Insula-specific responses induced by dental pain. A proton magnetic resonance spectroscopy study.
OBJECTIVE
To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate.


METHODS
Ten male volunteers were included in the pain group and compared with a control group of 10 other healthy volunteers. The pain group received a total of 87-92 electrically induced pain stimuli over 15 min to the right maxillary canine tooth. Contemporaneously, they evaluated the subjective pain intensity of every stimulus using an analogue scale. Neurotransmitter changes within the left insular cortex were evaluated by MR spectroscopy.


RESULTS
Significant metabolic changes in glutamine (+55.1%), glutamine/glutamate (+16.4%) and myo-inositol (-9.7%) were documented during pain stimulation. Furthermore, there was a significant negative correlation between the subjective pain intensity perception and the metabolic levels of Glx, Gln, glutamate and N-acetyl aspartate.


CONCLUSIONS
The insular cortex is a metabolically active region in the processing of acute dental pain. Induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex resulting in significant alterations in metabolites. Negative correlation between subjective pain intensity rating and specific metabolites could be observed.
Gutzeit
A
A
Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland. Andreas.Gutzeit@ksw.ch
Meier
D
D
Meier
M L
ML
von Weymarn
C
C
Ettlin
D A
DA
Graf
N
N
Froehlich
J M
JM
Binkert
C A
CA
Brügger
M
M
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D002540:Cerebral Cortex / Q000473:pathology; D004566:Electrodes; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006801:Humans; D007294:Inositol / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D018377:Neurotransmitter Agents / Q000378:metabolism; D010146:Pain / Q000473:pathology*; D011446:Prospective Studies; D011522:Protons; D014076:Tooth Diseases / Q000473:pathology; D014276:Trigeminal Nerve / Q000473:pathology*
D018377:Neurotransmitter Agents; D011522:Protons; D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; D007294:Inositol; C000179:N-acetylaspartate