The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and Mood Processing—An Experimental Study

Pain Medicine

Volume 13, Issue 2, pages 215–228, February 2012

1. Volker Busch MD^1,*, 
2. Walter Magerl MD²,
3. Uwe Kern MD³, 
4. Joachim Haas MD¹, 
5. Göran Hajak MD¹, 
6. Peter Eichhammer MD¹

Article first published online: 21 SEP 2011

DOI: 10.1111/j.1526-4637.2011.01243.x

Abstract

Objective.  Deep and slow breathing (DSB) techniques, as a component of various relaxation techniques, have been reported as complementary approaches in the treatment of chronic pain syndromes, but the relevance of relaxation for alleviating pain during a breathing intervention was not evaluated so far.

Methods.  In order to disentangle the effects of relaxation and respiration, we investigated two different DSB techniques at the same respiration rates and depths on pain perception, autonomic activity, and mood in 16 healthy subjects. In the attentive DSB intervention, subjects were asked to breathe guided by a respiratory feedback task requiring a high degree of concentration and constant attention. In the relaxing DSB intervention, the subjects relaxed during the breathing training. The skin conductance levels, indicating sympathetic tone, were measured during the breathing maneuvers. Thermal detection and pain thresholds for cold and hot stimuli and profile of mood states were examined before and after the breathing sessions.

Results.  The mean detection and pain thresholds showed a significant increase resulting from the relaxing DSB, whereas no significant changes of these thresholds were found associated with the attentive DSB. The mean skin conductance levels indicating sympathetic activity decreased significantly during the relaxing DSB intervention but not during the attentive DSB. Both breathing interventions showed similar reductions in negative feelings (tension, anger, and depression).

Conclusion.  Our results suggest that the way of breathing decisively influences autonomic and pain processing, thereby identifying DSB in concert with relaxation as the essential feature in the modulation of sympathetic arousal and pain perception.

Highly localized interactions between sensory neurons and sprouting sympathetic fibers observed in a transgenic tyrosine hydroxylase reporter mouse

Molecular Pain 2011, 7:53 doi:10.1186/1744-8069-7-53

Published: 27 July 2011

Wenrui Xie, Judith A Strong, Juxian Mao and Jun-Ming Zhang

Abstract (provisional)

Background

Sprouting of sympathetic fibers into sensory ganglia occurs in many preclinical pain models, providing a possible anatomical substrate for sympathetically enhanced pain. However, the functional consequences of this sprouting have been controversial. We used a transgenic mouse in which sympathetic fibers expressed green fluorescent protein, observable in live tissue. Medium and large diameter lumbar sensory neurons with and without nearby sympathetic fibers were recorded in whole ganglion preparations using microelectrodes.

Results

After spinal nerve ligation, sympathetic sprouting was extensive by 3 days. Abnormal spontaneous activity increased to 15% and rheobase was reduced. Spontaneously active cells had Aalpha/beta conduction velocities but were clustered near the medium/large cell boundary. Neurons with sympathetic basket formations had a dramatically higher incidence of spontaneous activity (71%) and had lower rheobase than cells with no sympathetic fibers nearby. Cells with lower density nearby fibers had intermediate phenotypes. Immunohistochemistry of sectioned ganglia showed that cells surrounded by sympathetic fibers were enriched in nociceptive markers TrkA, substance P, or CGRP. Spontaneous activity began before sympathetic sprouting was observed, but blocking sympathetic sprouting on day 3 by cutting the dorsal ramus in addition to the ventral ramus of the spinal nerve greatly reduced abnormal spontaneous activity.

Conclusions

The data suggest that early sympathetic sprouting into the sensory ganglia may have highly localized, excitatory effects. Quantitatively, neurons with sympathetic basket formations may account for more than half of the observed spontaneous activity, despite being relatively rare. Spontaneous activity in sensory neurons and sympathetic sprouting may be mutually re-enforcing.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Acupuncture modulates temporal neural responses in wide brain networks: evidence from fMRI study

Molecular Pain 2010, 6:73

doi:10.1186/1744-8069-6-73(Open Access)

Lijun Bai¹ , Jie Tian^1,2 , Chongguang Zhong¹ , Ting Xue² , Youbo you¹ , Zhenyu Liu¹ , Peng Chen³ , Qiyong Gong⁴ , Lin Ai⁵ , Wei Qin² , Jianping Dai⁵  and Yijun Liu^6,7 

¹ Medical Image Processing Group, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China

² School of Life Science and Technology, Xidian University, Xi'an 710071, China

³ Beijing TCM Hospital affiliated to Capital University of Medical Sciences, Beijing 10010, China

⁴ West China Hospital of Sichuan University, Sichuan 610041, China

⁵ Department of Radiology, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, 100050, China

⁶ McKnight Brain Institute, Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, FL 32610, USA

⁷ Department of Biomedical Engineering, Peking University, Beijing 100871, China

Published:	2 November 2010

Abstract

Background

Accumulating neuroimaging studies in humans have shown that acupuncture can modulate a widely distributed brain network, large portions of which are overlapped with the pain-related areas. Recently, a striking feature of acupuncture-induced analgesia is found to be associated with its long-last effect, which has a delayed onset and gradually reaches a peak even after acupuncture needling being terminated. Identifying temporal neural responses in these areas that occur at particular time -- both acute and sustained effects during acupuncture processes -- may therefore shed lights on how such peripheral inputs are conducted and mediated through the CNS. In the present study, we adopted a non-repeated event-related (NRER) fMRI paradigm and control theory based approach namely change-point analysis in order to capture the detailed temporal profile of neural responses induced by acupuncture.

Results

Our findings demonstrated that neural activities at the different stages of acupuncture presented distinct temporal patterns, in which consistently positive neural responses were found during the period of acupuncture needling while much more complex and dynamic activities found during a post-acupuncture period. These brain responses had a significant time-dependent effect which showed different onset time and duration of neural activities. The amygdala and perigenual anterior cingulate cortex (pACC), exhibited increased activities during the needling phase while decreased gradually to reach a peak below the baseline. The periaqueductal gray (PAG) and hypothalamus presented saliently intermittent activations across the whole fMRI session. Apart from the time-dependent responses, relatively persistent activities were also identified in the anterior insula and prefrontal cortices. The overall findings indicate that acupuncture may engage differential temporal neural responses as a function of time in a wide range of brain networks.

Conclusions

Our study has provided evidence supporting a view that acupuncture intervention involves complex modulations of temporal neural response, and its effect can gradually resolve as a function of time. The functional specificity of acupuncture at ST36 may involve multiple levels of differential activities of a wide range of brain networks, which are gradually enhanced even after acupuncture needle being terminated.

The Pain of Vertebral Compression Fractures Can Arise in the Posterior Elements

• Pain Medicine

  Volume 11, Issue 11, pages 1666–1673, November 201

  1. Nikolai Bogduk MD, 
  2. John MacVicar MB, ChB, 
  3. James Borowczyk MB, ChB

  Article first published online: 2 NOV 2010

Abstract

Objectives.  To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body.

Methods.  The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. Proof of principle was provided by performing controlled diagnostic blocks in six patients.

Results.  The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies.

Conclusions.  In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies.

Whiplash-Associated Disorders

EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders 
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl 

ABSTRACT

Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.

In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.

Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).

Acupuncture for Lower Back Pain: A Review

The Clinical Journal of Pain:
January 2010 - Volume 26 - Issue 1 - pp 60-69
Lewis, Katrina MD; Abdi, Salahadin MD, PhD
doi: 10.1097/AJP.0b013e3181bad71e
Review Articles


Objective: We briefly discuss the history of acupuncture and its postulated mechanisms of action, but our primary objective is to discuss the evidence for acupuncture's efficacy in low back pain as well as approaches of newer study protocols to define more clearly the true usefulness of this alternative modality in low back pain.

Methods: Pubmed online search of all articles and other literature in the past 50 years related to acupuncture efficacy in low back pain, including case reports, randomized controlled trials and meta-analyses.

Results: Lower back pain and its associated incapacitating sequelae constitute an important healthcare and socioeconomic problem. There have been multiple, generally poor quality studies on the efficacy of acupuncture for this multi-factorial pain condition. Although newer studies seem to show promise, effectiveness has not been clearly demonstrated.

Conclusions: There is a paucity of high-quality research assessing efficacy of acupuncture in the management of LBP. Nonetheless, it continues to play a significant role in our clinical practice, not as a sole therapeutic modality but rather as an adjunct to a multidisciplinary integrative approach of LBP management. Most of the published articles about acupuncture in the biomedical literature consist of case reports, case series, or intervention studies with designs inadequate to assess its efficacy. Thus it is imperative that further research be performed, both preclinical to help elucidate the mechanisms underlying acupuncture, and clinical to justify its clinical application.

Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain

Practical Pain Management. Vol.9, No.1 Jan/Feb 2009
by Leonard B. Goldstein, DDS, PhD and Howard W. Makofsky, PT, DHSc, OCS

Nearly fifty percent (50%) of the population is affected by cervical spine pain and/or headaches during their lives.1 Headache is not only one of the most common human ailments,2 but also accounts for the expenditures of billions of health care dollars annually and is a leading cause of lost time from work.3

Cervical dysfunction may be seen in up to seventy percent (70%) of the population suffering from any type of headache.4 This suggests that the cervical spine may be either a causative or contributing factor in the pathogenesis of many headaches.5

The pilot study by Placzek, Pagett, et al. demonstrated and supported the theory that headache may be influenced by cervical muscle strength, and that weakness of the cervical spine musculature may lead to abnormal stress on the upper cervical facets which are related to head and neck pain. It is further speculated that stability, and thus normal function and biomechanics, is dependent on a balance of anterior and posterior cervical muscle balance. Despite advances, the pathogenesis of tension-type headache is not clearly understood. However, cervical musculoskeletal abnormalities have been linked to multiple headache types.6-8

In the study published by Fernandez-De-Las-Penas, Perez-De-Heredia, Molero-Sanchez, and Miangolarra-Page,9 the authors presented results similar to those previously reported:

impairment in deep neck flexor muscles in individuals with cervicogenic headaches, and
deficits in the performance of the cranio-cervical flexion test (ie., reduced endurance or holding capacity of the deep neck flexor muscles).
Please refer to the Jan/Feb 2009 issue for the complete text.

Chronic Tension-Type Headache With Vitamin D Deficiency: Casual or Causal Association?

Brief Communications
Chronic Tension-Type Headache With Vitamin D Deficiency: Casual or Causal Association?
Headache: The Journal of Head and Face Pain
Volume 49 Issue 8, Pages 1214 - 1222
Published Online: 8 Jul 2009
Sanjay Prakash, DM; Nilima D. Shah, MD
From the Department of Neurology, Medical College, Baroda, Gujarat, India (S. Prakash); Department of Psychiatry, Medical College, Baroda, Gujarat, India (N.D. Shah).
Correspondence to S. Prakash, O-19, Doctor's Quarter, Jail Road, Baroda, Gujarat, 390001 India.
Funding source: No grant or support was required.

Conflict of Interest: None

Copyright Copyright © 2009 American Headache Society
KEYWORDS
vitamin D • tension-type headache • pain • musculoskeletal symptoms
(Headache 2009;49:1214-1222)

ABSTRACT
The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.


--------------------------------------------------------------------------------

Accepted for publication May 18, 2009.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01483.x About DOI