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» Neuropathic pain

Chronic Pain changes the brain. On the functional activation level an increase in cortical excitability and an increase in cortical activation (primary sensorimotor cortex (M1/S1), anterior insula, and anterior cingulate cortex (ACC) during movement of the affected body part) could be verified especially for neuropathic pain (e.g. complex regional pain syndrome; CRPS) but also partially for other pain syndromes (e.g., craniomandibular dysfunction; CMD). For neuropathic pain this had been related to altered thalamo (Th) - cortical GABA availability. On the structural level a decrease in grey matter volume (GMV) had been demonstrated in a number of different pain syndromes (CMD, head pain, low back pain) especially in the ACC. This interacts with increased stress, increase of cigarette smoking, decreased sleeping times, increased body mass index (BMI) but inversely with the years spent with education (school, University; see glass brains on the left side of the figure). Other brain areas showing a reduction of GMV are the thalamus (for CRPS) and the anterior insula (for low back pain). On the right covariates of a population based cohort (SHIP-cohorts) for a VBM-analysis is plotted.

New funding for three years starting 2022 on pain research from the DFG for the following projects:
- Einflussfaktoren von Gehirnveränderung bei chronischen Schmerzen LO 795/37
- Antinozizeptive Effekte und Wirkmechanismen transaurikulärer Vagusnervstimulation LO 795/38

31.08.2021: New Article in Frontiers in Neurology: Domin M.*, Strauss S.*, McAuley J.H., Lotze M. (2021) Complex regional pain syndrome: thalamic GMV atrophy and associations of lower GMV with clinical and sensorimotor performance data. *equal contribution

12.08.2021: New Article in Brain Communications on our GMI-CRPS biomarker study: Strauss S., Barby S., Härtner J., Pfannmöller J., Neumann N., Moseley G.L., Lotze M. (2021) Graded motor imagery modifies movement pain, cortical excitability and sensorimotor function in CRPS. Brain Communications, accepted.

29.12.20: New paper accepted from our longitudinal trial on CRPS patients treated with GMI funded by Else Kröner Fresenius Stiftung: Strauss S., Barby S., Härtner J., Neumann N., Moseley G.L., Lotze M. (2021) Modifications in fMRI representation of mental rotation following a 6 week graded motor imagery training in chronic CRPS patients. Journal of Pain, accepted.

Most discussed article in social media on chronic back pain and alterations of the brains grey mater volume: Fritz, H.C., McAuley, J.H., Wittfeld, K., Hegenscheid, K., Schmidt, C.O., Langner, S., Lotze, M. (2015) Chronic back pain is associated with decreased prefrontal and anterior insular gray matter. Results from a population-based cohort study.


The following protocols are running right now:

- Voxel Based Morphometry findings for different pain syndromes: what is common for chronic pain and what is specific for the syndrome? Funding for 3 years by the DFG starting 10.21 (LO 795/36-1).

- CRPS Type I study: Intracortical Inhibition and changes in S1-finger representation

- Mental rotation of hands in CRPS-patients; fMRI representation

- Graded Motor Imagery Training for neuropathic pain and changes in the brains fMRI representation of somatosensory and motor representation of the hand

- Voxel-based-Morphometry on chronic pain (SHIP)

- Auricular stimulation on the cerebral processing of thermic pain

- Memoir: GMI and NMDA-antagonist (multicenter study by James McAuley; Sydney)

- Pain observation in patients with insular lesion (Alexander Lischke)


Literature:
Moseley G.L., Lotze M. (2022) Clinical and neurophysiological effects of progressive movement imagery training for pathological pain, The Journal of Pain, in press.
Domin M.*, Strauss S.*, McAuley J.H., Lotze M. (2021) Complex regional pain syndrome: thalamic GMV atrophy and associations of lower GMV with clinical and sensorimotor performance data. *equal contribution
Strauss S., Barby S., Härtner J., Pfannmöller J., Neumann N., Moseley G.L., Lotze M. (2021) Graded motor imagery modifies movement pain, cortical excitability and sensorimotor function in CRPS. Brain Communications, accepted.
Strauss S., Barby S., Härtner J., Neumann N., Moseley G.L., Lotze M. (2021) Modifications in fMRI representation of mental rotation following a 6 week graded motor imagery training in chronic CRPS patients. The Journal of Pain, S1526-5900(20)30119-X. doi: 10.1016/j.jpain.2020.12.003.
Kohler M., Strauss S., Horn U., Langner I., Usichenko T., Neumann N., Lotze M. (2019) Differences in neuronal representation of mental rotation in CRPS patients and healthy controls. The Journal of Pain, 20:898-907.
Review on resting state biomarkers for pain chronification in Brain and Cognition: Resting-State Biomarkers for Chronic Pain - A Network View (2018); Authors: Jörg Pfannmöller and Martin Lotze
Usichenko T., Hacker H., Lotze M. (2017) Transcutaneous auricular vagal nerve stimulation (taVNS) might be a mechanism behind the analgesic effects of auricular acupuncture. Brain Stimulation, 10(6):1042-1044.
Usichenko, T.*, Laqua, R.*, Leutzo, B., Lotze, M. (2015) Preliminary Findings of Cerebral Responses on Transcutaneous Vagal Nerve Stimulation on Experimental Heat Pain. Brain Imaging and Behavior, accepted. * equal contribution.
Fritz, H.C., McAuley, J.H., Wittfeld, K., Hegenscheid, K., Schmidt, C.O., Langner, S., Lotze, M. (2015) Chronic back pain is associated with decreased prefrontal and anterior insular gray matter. Results from a population-based cohort study. Journal of Pain, in press.
Strauß S, Grothe M, Usichenko T, Neumann N, Byblow WD, Lotze M. (2015) Inhibition of the primary sensorimotor cortex by topical anesthesia of the forearm in patients with CRPS. Pain. in press.
Lotze M. and Moseley GL. (2015) Theoretical considerations for chronic pain rehabilitation. Physical Therapy, in press.
Usichenko T.I., Wesolowski T., Lotze M. (2015) Verum and sham acupuncture exert distinct cerebral activation in pain processing areas: a crossover fMRI investigation in healthy volunteers, Brain Imaging and Behavior, 9(2):236-44.
Lotze, M and Di Pietro F (2014) Brain activity and reorganization in CRPS. In: The Brain Adapting with Pain: Contribution of Neuroimaging Technology to pain mechanisms. Ed: Vania Apkarian. IASP Press, in press.
DiPietro F, Stanton TR, Moseley GL, Lotze M, Mc Aulley JH (2014) Interhemispheric somatosensory differences in chronic pain reflect abnormality of the healthy side. Human Brain Mapping, in press.
Di Pietro F., Stanton, TR., Parkitny L., McAuley JH., Lotze M., Wand BW, Moseley GL (2013) Primary somatosensory cortex function in complex regional pain syndrome: a systematic review & meta-analysis. Journal of Pain, in press.
Di Pietro F., McAuley JH. Parkitny L., Lotze M., Wand BW, Moseley GL Stanton, TR., (2013) Primary motor cortex function in complex regional pain syndrome: a systematic review & meta-analysis. Journal of Pain, in press.
Walz AD., Usichenko T., Moseley GL., Lotze M. (2012) Graded motor imagery and the impact on pain processing in a case of CRPS. Journal of Clinical Pain, in press.
Friebel, U., Eickhoff, S., Lotze M. (2011) Coordinate-based meta-analysis of experi-mentally induced and chronic persistent neuropathic pain, Neuroimage, 58(4):1070-80.
Gustin S.*, Schwarz A.*, Birbaumer N., Sines N., Veit R., Larbig W., Flor H., Lotze M (2010) NMDA-antagonist and morphine decrease CRPS-pain and cerebral pain-representation. Pain, 151: 69-76.
Wesolowski T., Lotze M., Domin M., Langner S., Lehmann C., Wendt M, Usichenko T (2009) Acupuncture reveals no specific effect on primary auditory cortex - an fMRI study. NeuroReport; 20(2):116-20.
Flor H., Nikolajsen L., Jensen T.S. Phantom limb pain: a case of maladaptive CNS plasticity? Nature Neuroscience Reviews (2006) 7: 873-881.
Lotze M., Flor H., Grodd W., Larbig W., Birbaumer N. Phantom movements and pain: an fMRI study in upper limb amputees. Brain (2001) 124: 2268-2277.
Lotze M., Grodd W., Birbaumer N., Erb M., Huse E., Flor H. Does the use of a myoelectric prosthesis prevent cortical reorganization and phantom limb pain? Nature Neuroscience (1999) 2: 501-502.

Table for the longitudinal study applying graded motor imagery in chronic CRPS patients:


The „German Pain Award” in 2000 and 2014 and the promotional award from the German Association of Neurotraumatology and Clinical Neuropsychology in 2002.