Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study.
Spinal cord stimulation (SCS) is an effective therapy for chronic neuropathic pain. However, the detailed mechanisms underlying its effects are not well understood. Positron emission tomography (PET) with H(2)(15)O was applied to clarify these mechanisms. Nine patients with intractable neuropathic pain in the lower limbs were included in the study. All patients underwent SCS therapy for intractable pain, which was due to failed back surgery syndrome in three patients, complex regional pain syndrome in two, cerebral hemorrhage in two, spinal infarction in one, and spinal cord injury in one. Regional cerebral blood flow (rCBF) was measured by H(2)(15)O PET before and after SCS. The images were analyzed with statistical parametric mapping software (SPM2). SCS reduced pain; visual analog scale values for pain decreased from 76.1+/-25.2 before SCS to 40.6+/-4.5 after SCS (mean+/-SE). Significant rCBF increases were identified after SCS in the thalamus contralateral to the painful limb and in the bilateral parietal association area. The anterior cingulate cortex (ACC) and prefrontal areas were also activated after SCS. These results suggest that SCS modulates supraspinal neuronal activities. The contralateral thalamus and parietal association area would regulate the pain threshold. The ACC and prefrontal areas would control the emotional aspects of intractable pain, resulting in the reduction of neuropathic pain after SCS.
Kishima
Haruhiko
H
Department of Neurosurgery, Osaka University, Graduated school of Medicine, Suita, Osaka, Japan.
Saitoh
Youichi
Y
Oshino
Satoru
S
Hosomi
Koichi
K
Ali
Mohamed
M
Maruo
Tomoyuki
T
Hirata
Masayuki
M
Goto
Tetsu
T
Yanagisawa
Takufumi
T
Sumitani
Masahiko
M
Osaki
Yasuhiro
Y
Hatazawa
Jun
J
Yoshimine
Toshiki
T
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D001931:Brain Mapping; D002560:Cerebrovascular Circulation / Q000502:physiology; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging*; D009474:Neurons / Q000000981:diagnostic imaging*; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography; D013116:Spinal Cord / Q000502:physiology
D010104:Oxygen Radioisotopes