Abstract
Contralateral thalamus, the place of termination of spinothalamic tract, is affected in patients with pain. We employed single photon emission computed tomography (SPECT) to evaluate the thalamic perfusion in patients with spontaneous neuropathic pain. Ten patients with complex regional pain syndrome (CRPS) and eleven radiculopathiy patients were enrolled in this study. Regional cerebral blood flow of thalamus was assessed bilaterally by iodine-123-labelled iodoamphetamine SPECT. To standardize the inter-patient data, we set a contralateral thalamic uptake index (CTUI) for assessing thalamic asymmetry. In one study, we found elevation of CTUI in patients with symptoms of neuropathic pain for less than 12 month, whereas no change was observed in the case of a longer lasting disease. An another study demonstrated decrease of CTUI after pain treatment, even though it was unrelated to the pain intensity prior to treatment. Our SPECT study revealed that neuropathic pain altered thalamic neuronal activity. CTUIs were increased in early stage of the disease but decreased as the disease progressed to the chronic stage. These results suggest that CTUI can be used to improve management of neuropathic pain for proper evaluation of spontaneous pain.
Highlights
Neuromuscular disorders are manifested by a variety of clinical symptoms, pain is among those that are hard to endure
Several brain imaging techniques, namely single photon emission computed tomography (SPECT), positron emission tomography (PET) and functional MRI, emerged as powerful tools used to explore the biology of brain and to diagnose its pathological conditions [6,7,8]
The Open Neuroimaging Journal, 2010, Volume 4 183 setting the identical region of interest (ROI) over the both thalami, regional cerebral blood flow (rCBF) corresponding to it was measured bilaterally; b) thalamic perfusion was standardized by subtracting rCBF of the whole brain to rCBF in ipsilateral and contralateral thalami, respectively; c) contralateral thalamic uptake index (CTUI) was calculated as the ratio of contralateral to ipsilateral thalamic uptake (Fig. 1A)
Summary
Neuromuscular disorders are manifested by a variety of clinical symptoms, pain is among those that are hard to endure. A number of animal models of spinerelated diseases, such as radiculopathy, spinal stenosis, etc., was introduced to explore the pathways of pain and to examine other related changes [3,4,5]. These studies were primarily focused on spinal cord due to its accessibility. Several brain imaging techniques, namely single photon emission computed tomography (SPECT), positron emission tomography (PET) and functional MRI (fMRI), emerged as powerful tools used to explore the biology of brain and to diagnose its pathological conditions [6,7,8]. Temporal resolution of SPECT and PET are lower than fMRI technology and beneficial usage of these technologies are rather static brain
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