A Functional Magnetic Resonance Imaging Study to Investigate the Utility of a Picture Imagination Task in Investigating Neural Responses in Patients with Chronic Musculoskeletal Pain to Daily Physical Activity Photographs.
Pain-related anxiety and fear are associated with increased difficulties in attention, increased awareness of pain, impaired disengagement from pain, and can moderate the effects of attentional coping attempts. Accurately assessing the direct impact of pain-related anxiety and fear on pain behavior has proved difficult. Studies have demonstrated no or limited influence of pain-related fear and anxiety on behavior but this may be due to inherent problems with the scales used. Neuroimaging has improved the understanding of neural processes underlying the factors that influence pain perception. This study aimed to establish if a Picture and Imagination Task (PIT), largely developed from the Photographs of Daily Activity (PHODA) assessment tool, could help explore how people living with chronic pain process information about daily activities. Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to compare brain responses in patients with chronic musculoskeletal pain (CMSKP) (n = 15) and healthy controls (n = 15). Subjects were asked to imagine how they would feel mentally and physically if asked to perform daily activities illustrated in PIT. The results found that a number of regions involved in pain processing saw increased BOLD activation in patients compared with controls when undertaking the task and included the insula, anterior cingulate cortex, thalamus and inferior and superior parietal cortices. Similarly, increased BOLD responses in patients compared to controls in the frontal pole, paracingulate and the supplementary motor cortex may be suggestive of a memory component to the responses The amygdala, orbitofrontal cortex, substantia nigra/ventral tegmentum, putamen, thalamus, pallidum, inferior parietal (supramarginal and angular gyrus) and cingulate cortex were also seen to have greater differences in BOLD signal changes in patients compared with controls and many of these regions are also associated with general phobic responses. Therefore, we suggest that PIT is a useful task to explore pain- and movement-related anxiety and fear in fMRI studies. Regions in the Default Mode Network remained active or were less deactivated during the PIT task in patients with CMSKP compared to healthy controls supporting the contention that the DMN is abnormal in patients with CMSKP.
Institute of Infection and Immunity, Cardiff University, Wales, United Kingdom.
Ann M
AM
Taylor
Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, United States of America; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, United States of America.
Ashley D
AD
Harris
Department of Psychology, Swansea University, Singleton Park, Swansea, Wales, United Kingdom; School of Psychology, Cardiff University, Wales, United Kingdom.
Alice
A
Varnava
Institute of Primary Care and Public Health, Cardiff University, Wales, United Kingdom.
Rhiannon
R
Phillips
Barry Chiropractic Clinic, Barry, Wales, United Kingdom.
Justin O
JO
Taylor
Bronllys Pain and Fatigue Management Centre, Brecon, Powys, Wales, United Kingdom.
Owen
O
Hughes
Institute of Infection and Immunity, Cardiff University, Wales, United Kingdom.
Antony R
AR
Wilkes
Institute of Infection and Immunity, Cardiff University, Wales, United Kingdom.
Judith E
JE
Hall
Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Wales, United Kingdom.
Richard G
RG
Wise
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D059350:Chronic Pain / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009043:Motor Activity; D059352:Musculoskeletal Pain / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D009415:Nerve Net / Q000473:pathology / Q000503:physiopathology*; D059906:Neuroimaging / Q000379:methods / Q000523:psychology; D010781:Photography