title: Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Osaka University, Graduated school of Medicine, Suita, Osaka, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Koichi
authors.initials: K
authors.lastname: Hosomi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ali
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Maruo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirata
authors.forename: Tetsu
authors.initials: T
authors.lastname: Goto
authors.forename: Takufumi
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sumitani
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Osaki
authors.forename: Jun
authors.initials: J
authors.lastname: Hatazawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: 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
chemical_list: D010104:Oxygen Radioisotopes