A case of spinal cord injury-related pain with baseline rCBF brain SPECT imaging and beneficial response to gabapentin.
Central pain following spinal cord injury is poorly understood, and is often resistant to conventional pain therapy regimens. We describe an individual with paraplegia who for many years experienced rapidly fluctuating, severe, unilateral pain below the level of his lesion. Prior to the initiation of pharmacological treatment, regional cerebral blood flow (rCBF) was measured during PAIN and NON-PAIN states using single photon emission computed tomography (SPECT). When experiencing pain, the subject had increased anterior cingulate gyrus blood flow, increased thalamic blood flow bilaterally and increased somatosensory cortex blood flow contralaterally but decreased caudate blood flow bilaterally. The subject's subsequent clinical course included a trial of gabapentin which produced a substantial reduction in frequency and average intensity of his episodic pain and which has been maintained for almost 2 years. This case demonstrates the correspondence between rCBF and pain associated with spinal cord injury and also suggests the potential utility of gabapentin for treatment of this central pain state.
Ness
Timothy J
TJ
Department of Anesthesiology, Pain Treatment Center, University of Alabama at Birmingham, Birmingham, AL, USA Division of Nuclear Medicine, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA Department of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL, USA.
San Pedro
Elmer C
EC
Richards
Scott J
SJ
Kezar
Laura
L
Liu
Hong-Gang
HG
Mountz
James M
JM
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D000588:Amines; D000700:Analgesics / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003509:Cyclohexanecarboxylic Acids; D000077206:Gabapentin; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin