Trends in Cognitive Sciences
OpinionFrontostriatal Gating of Tinnitus and Chronic Pain
Section snippets
Brain Structure and Function in Tinnitus and Chronic Pain
Neuroimaging and neurophysiological studies have revealed extensive changes of brain structure and function in tinnitus and chronic pain, as shown by altered measures of grey and white matter as well as local and network activity. Figure 1 illustrates how remarkably-similar structures are involved in both disorders.
Mechanisms of Frontostriatal Gating
Converging lines of evidence, as outlined above, indicate that tinnitus and chronic pain are associated with structural and functional brain changes that overlap remarkably between the two conditions (Figure 1). The changes predominantly affect frontostriatal circuits including vmPFC and NAc, with possible additional roles for the thalamus and for medial temporal lobe structures, such as amygdala and hippocampus. Frontostriatal circuits with their closed-loop structure are anatomically
Neurotransmitter Systems Involved in Frontostriatal Gating
Figure 3 demonstrates that the frontostriatal gating and valuation process is under the control of two major transmitter systems: dopamine and serotonin.
Decreasing dopamine activity seems to reduce tinnitus perception [111]. Furthermore, serotonin has long been hypothesized to play a role in tinnitus and in its comorbidity with depression and insomnia 112, 113. In addition, the proposed loss of inhibition in tinnitus has been suggested to be due to lowered γ-amino butyric acid (GABA) levels
Concluding Remarks and Clinical Implications
As discussed in this review, a central and causal role of frontostriatal circuits for the development and maintenance of tinnitus and chronic pain is emerging. We specifically propose that the ventromedial prefrontal cortex and the nucleus accumbens are part of a central ‘gatekeeping’ system, which evaluates the relevance and affective value of sensory stimuli and controls information flow via descending pathways.
Having identified the frontostriatal gating system as crucial for the development
Acknowledgments
Tinnitus research in the laboratory of J.P.R. has been supported by the National Institutes of Health (RC1-DC010720), the American Tinnitus Association, the Skirball Foundation, the Tinnitus Research Initiative, and the Tinnitus Research Consortium. A.M. is funded by the Belgian American Educational Foundation (BAEF). The work of E.S.M. and M.P. is funded by the Deutsche Forschungsgemeinschaft (PL 321/10-1, PL 321/11-1).
Glossary
- Allodynia
- pain due to a stimulus that does not normally provoke pain.
- Chronic pain
- pain that persists past healing time, lasts or recurs for more than 3–6 months, and lacks the warning function of acute pain.
- Hyperacusis
- decreased tolerance or heightened sensitivity to specific sound frequencies beyond a particular volume. Can lead to a painful or troublesome sensation with sounds that would not trouble a normal individual.
- Hyperalgesia
- increased pain from a stimulus that normally provokes pain.
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These authors contributed equally to this work.