Page 90 - BH-2-1

Brain & Heart QTc interval in BMS

considered to have an activated salience network and an In conclusion, our study showed that drug-naïve BMS
activated anterior cingulate gyrus, which is one of the patients have increased sympathetic tone. The intraoral
important hubs of the salience network and the center of environment of BMS patients was worse than that of
the sympathetic nervous system. On the other hand, the general dental patients. Thus, it is necessary to examine
12
VAS did not correlate with QTc interval, suggesting that whether there is a relationship between the oral condition
pain itself does not tone the sympathetic nervous system. of BMS patients and the sympathetic tone. Ultimately,
Energy-intensive organs such as the brain attempt to treatments need to be designed, taking into account the
conserve energy in every way possible. Sympathetic tone neural networks of individual BMS patients and target
with acute pain increases daily energy expenditure by 60%, key hub functions such as the basal ganglia and anterior
while chronic pain increases energy expenditure by only cingulate gyrus. Further studies on brain networks and
15%. Chronic pain normally strengthens the functional neurocardiac axis in these patients are needed.
7
connectivity between the somatosensory cortex and the
default mode network, increasing the parasympathetic Acknowledgments
tone and decreasing energy expenditure. Patients with I would like to thank everyone at the Department of
8
high VAS but no shortening of QTc may have reduced Psychosomatic Dentistry, Tokyo Medical and Dental
energy consumption by decoupling pain from the University (Prof. Toyofuku A.), for their generous cooperation
sympathetic nervous system and connecting it to the in conducting this research.
parasympathetic nervous system. Although it is necessary
to use the hub of the default mode network to link pain Funding
to the parasympathetic nervous system, the default mode None.
network is also a network of self-recognition, which may
also mean internalizing pain as one’s own. Conflict of interest
The VAS and PCS correlate only to some extent The authors declare that they have no competing interests.
because the brain network may also be different for each
individual BMS patient. The balance between the salience Author contributions
network and the default mode network is important for
the autonomic nervous system to be stable. The salience Conceptualization: Takahiko Nagamine
network is controlled primarily by dopaminergic neurons, Investigation: Takeshi Watanabe
and the default mode network is regulated mainly by Methodology: Takahiko Nagamine
Writing – original draft: Takahiko Nagamine
serotonergic neurons. Thus, pharmacotherapy such as Writing – review & editing: All authors
aripiprazole (a dopamine D2 receptor partial agonist) and
amitriptyline (a tricyclic antidepressant) may be effective Ethics approval and consent to participate
for some BMS patients by modulating dopamine and
serotonin. However, a dose-response relationship is not All patients provided written informed consent to
9
seen with pharmacotherapy, and the therapeutic effect is participate in this study. The study protocol was approved
only pronounced when high doses of pharmacotherapy, by the Ethics Committee of the School of Dentistry, Tokyo
which are sufficient to induce antidepressant effect, Medical and Dental University. The personally identifiable
are applied. This indicates that drug therapies that information was not disclosed throughout the study.
10
target monoamines to alter neurotransmission may not Consent for publication
necessarily improve the balance of the neural network
because they are not site-selective and altering hub Not applicable.
functions. As Yu et al. have shown, new treatments
need to be considered for hub protection and network Availability of data
stability. Network science provides theoretical and Data are available from corresponding author on
2
computational tools that can be used to understand reasonable request.
simple concepts of human brain function; for instance,
neuroimaging data analysis of functional networks of References
neurons emerges as a useful approach to enhancing our 1. Petersen SE, Sporns O. Brain networks and cognitive
11
understanding of brain function. New, network science- architectures. Neuron. 2015;88(1):207-219.
based psychopharmacological treatments that target key
hub functions of pain circuits are warranted to alleviate doi: 10.1016/j.neuron.2015.09.027
the sufferings of BMS patients. 2. Yu Q, Jiao Y, Huo R, et al. Application of the concept

Volume 2 Issue 1 (2024) 3 https://doi.org/10.36922/bh.2016