Vitaly Napadow

Vitaly Napadow
Spaulding Rehabilitation Hospital · Department of Physical Medicine and Rehabilitation

PhD

About

331
Publications
62,752
Reads
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Citations
Introduction
Aversive symptomatology, such as pain and nausea, leads to significant morbidity and the brain circuitry supporting such perceptions is unknown. Understanding this circuitry will aid greatly in developing novel therapeutic interventions. The Napadow lab has pioneered neuroimaging techniques to better understand the brain circuitry underlying aversive perceptual states, and existing conventional and non-conventional therapies, such as acupuncture. http://scholar.harvard.edu/napadow/home
Additional affiliations
August 2021 - present
Spaulding Rehabilitation Hospital
Position
  • Professor
Description
  • Director, Scott Schoen and Nancy Adams Discovery Center for Recovery from Chronic Pain, Spaulding Rehabilitation Hospital
January 2021 - present
Massachusetts General Hospital
Position
  • Professor
Description
  • Director, Center for Integrative Pain NeuroImaging (CiPNI), Martinos Center for Biomedical Imaging, Mass General Hospital

Publications

Publications (331)
Article
While patients suffering from fibromyalgia (FM) are known to exhibit hyperalgesia, the central mechanisms contributing to this altered pain processing are not fully understood. In this study we investigate potential dysregulation of the neural circuitry underlying cognitive and hedonic aspects of the subjective experience of pain such as anticipati...
Article
Full-text available
The autonomic nervous system (ANS) is of paramount importance for daily life. Its regulatory action on respiratory, cardiovascular, digestive, endocrine, and many other systems is controlled by a number of structures in the CNS. While the majority of these nuclei and cortices have been identified in animal models, neuroimaging studies have recently...
Article
Recent functional brain connectivity studies have contributed to our understanding of the neurocircuitry supporting pain perception. However, evoked-pain connectivity studies have employed cutaneous and/or brief stimuli, which induce sensations that differ appreciably from the clinical pain experience. Sustained myofascial pain evoked by pressure c...
Article
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Introduction: Chronic pain is a debilitating medical problem that is difficult to treat. Neuroinflammatory pathways have emerged as a potential therapeutic target, as preclinical studies have demonstrated that glial cells and neuroglial interactions play a role in the establishment and maintenance of pain. Recently, we used positron emission tomog...
Article
Full-text available
Objective The COVID-19 pandemic has strongly influenced psychological and physical health worldwide. The aim of this study was to examine the impact of the pandemic on women with fibromyalgia. Methods This mixed methods pilot study explored measures of pain severity and interference, as well as pain catastrophizing and level of fibromyalgia impact...
Preprint
Introduction Chronic pain is an extremely prevalent public health issue. However, the underlying mechanisms are poorly understood, thus limiting effective treatment options. Both preclinical studies, and more recent clinical imaging studies, suggest that glia-mediated neuroinflammation may be implicated in chronic pain, and therefore might be a pot...
Article
Full-text available
Objectives Various active control interventions for Mindfulness-Based Stress Reduction (MBSR) have been developed, though many can fall short in controlling for non-specific or placebo effects. We developed a Nature-Based Stress Reduction (NBSR) program based on previously reported positive results from virtual natural environment exposure on menta...
Article
A previous study by our group showed that knee osteoarthritis (KOA) patients demonstrate alterations in the thalamic levels of several metabolites, as measured by 1H-magnetic resonance spectroscopy: i.e., higher myo-inositol (mIns), lower N-acetylaspartate (NAA) and lower Choline (Cho), when compared to healthy controls. We sought to replicate thes...
Article
The patient/clinician relationship is central in clinical therapies for chronic pain and has been linked with treatment efficacy. To assess the brain mechanisms underlying these psychosocial interactions, neurophysiological objective measures are still needed. A recent publication from our team applied functional MRI hyperscanning (synchronized neu...
Article
While the neural correlates of migraine have been widely studied, it remains unclear whether glial cells contribute to neuroinflammation in migraine. One marker of glial activation is the presence of elevated levels of 18 kDa translocator protein (TSPO), and earlier studies have shown that individuals suffering from migraine with aura (MWA) exhibit...
Article
The patient-clinician therapeutic alliance is a powerful modulator shaping patients’ treatment experience and clinical outcomes. Before and after a 3-week electro-acupuncture intervention (6 sessions), fMRI hyper-scanning was applied to investigate the influence of either an Augmented (warm/attentive) or a Limited (neutral/business-like) clinician...
Article
Migraine is a highly prevalent chronic pain disorder that is characterized by sensitization and dysregulation of the central autonomic nervous system. Interoception is the sensing of signals originating from within the body, and is altered in chronic pain conditions including episodic migraine. The relationship between brain mechanisms of interocep...
Article
Background: Functional dyspepsia (FD) is a disorder of gut-brain interaction, and its putative pathophysiology involves dysregulation of gastric motility and central processing of gastric afference. The vagus nerve modulates gastric peristalsis and carries afferent sensory information to brainstem nuclei, specifically the nucleus tractus solitarii...
Article
Full-text available
Objective To evaluate changes in cortical thickness and right posterior insula (r-pIns) gamma-aminobutyric acid (GABA) concentrations in veterans with fibromyalgia treated with auricular percutaneous electric nerve field stimulation (PENFS). Materials & Methods This was a randomized, controlled, open label investigation conducted in a government h...
Article
Introduction: Despite substantial progress made in the field of acupuncture research, the existence and specificity of acupoints remain controversial. In recent years, the concept of acupoint sensitization has emerged as a theoretical framework for understanding acupoints as dynamic functional entities that are sensitized in pathological conditions...
Article
Full-text available
Background The establishment of test–retest reliability and reproducibility (TRR) is an important part of validating any research tool, including functional magnetic resonance imaging (fMRI). The primary objective of this study is to investigate the reliability of pseudo-Continuous Arterial Spin Labeling (pCASL) and Blood Oxygen Level Dependent (BO...
Article
Objective Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVAN...
Article
Full-text available
Patient–clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient–clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how...
Chapter
This chapter introduces the neurocircuitry that mediates nausea and vomiting. It starts by explaining the concept of the dynamic threshold in triggering nausea. Subsequently, the anatomical pathways and interplay of central and peripheral autonomic pathways involved in the development of nausea and vomiting are delineated. Lastly, the proposed mech...
Article
Full-text available
This column continues the JACM commentary series from the Society for Acupuncture Research (SAR). This is a first in the 5 years of this column partnership, a review of top developments in acupuncture research, with an eye to the way cultural contexts are compelling heightened or new foci for the field. The present commentary began with a survey pr...
Preprint
Resting-state functional MRI (rs-fMRI) is being used to develop diagnostic, prognostic, and therapeutic biomarkers for critically ill patients with severe brain injuries. In studies of healthy volunteers and non-critically ill patients, prospective cardiorespiratory data are routinely collected to remove non-neuronal fluctuations in the rs-fMRI sig...
Article
Objective Abnormal central pain processing is a leading etiology underlying fibromyalgia (FM) pain and is perceptually characterized with the psychophysical measure of temporal summation of pain (TSP). TSP is the perception of increasingly greater pain to repetitive or tonic noxious stimuli. Previous neuroimaging studies have used static (i.e. summ...
Article
Full-text available
Carpal Tunnel Syndrome (CTS) is a median nerve entrapment neuropathy that alters primary somatosensory cortex (S1) organization. While electro-acupuncture (EA), a form of peripheral neuromodulation, has been shown to improve clinical and neurophysiological CTS outcomes, the role of EA-evoked brain response during therapy (within and beyond S1) for...
Article
Full-text available
Objective Chronic pain can have detrimental effects on quality of life and a profound impact on one’s identity. The Pictorial Representation of Illness- and Self-Measure (PRISM), is a visual tool designed to measure the self-illness separation (SIS) that represents the degree of schema-enmeshment (i.e., the degree to which the self-schema and the i...
Preprint
Full-text available
Background: The establishment of test-retest reliability and reproducibility (TRR) is an important part of validating any research tool, including functional magnetic resonance imaging (fMRI). The primary objective of this study is to investigate the reliability of pseudo-Continuous Arterial Spin Labeling (pCASL) and Blood Oxygen Level Dependent (B...
Article
We recently showed that patients with different chronic pain conditions (such as chronic low back pain, fibromyalgia, migraine, and Gulf War Illness) demonstrated elevated brain and/or spinal cord levels of the glial marker 18 kDa translocator protein, which suggests that neuroinflammation might be a pervasive phenomenon observable across multiple...
Article
Background Negative stress significantly impacts major depressive disorder (MDD), given the shared brain circuitry between the stress response and mood. Thus, interventions that target this circuitry will have an important impact on MDD. The aim of this study was to evaluate the acute effects of a novel respiratory-gated auricular vagal afferent ne...
Article
The cover image is based on the Original Article Non‐uniform gastric wall kinematics revealed by 4D Cine magnetic resonance imaging in humans by Roberta Sclocco et al., https://doi.org/10.1111/nmo.14146.
Article
The positron emission tomography (PET) radiotracer [ ¹¹ C]PBR28 has been increasingly used to image the translocator protein (TSPO) as a marker of neuroinflammation in a variety of brain disorders. Interrelatedly, similar clinical populations can also exhibit altered brain perfusion, as has been shown using arterial spin labelling in magnetic reson...
Article
Background Fibromyalgia is a centralized multidimensional chronic pain syndrome, but its pathophysiology is not fully understood. Methods We applied 3D magnetic resonance spectroscopic imaging (MRSI), covering multiple cortical and subcortical brain regions, to investigate the association between neuro-metabolite (e.g., combined glutamate and glut...
Article
In chronic pain management and treatment, a positive patient-clinician relationship is associated with higher patient satisfaction and treatment efficacy. In this study, we investigated synchronization of brain activity between patients and clinicians during an experimentally controlled augmented (empathetic) compared to limited (business-like) cli...
Article
The weak association between disability levels and “peripheral” (i.e., knee) findings suggests that central nervous system alterations may contribute to the pathophysiology of knee osteoarthritis (KOA). Here, we evaluated brain metabolite alterations in KOA patients, before and after total knee arthroplasty (TKA), using 1H-magnetic resonance spectr...
Article
Carpal Tunnel Syndrome (CTS) is an entrapment neuropathy of the median nerve that alters the organization of the brain's primary somatosensory cortex (S1), both structurally and functionally. Our prior research also demonstrated that electro-acupuncture (EA), both local and remote/distal to the wrist, but not sham acupuncture, improved S1 somatotop...
Article
We recently showed elevated levels of the 18kDa translocator protein (TSPO), a marker of neuroinflammation, in chronic low back pain patients (cLBP) compared to healthy controls(Loggia et al., 2015). Here, we test whether TSPO signal 1) can further subtype cLBP patients based on their clinical presentation, and 2) is associated with functional conn...
Article
Compared to healthy controls (HC), fibromyalgia (FM) patients exhibit enhanced temporal summation of pain (TSP) – i.e. perception of increasingly greater pain in response to repetitive or sustained noxious stimuli. Previous neuroimaging studies have linked static functional connectivity (sFC) and stimulus-evoked brain fMRI response to enhanced TSP...
Article
Functional dyspepsia (FD) is a common gastrointestinal (GI) disorder of the upper GI tract associated with a variety of symptoms, such as abdominal pain and bloating, but lacking identifiable organic abnormalities. Altered motility patterns in FD occur in the stomach, pylorus and small intestine during digestive or interdigestive periods, and up to...
Article
While patient/clinician relationships significantly impact pain outcomes, the behavioral and neural mechanisms supporting this phenomenon are unknown. Specifically, the precise role of facial expressions in contributing to analgesia and brain-to-brain communication has not been investigated. In this Hyperscan fMRI study, we explored how pain-relate...
Article
Research suggests that a good patient-clinician therapeutic alliance can improve clinical outcomes. In this ongoing, longitudinal study, we applied fMRI hyper-scanning to determine whether behavioral, neural, and clinical variables associated with the therapeutic relationship between chronic pain patients and their clinicians influences clinical ou...
Article
Chronic pain is characterized by hyperalgesia and heightened temporal summation of pain, however, the brain mechanisms underlying these phenomena remain understudied. We sought to understand the relationship of hyperalgesia and temporal summation with the balance between basal excitatory and inhibitory neurotransmission (E-I balance) and brain func...
Article
Chronic low back pain (CLBP) is the leading cause of disability in the United States. There is considerable interest in the development of safe, effective, nonpharmacological approaches to managing CLBP. Respiratory-gated electrical stimulation of the somatosensory vagal afferent receptors in the ear (RAVANS), has been shown to reduce chronic pelvi...
Article
Fibromyalgia is a multidimensional chronic pain syndrome. It is thought to result mainly from central nervous system dysfunction, but its working mechanism is not fully understood. In this study, we applied multi-slice magnetic resonance spectroscopy imaging (MRSI) to investigate the relationship between brain metabolite (e.g., combined glutamate a...
Article
Previous studies have demonstrated that fibromyalgia results in gray matter alterations as well as changes in GABA concentrations in various cortical regions when compared to healthy controls [1,2,3]. In veterans with fibromyalgia, we investigate the effect of PENFS on gray matter alterations and GABA concentrations and correlate them with clinical...
Article
Background Assessment of gastric function in humans has relied on modalities with varying degrees of invasiveness, which are usually limited to the evaluation of single aspects of gastric function, thus requiring patients to undergo a number of often invasive tests for a full clinical understanding. Therefore, the development of a non‐invasive tool...
Article
Full-text available
Negative affect (NA) is a significant cause of disability for chronic pain patients. While little is known about the mechanism underlying pain-comorbid NA, previous studies have implicated neuroinflammation in the pathophysiology of both depression and chronic pain. Here, we tested the hypothesis that NA in pain patients is linked to elevations in...
Article
'Blinding' involves concealing knowledge of which trial participants received the interventions from participants themselves and other trial personnel throughout the trial. Blinding reduces bias arising from the beliefs and expectations of these groups. It is agreed that where possible, blinding should be attempted, for example by ensuring that exp...
Article
Full-text available
Objective: To examine the role of several interrelated, potentially modifiable psychological factors (i.e., mindfulness and catastrophizing) in influencing patient-reported functioning. Methods: In this cross-sectional study, 107 patients with fibromyalgia completed self-report assessments of pain severity, functioning and impact of symptoms, mi...
Article
The weak association between disability levels and "peripheral" (i.e., knee) findings suggests that central nervous system alterations may contribute to the pathophysiology of knee osteoarthritis (KOA). Here, we evaluated brain metabolite alterations in KOA patients, before and after total knee arthroplasty (TKA), using 1H-magnetic resonance spectr...
Article
Full-text available
Interoceptive pathways may be manipulated at various levels to develop interventions to improve symptoms in a range of disorders. Primarily through the lens of the respiratory system, we outline various pathways that can be manipulated at neural, behavioral, and psychological levels to change the representation of and attention to interoceptive sig...
Article
Objective Acupuncture is a complex multi‐component treatment that has shown promise for the treatment of Fibromyalgia (FM), however, clinical trials have shown mixed results, possibly due to heterogeneous methodology and lack of understanding of the underlying mechanism of action. We sought to understand the specific contribution of somatosensory a...
Article
Animal studies reported that vagus nerve stimulation increases noradrenalin release in target areas of the locus coeruleus (LC). Furthermore, after stimulation, animals exhibited improved retention performance. Evidence for memory improvement using transcutaneous vagus nerve stimulation (tVNS), a non‐invasive alternative, is scarce. Given that the...
Article
Acupuncture consists of multiple components, and neuroimaging studies are beginning to tease apart potential brain-based mechanisms supporting this nonpharmacologic intervention. Brain imaging in patient populations is important for the acupuncture neuroimaging field, and recent studies have incorporated neuroimaging into a clinical trial framework...
Article
Chronic low back pain (cLBP) has been associated with changes in brain plasticity. Non-pharmacological therapies such as Manual Therapy (MT) have shown promise for relieving cLBP. However, translational neuroimaging research is needed to understand potential central mechanisms supporting MT. We investigated the effect of MT on resting-state salienc...
Article
Pain catastrophizing is prominent in chronic pain conditions such as fibromyalgia and has been proposed to contribute to the development of pain widespreadness. However, the brain mechanisms responsible for this association are unknown. We hypothesized that increased resting salience network (SLN) connectivity to nodes of the default mode network (...
Article
Full-text available
Objective To evaluate the feasibility of recruitment, preliminary efficacy, and acceptability of auricular percutaneous electrical nerve field stimulation (PENFS) for the treatment of fibromyalgia in veterans, using neuroimaging as an outcome measure and a biomarker of treatment response. Design Randomized, controlled, single-blind. Setting Gover...
Article
Using positron emission tomography, we recently demonstrated elevated brain levels of the 18kDa translocator protein (TSPO), a glial activation marker, in chronic low back pain (cLBP) patients, compared to healthy controls (HC). Here, we first sought to replicate the original findings in an independent cohort (15 cLBP, 37.8±12.5 y/o; 18 HC, 48.2±12...
Article
Full-text available
Introduction: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. Objective: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and...
Article
Full-text available
The patient-clinician interaction can powerfully shape treatment outcomes such as pain but is often considered an intangible “art of medicine” and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory of mind have been studied using single-subject designs, specific behavioral and neural mech...
Article
Full-text available
Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve s...
Article
Full-text available
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Article
Objective: Self-compassion meditation, which involves compassion toward the self in moments of suffering, shows promise for improving pain-related functioning, but its underlying mechanisms are unknown. This longitudinal, exploratory pilot study investigated the effects of a brief (eight contact hours, two weeks of home practice) self-compassion t...
Article
Full-text available
Thalamocortical dysrhythmia is a key pathology of chronic neuropathic pain, but few studies have investigated thalamocortical networks in chronic low back pain (cLBP) given its non-specific etiology and complexity. Using fMRI, we propose an analytical pipeline to identify abnormal thalamocortical network dynamics in cLBP patients and validate the f...
Preprint
Full-text available
The patient-clinician interaction can powerfully shape treatment out-comes such as pain, but is often considered an intangible 'art-of-medicine', and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory-of-mind have been studied using single-subject designs, the specific behavioral and neur...