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Pain Med. 2017 Mar 1;18(3):428-440. doi: 10.1093/pm/pnw180.

HIV Distal Neuropathic Pain Is Associated with Smaller Ventral Posterior Cingulate Cortex.

Author information

1
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
2
VA San Diego Healthcare System, San Diego, California, USA.
3
Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
4
Department of Family and Preventative Medicine, University of California San Diego Medical Center, San Diego, California, USA.
5
Department of Clinical Neurosciences, University of Oxford, Oxford, England.
6
Psychiatry, University of California San Diego, California, USA.
7
Department of Electrical Engineering, Pennsylvania State University, State College, Pennsylvania, USA.
8
Neurosciences, University of California San Diego, San Diego, California, USA.

Abstract

Objective:

. Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller.

Methods:

. HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N = 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images.

Results:

. Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P  = 0.017; peak t = 5.15; MNI coordinates x = -6, y = -54, z = 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain.

Conclusions:

. The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain.

KEYWORDS:

HIV Distal Neuropathic Pain; Posterior Cingulate Cortex; Structural Magnetic Resonance Imaging; Voxel-Based Morphometry

PMID:
27497320
PMCID:
PMC6074843
DOI:
10.1093/pm/pnw180
[Indexed for MEDLINE]
Free PMC Article

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