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Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain
Peter Foley1, Yazhuo Kong2,3, Ramune Dirvanskiene1
1Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Brain Communications
|June 6, 2022
Summary
Chronic neuropathic pain in multiple sclerosis is linked to executive dysfunction and altered descending pain modulation. This study reveals impaired brain connectivity in patients with multiple sclerosis and chronic pain.
Area of Science:
- Neuroscience
- Neurology
- Pain Research
Background:
- Chronic pain is prevalent and challenging to manage in multiple sclerosis (MS).
- The mechanisms underlying MS-related pain, particularly neuropathic pain, are not fully understood.
- Dysfunction in the descending pain modulatory system (DPMS) is implicated in chronic pain, but its link to executive function in MS is unclear.
Purpose of the Study:
- To investigate the relationship between executive dysfunction and altered functional connectivity of the DPMS in adults with MS-associated chronic neuropathic limb pain.
- To specifically examine if reduced mental flexibility is associated with DPMS dysfunction.
- To compare brain lesion and atrophy patterns in MS patients with and without chronic neuropathic limb pain.
Main Methods:
- A case-control cross-sectional study involving 47 adults with relapsing-remitting MS (31 with chronic neuropathic limb pain, 16 without).
- Utilized clinical assessments, neuropsychological testing (including Delis-Kaplan Executive Function System), structural MRI, and functional MRI (fMRI).
- Measured brain lesions, atrophy affecting DPMS structures, and functional connectivity of key DPMS regions (rostral anterior cingulate, ventrolateral periaqueductal gray).
Main Results:
- The chronic neuropathic pain group exhibited significant executive dysfunction, notably reduced mental flexibility (P < 0.001).
- Lower functional connectivity was observed between the rostral anterior cingulate and ventrolateral periaqueduceal gray in the pain group.
- Higher brainstem-specific lesion volume was found in the pain group (P = 0.0017), but differential connectivity persisted after correction.
Conclusions:
- Executive dysfunction, particularly impaired mental flexibility, is present in MS patients with chronic neuropathic limb pain.
- Findings provide functional and structural MRI evidence of DPMS dysfunction in this population.
- These results highlight the intricate interplay between cognition, DPMS function, and chronic pain in MS, suggesting potential targets for pharmacological and cognitive interventions.
