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2014 ; 155
(9
): 1727-1742
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The responsive amygdala: treatment-induced alterations in functional connectivity
in pediatric complex regional pain syndrome
#MMPMID24861582
Simons LE
; Pielech M
; Erpelding N
; Linnman C
; Moulton E
; Sava S
; Lebel A
; Serrano P
; Sethna N
; Berde C
; Becerra L
; Borsook D
Pain
2014[Sep]; 155
(9
): 1727-1742
PMID24861582
show ga
The amygdala is a key brain region with efferent and afferent neural connections
that involve complex behaviors such as pain, reward, fear, and anxiety. This
study evaluated resting state functional connectivity of the amygdala with
cortical and subcortical regions in a group of chronic pain patients (pediatric
complex regional pain syndrome) with age-sex matched control subjects before and
after intensive physical-biobehavioral pain treatment. Our main findings include
(1) enhanced functional connectivity from the amygdala to multiple cortical,
subcortical, and cerebellar regions in patients compared with control subjects,
with differences predominantly in the left amygdala in the pretreated condition
(disease state); (2) dampened hyperconnectivity from the left amygdala to the
motor cortex, parietal lobe, and cingulate cortex after intensive pain
rehabilitation treatment within patients with nominal differences observed among
healthy control subjects from time 1 to time 2 (treatment effects); (3)
functional connectivity to several regions key to fear circuitry (prefrontal
cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus)
correlated with higher pain-related fear scores; and (4) decreases in
pain-related fear associated with decreased connectivity between the amygdala and
the motor and somatosensory cortex, cingulate, and frontal areas. Our data
suggest that there are rapid changes in amygdala connectivity after an aggressive
treatment program in children with chronic pain and intrinsic amygdala functional
connectivity activity serving as a potential indicator of treatment response.