Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study

Author(s)

Simis, Marcel ; Marques, Lucas Murrins ; Barbosa, Sara Pinto ; Sugawara, Andre Tadeu ; Sato, Joao Ricardo ; Pacheco-Barrios, Kevin ; Battistella, Linamara Rizzo ; Fregni, Felipe

• Document type: Journal article
• Source: NEUROPHYSIOLOGIE CLINIQUE-CLINICAL NEUROPHYSIOLOGY; v. 54, n. 1, p. 8-pg., 2024-02-20.

Abstract

Background: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. Objectives: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). Methods: Sixty participants were recruited from the rehabilitation program in Sao Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. Results: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. Conclusion: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations. (AU)

• FAPESP's process: 20/08512-4 - Inhibition deficit as a marker of neuroplasticity in rehabilitation
• Grantee: Sara Barbosa Franco
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 17/12943-8 - Inhibitory deficit as a marker of neuroplasticity in rehabilitation
• Grantee: Felipe Fregni
• Support Opportunities: Research Projects - SPEC Program
• FAPESP's process: 21/05897-5 - Inhibition deficit as a marker of neuroplasticity in rehabilitation
• Grantee: Lucas Murrins Marques
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 21/05332-8 - Brazilian high-risk cohort for psychiatric disorders: 10 years follow-up
• Grantee: Rodrigo Affonseca Bressan
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/04654-9 - Time series, wavelets and high dimensional data
• Grantee: Pedro Alberto Morettin
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/21934-5 - Network statistics: theory, methods, and applications
• Grantee: André Fujita
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 23/02538-0 - Time series, wavelets, high dimensional data and applications
• Grantee: Aluísio de Souza Pinheiro
• Support Opportunities: Research Projects - Thematic Grants