation (CPM) paradigm. Third, we explored whether brain-derived neurotrophic factor (BDNF) had an influence on the relationship between motor cortex excitability and structural pathology. This cross-sectional study pooled baseline data from three randomized clinical trials. We included females (n = 114), aged 19-65 years old with disability by chronic pain syndromes (CPS): FM (n = 19), MPS (n = 54), OA (n = 27) and healthy subjects (n = 14). We assessed the serum BDNF, the motor cortex excitability by parameters the TMS measures and the change on numerical pain scale [NPS (0-10)] during CPM-task. The adjusted mean (SD) on the SICI observed in the absence of tissue injury was 56.36% lower than with persistent nociceptive input [0.31(0.18) vs. 0.55 (0.32)], respectively. The BDNF was inversely correlated with the SICI and with the change on NPS (0-10) during CPM-task. These findings suggest greater disinhibition in the motor cortex and the descending pain inhibitory system in FM and MPS than in OA and healthy subjects. Likewise, the inteThis research was supported by grants and materials support from the following Brazilian agencies: (grants to; AD, JAD-S, FC) and material support. National Council for Scientific and Technological Development-CNPq (grants to ILdST, WC). Postgraduate Program in Medical Sciences at the School of Medicine of the Federal University of Rio Grande do Sul (material support). International Cooperation Program-CAPES-PGI-project (023-11). CAPES 129/2013 material support and grant for FP as visiting professor (AD, WC, PP). Postgraduate Research Group at the Hospital de Clinicas de Porto Alegre-PIPE HCPA (material support). Foundation for Support of Research at Rio Grande do Sul (FAPERGS) (material support). Brazilian Innovation Agency (FINEP) process number-1245/13 (ILdST, WC). Research grant: National Council for Scientific and Technological Development-CNPq (ILdS 302345/2011-6 and WC-301256/2013-6)

Role of BDNF-mediated neuroplasticity in patients affected by Fibromyalgia versus other chronic rheumatic diseases.

Background Fibromyalgia (FM) is still often viewed as a psychosomatic disorder. However, the increased pain sensitivity to stimuli in FM patients is not a phenomena of imagination, but the result of specific abnormalities in the central nervous system (CNS) pain matrix. Brain-derived neurotrophic factor (BDNF) is an endogenous protein involved in neuronal survival and synaptic plasticity of the central and peripheral nervous systems. Several lines of evidence converge to indicate that BDNF also participates in structural and functional plasticity of nociceptive pathways in the CNS and within the dorsal root ganglia and spinal cord. At these levels, release of BDNF appears to modulate or even mediate nociceptive sensory inputs and pain hypersensitivity. In the literature few studies evaluated BDNF levels in serum, plasma and cerebrospinal fluid samples of FM patients, finding increased levels of this neurotrophin compared to healthy controls. A number of studies also investigated BDNF levels in synovial fluid and plasma samples from patients affected by rheumatoid arthritis (RA), who are chronically subjected to pain, even though of inflammatory and autoimmune origin. No studies instead have been performed on patients affected by chronic fatigue syndrome (CFS), a condition that frequently overlaps with FM and whose etiopathogenesis, still unclear, is probably different from that of FM. Objectives The primary objective of the present PhD thesis project was therefore to investigate BDNF-mediated neuroplasticity, by detecting BDNF levels in FM patients, and therefore by comparing these levels to the ones found in CFS, RA and healthy volunteers. Secondary objectives were: (i) the relation between BDNF levels and clinical variables, including neurocognitive disorders, which were assessed in FM and CFS patients by means of a computerized system; (ii) the relation between BDNF levels and psychiatric comorbidity in FM and CFS patients; (iii) the relation between BDNF levels and inflammatory status in RA patients; (iv) serum and plasmatic BDNF levels in a subgroup of FM patients before, immediately after, and 3-months after thermal treatments. Materials and methods Among the patients recruited in the study, there were 68 FM, 45 CFS, and 46 RA together with 40 healthy controls. BDNF serum levels were determined by enzyme-linked immune-sorbent assay (Promega), and the differences among the various groups were observed. Demographic and clinical parameters were investigated in relation to BDNF levels. Moreover, a subgroup of FM patients (n=28) also participated to a clinical trial held at the Montecatini Thermal Baths, and another subgroup of FM patients (n=40), together with CFS patients, also completed a computerized test battery for the assessment of neurocognitive disorders. Results The main findings of the work can be summarized as follows: (i) the increased BDNF levels in sera of patients affected by FM, CFS and RA (but only those who were positive to rheumatoid factor of all isotypes), compared to healthy volunteers; (ii) the positive correlation between BDNF and rheumatoid factor (IgG and IgM isotypes), and the negative one with C-reactive protein; (iii) the lack of correlation between BDNF and neurocognitive disorders, assessed by the software CNS Vital Signs©; (iv) the higher prevalence of neurocognitive disorders in FM than in CFS patients, despite the more frequent complaint of CFS patients; (v) the tight relationship between neurocognitive impairments and chronic pain, which is independent of psychiatric comorbidity. Conclusions The conclusion reached by this study is that BDNF-mediated neuroplasticity in FM, CFS and RA could be interpreted as a protective mechanism against injuries, chronic pain and, more generally, against chronic stress conditions. This hypothesis could explain the elevated BDNF levels found in sera -but not in plasma- samples, and their decrease after thermal treatment. Although BDNF is not specific for FM or chronic pain -the difference here reported between BDNF levels of FM, CFS, RA patients compared to healthy controls are not strong enough to allow the use of BDNF in the diagnostic field- this work on one hand opens the way to new investigations on FM, CFS and RA etiopathogenesis, and on the other could suggest BDNF as a useful biomarker for FM/chronic pain therapy monitoring