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Brain moderators supporting the relationship between depressive mood and pain

Adler-Neal, Adrienne L.a; Emerson, Nichole M.a; Farris, Suzan R.a; Jung, Youngkyoob; Coghill, Robert C.c,d; Zeidan, Fadela,e,*

doi: 10.1097/j.pain.0000000000001595
Research Paper

Pain and depressive mood commonly exhibit a comorbid relationship. Yet, the brain mechanisms that moderate the relationship between dysphoric mood and pain remain unknown. An exploratory analysis of functional magnetic resonance imaging, behavioral, and psychophysical data was collected from a previous study in 76 healthy, nondepressed, and pain-free individuals. Participants completed the Beck Depression Inventory-II (BDI), a measure of negative mood/depressive symptomology, and provided pain intensity and pain unpleasantness ratings in response to noxious heat (49°C) during perfusion-based, arterial spin–labeled functional magnetic resonance imaging. Moderation analyses were conducted to determine neural mechanisms involved in facilitating the hypothesized relationship between depressive mood and pain sensitivity. Higher BDI-II scores were positively associated with pain intensity (R2 = 0.10; P = 0.006) and pain unpleasantness (R2 = 0.12; P = 0.003) ratings. There was a high correlation between pain intensity and unpleasantness ratings (r = 0.94; P < 0.001); thus, brain moderation analyses were focused on pain intensity ratings. Individuals with higher levels of depressive mood exhibited heightened sensitivity to experimental pain. Greater activation in regions supporting the evaluation of pain (ventrolateral prefrontal cortex; anterior insula) and sensory-discrimination (secondary somatosensory cortex; posterior insula) moderated the relationship between higher BDI-II scores and pain intensity ratings. This study demonstrates that executive-level and sensory-discriminative brain mechanisms play a multimodal role in facilitating the bidirectional relationship between negative mood and pain.

Novel evidence is provided showing neural regions process pain-related appraisals in a multimodal manner that is dependent on an individual's mood.

Departments of aNeurobiology and Anatomy and

bRadiology, Wake Forest School of Medicine, Winston-Salem, NC, United States

cDepartment of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States

dDivision of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

eDepartment of Anesthesiology, University of California San Diego, San Diego, CA, United States

*Corresponding author. Address: Department of Anesthesiology, University of California San Diego, 9500 Gilman Dr, MC0719, San Diego, CA 92093, United States. Tel.: 858-246-2391. E-mail address: (F. Zeidan).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

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© 2019 International Association for the Study of Pain
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