Neuroimaging reveals a potential brain-based pre-existing mechanism that confers vulnerability to development of chronic painful chemotherapy-induced peripheral neuropathy

TY - JOUR

T1 - Neuroimaging reveals a potential brain-based pre-existing mechanism that confers vulnerability to development of chronic painful chemotherapy-induced peripheral neuropathy

AU - Seretny, Marta

AU - Romaniuk, Liana

AU - Whalley, Heather C.

AU - Sladdin, Kim

AU - Lawrie, Stephen

AU - Warnaby, Catherine Elizabeth

AU - Roberts, Neil

AU - Colvin, Lesley

AU - Tracey, Irene

AU - Fallon, Marie

N1 - Funding: MS and this study were funded by the Welcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (STMTI). Copyright: © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

PY - 2023/1

Y1 - 2023/1

N2 - Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition impacting 30% of cancer survivors. This study is the first to explore whether a brain-based vulnerability to chronic sensory CIPN exists.Methods: This prospective, multicentre cohort study recruited from three sites across Scotland. Brain functional MRI (fMRI) scans (3 Tesla) were carried out on chemotherapy naïve patients at a single fMRI centre in Edinburgh, Scotland. Nociceptive stimuli (with a 256 mN monofilament) were administered during the fMRI. Development of chronic sensory/painful CIPN (CIPN+) was determined based upon European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 changes conducted 9 months after chemotherapy, and imaging data analysed using standard software.Results: Of 30 patients recruited (two lung, nine gynaecological, and 19 colorectal malignancies), data from 20 patients at 9 months after chemotherapy was available for analysis. Twelve were classified as CIPN+ (mean age, 63.2[9.6] yr, 9.6; six female), eight as CIPN– (mean age 62.9 [SD 5.5] yr, four female). In response to punctate stimulation, group contrast analysis showed that CIPN+ compared with CIPN– had robust activity in sensory, motor, attentional, and affective brain regions. An a priori chosen region-of-interest analysis focusing on the periaqueductal grey, an area hypothesised as relevant for developing CIPN+, showed significantly increased responses in CIPN– compared with CIPN+ patients. No difference in subcortical volumes between CIPN+ and CIPN– patients was detected.Conclusions: Before administration of any chemotherapy or appearance of CIPN symptoms, we observed altered patterns of brain activity in response to nociceptive stimulation in patients who later developed chronic sensory CIPN. This suggests the possibility of a pre-existing vulnerability to developing CIPN centred on brainstem regions of the descending pain modulatory system.

AB - Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition impacting 30% of cancer survivors. This study is the first to explore whether a brain-based vulnerability to chronic sensory CIPN exists.Methods: This prospective, multicentre cohort study recruited from three sites across Scotland. Brain functional MRI (fMRI) scans (3 Tesla) were carried out on chemotherapy naïve patients at a single fMRI centre in Edinburgh, Scotland. Nociceptive stimuli (with a 256 mN monofilament) were administered during the fMRI. Development of chronic sensory/painful CIPN (CIPN+) was determined based upon European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 changes conducted 9 months after chemotherapy, and imaging data analysed using standard software.Results: Of 30 patients recruited (two lung, nine gynaecological, and 19 colorectal malignancies), data from 20 patients at 9 months after chemotherapy was available for analysis. Twelve were classified as CIPN+ (mean age, 63.2[9.6] yr, 9.6; six female), eight as CIPN– (mean age 62.9 [SD 5.5] yr, four female). In response to punctate stimulation, group contrast analysis showed that CIPN+ compared with CIPN– had robust activity in sensory, motor, attentional, and affective brain regions. An a priori chosen region-of-interest analysis focusing on the periaqueductal grey, an area hypothesised as relevant for developing CIPN+, showed significantly increased responses in CIPN– compared with CIPN+ patients. No difference in subcortical volumes between CIPN+ and CIPN– patients was detected.Conclusions: Before administration of any chemotherapy or appearance of CIPN symptoms, we observed altered patterns of brain activity in response to nociceptive stimulation in patients who later developed chronic sensory CIPN. This suggests the possibility of a pre-existing vulnerability to developing CIPN centred on brainstem regions of the descending pain modulatory system.

KW - Descending pain modulatory system (DPMS)

KW - fMRI

KW - Pain

KW - Painful Chemotherapy Induced Peripheral Neuropathy (CIPN)

KW - Prospective, multicentre cohort study

KW - chemotherapy induced peripheral neuropathy

KW - multicentre cohort study

KW - pain

KW - descending pain modulatory system

UR - https://www.scopus.com/pages/publications/85142225998

U2 - 10.1016/j.bja.2022.09.026

DO - 10.1016/j.bja.2022.09.026

M3 - Article

C2 - 36396483

SN - 0007-0912

VL - 130

SP - 83

EP - 93

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

ER -