An Integrated Quantitative Index for Measuring Chronic Multisite Pain: The Multiple Areas of Pain (MAP) Study.

OBJECTIVE: Despite the high prevalence of chronic multisite pain, there is little consensus on methods to characterize it. Commonly used assessments report only one dimension of pain, that is, intensity, thus ignoring the spatial aspect of pain. We developed a novel pain quantification index, the Integrated Pain Quantification Index (IPQI), on a scale of 0 to 1 that integrates multiple distinct pain measures into a single value, thus representing multidimensional pain information with a single value. DESIGN: Single-visit, noninterventional, epidemiological study. SETTING: Fourteen outpatient multidisciplinary pain management programs. PATIENTS: Patients with chronic pain of the trunk and/or limbs for at least six months with average overall pain intensity of at least 5 on the numeric rating scale. METHODS: Development of IPQI was performed in a large population (N = 810) of chronic pain patients from the Multiple Areas of Pain (MAP) study. RESULTS: Prevalence of two or more noncontiguous painful areas was at 88.3% (95% confidence interval [CI] = 0.86-0.90), with a mean of 6.3 areas (SD = 5.57 areas). Prevalence of more than 10% body area in pain was at 52.8% (95% CI = 0.49-0.56), with a mean at 16.1% (17.16%). On average, IPQI values were near the middle of the scale, with mean and median IPQI at 0.52 (SD = 0.13) and 0.55, respectively. The IPQI was generalizable and clinically relevant across all domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. CONCLUSIONS: IPQI provided a single pain score for representing complex, multidimensional pain information on one scale and has implications for comparing pain populations across longitudinal clinical trials.

Temporal plasticity in auditory cortex improves neural discrimination of speech sounds.

BACKGROUND: Many individuals with language learning impairments exhibit temporal processing deficits and degraded neural responses to speech sounds. Auditory training can improve both the neural and behavioral deficits, though significant deficits remain. Recent evidence suggests that vagus nerve stimulation (VNS) paired with rehabilitative therapies enhances both cortical plasticity and recovery of normal function. OBJECTIVE/HYPOTHESIS: We predicted that pairing VNS with rapid tone trains would enhance the primary auditory cortex (A1) response to unpaired novel speech sounds. METHODS: VNS was paired with tone trains 300 times per day for 20 days in adult rats. Responses to isolated speech sounds, compressed speech sounds, word sequences, and compressed word sequences were recorded in A1 following the completion of VNS-tone train pairing. RESULTS: Pairing VNS with rapid tone trains resulted in stronger, faster, and more discriminable A1 responses to speech sounds presented at conversational rates. CONCLUSION: This study extends previous findings by documenting that VNS paired with rapid tone trains altered the neural response to novel unpaired speech sounds. Future studies are necessary to determine whether pairing VNS with appropriate auditory stimuli could potentially be used to improve both neural responses to speech sounds and speech perception in individuals with receptive language disorders.

Pairing tone trains with vagus nerve stimulation induces temporal plasticity in auditory cortex.

The selectivity of neurons in sensory cortex can be modified by pairing neuromodulator release with sensory stimulation. Repeated pairing of electrical stimulation of the cholinergic nucleus basalis, for example, induces input specific plasticity in primary auditory cortex (A1). Pairing nucleus basalis stimulation (NBS) with a tone increases the number of A1 neurons that respond to the paired tone frequency. Pairing NBS with fast or slow tone trains can respectively increase or decrease the ability of A1 neurons to respond to rapidly presented tones. Pairing vagus nerve stimulation (VNS) with a single tone alters spectral tuning in the same way as NBS-tone pairing without the need for brain surgery. In this study, we tested whether pairing VNS with tone trains can change the temporal response properties of A1 neurons. In naïve rats, A1 neurons respond strongly to tones repeated at rates up to 10 pulses per second (pps). Repeatedly pairing VNS with 15 pps tone trains increased the temporal following capacity of A1 neurons and repeatedly pairing VNS with 5 pps tone trains decreased the temporal following capacity of A1 neurons. Pairing VNS with tone trains did not alter the frequency selectivity or tonotopic organization of auditory cortex neurons. Since VNS is well tolerated by patients, VNS-tone train pairing represents a viable method to direct temporal plasticity in a variety of human conditions associated with temporal processing deficits.

Cortical activity patterns predict robust speech discrimination ability in noise.

The neural mechanisms that support speech discrimination in noisy conditions are poorly understood. In quiet conditions, spike timing information appears to be used in the discrimination of speech sounds. In this study, we evaluated the hypothesis that spike timing is also used to distinguish between speech sounds in noisy conditions that significantly degrade neural responses to speech sounds. We tested speech sound discrimination in rats and recorded primary auditory cortex (A1) responses to speech sounds in background noise of different intensities and spectral compositions. Our behavioral results indicate that rats, like humans, are able to accurately discriminate consonant sounds even in the presence of background noise that is as loud as the speech signal. Our neural recordings confirm that speech sounds evoke degraded but detectable responses in noise. Finally, we developed a novel neural classifier that mimics behavioral discrimination. The classifier discriminates between speech sounds by comparing the A1 spatiotemporal activity patterns evoked on single trials with the average spatiotemporal patterns evoked by known sounds. Unlike classifiers in most previous studies, this classifier is not provided with the stimulus onset time. Neural activity analyzed with the use of relative spike timing was well correlated with behavioral speech discrimination in quiet and in noise. Spike timing information integrated over longer intervals was required to accurately predict rat behavioral speech discrimination in noisy conditions. The similarity of neural and behavioral discrimination of speech in noise suggests that humans and rats may employ similar brain mechanisms to solve this problem.

Reversing pathological neural activity using targeted plasticity.

Brain changes in response to nerve damage or cochlear trauma can generate pathological neural activity that is believed to be responsible for many types of chronic pain and tinnitus. Several studies have reported that the severity of chronic pain and tinnitus is correlated with the degree of map reorganization in somatosensory and auditory cortex, respectively. Direct electrical or transcranial magnetic stimulation of sensory cortex can temporarily disrupt these phantom sensations. However, there is as yet no direct evidence for a causal role of plasticity in the generation of pain or tinnitus. Here we report evidence that reversing the brain changes responsible can eliminate the perceptual impairment in an animal model of noise-induced tinnitus. Exposure to intense noise degrades the frequency tuning of auditory cortex neurons and increases cortical synchronization. Repeatedly pairing tones with brief pulses of vagus nerve stimulation completely eliminated the physiological and behavioural correlates of tinnitus in noise-exposed rats. These improvements persisted for weeks after the end of therapy. This method for restoring neural activity to normal may be applicable to a variety of neurological disorders.

Cortical activity patterns predict speech discrimination ability.

Neural activity in the cerebral cortex can explain many aspects of sensory perception. Extensive psychophysical and neurophysiological studies of visual motion and vibrotactile processing show that the firing rate of cortical neurons averaged across 50-500 ms is well correlated with discrimination ability. In this study, we tested the hypothesis that primary auditory cortex (A1) neurons use temporal precision on the order of 1-10 ms to represent speech sounds shifted into the rat hearing range. Neural discrimination was highly correlated with behavioral performance on 11 consonant-discrimination tasks when spike timing was preserved and was not correlated when spike timing was eliminated. This result suggests that spike timing contributes to the auditory cortex representation of consonant sounds.