H-MR Spectroscopy of the Anterior Cingulated Cortex: Usefulness in the Prediction of Patients That Will Benefit from a Cognitive Behavioural Therapy in the Treatment of Chronic Pain

Sei Fuku,Nishiyama Junji,Katsunori Miyata,Masahiro Yoshimura

doi:10.4236/ojmi.2013.31003

Sei Fuku, Nishiyama Junji + Show 2 more

Open Access

https://doi.org/10.4236/ojmi.2013.31003

Copy DOI

Abstract

Anterior cingulated cortex (ACC) is involved in “the state in which patients do not care much about pain despite its presence” which is a goal of psychosomatic treatment. To investigate the absolute concentration of N-acetylaspartate (NAA) in the anterior cingulated cortex (ACC) as predictors of patients that may benefit from cognitive behavioural therapy in the treatment of chronic pain. Proton magnetic resonance spectroscopy (1H-MRS) was performed with a 1.5 T MR system on a voxel in the bilateral ACC in 85 chronic pain patients and 20 age-matched normal control subjects. Eighteen out of 24 (75.0%) patients whose NAA concentration decreased significantly in the ACC, respectively, compared to the mean NAA concentration of the normal control subjects, needed cognitive behavioural therapy. Our results suggest that decreased NAA concentration in the ACC is associated with the necessity of cognitive behavioural therapy. 1H-MRS may serve as a useful non-invasive tool for evaluating chronic pain patients.

Highlights

In recent years, studies using brain function imaging have gradually clarified the brain regions associated with pain leading to a more objective evaluation of pain [1]
Our results suggest that decreased NAA concentration in the anterior cingulated cortex (ACC) is associated with the necessity of cognitive behavioural therapy. 1H-MRS may serve as a useful non-invasive tool for evaluating chronic pain patients
To investigate whether the absolute concentration of NAA in the ACC can be a valuable evaluation tool of chronic pain that may benefit from a cognitive behavioural therapy (CBT), we investigated the absolute concentration of NAA in the ACC bilaterally, of chronic pain patients and healthy comparison subjects by 1H-MRS

Summary

Introduction

Studies using brain function imaging have gradually clarified the brain regions associated with pain leading to a more objective evaluation of pain [1]. Studies using voxel-based morphometry (VBM) or fMRI in patients with chronic pain have shown atrophy of the ACC [3], and activation of ACC have been produced by virtual pain stimulation using a video [4]. A recent study using Proton magnetic resonance spectroscopy (1H-MRS) showed suffering in neuropathic pain patients after spinal cord injury are associated with the level of N-acetylaspartate (NAA) in the ACC [10]. These findings suggest that ACC is involved in “the state in which patients do not care much about pain despite its presence” which is a goal of psychosomatic treatment

Methods

Results

Conclusion