title: Brain opioid receptor density predicts motor cortex stimulation efficacy for chronic pain.
abstract: The clinical effects of motor cortex stimulation (MCS) for neuropathic pain (NP) is thought to be mediated primarily by the secretion of endogenous opioids in humans and in animal models. Because opioid receptor density is itself decreased in patients with NP, we investigated whether the magnitude and distribution of the remaining opioid receptors in patients with NP could be biological predictors of the pain-relieving effects of MCS. Using (11)C-diprenorphine positron emission tomography scans, opioid receptor availability was assessed in 15 patients suffering refractory NP, who subsequently received chronically implanted MCS. All patients underwent 2 preoperative baseline scans at 2-wk intervals and were clinically assessed after 7mo of chronic MCS. The levels of preoperative opioid-binding in the insula, thalamus, periaqueductal gray, anterior cingulate, and orbitofrontal cortex were significantly and positively correlated with postoperative pain relief at 7mo. Patients with receptor density values below the lower limits in age-matched controls in the thalamus, periaqueductal gray and contralateral insula were the least likely to benefit from MCS. Opioid-receptor availability as shown in preoperative positron emission tomography scans appears to be related to the efficacy of MCS in NP and may help clinicians to select the candidates most likely to benefit from this procedure.
authors.affiliation: Central Integration of Pain, Lyon Neuroscience Research Center, Lyon, France Laboratory of Neurosciences, St. Joseph University, Beirut, Lebanon Department of Functional Neurosurgery, Hôpital Neurologique, Lyon, France Department of Neurology and Pain center, Hôpital Nord, St-Etienne, France CERMEP Imagerie du vivant, Lyon, France Department of Anatomy, Claude Bernard University, Lyon, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Maarrawi
authors.forename: Roland
authors.initials: R
authors.lastname: Peyron
authors.forename: Patrick
authors.initials: P
authors.lastname: Mertens
authors.forename: Nicolas
authors.initials: N
authors.lastname: Costes
authors.forename: Michel
authors.initials: M
authors.lastname: Magnin
authors.forename: Marc
authors.initials: M
authors.lastname: Sindou
authors.forename: Bernard
authors.initials: B
authors.lastname: Laurent
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Larrea
mesh_terms: D000328:Adult; D000368:Aged; D001923:Brain Chemistry / Q000502:physiology; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology; D038361:Neuronavigation; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications; D049268:Positron-Emission Tomography; D011957:Receptors, Opioid / Q000502:physiology*; D015203:Reproducibility of Results; D020521:Stroke / Q000150:complications
chemical_list: D011957:Receptors, Opioid
keywords: Brain opioid receptors; Diprenorphine; Motor cortex stimulation; Neuropathic pain; PET scan
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