Abstract
Diffusion tensor tractography (DTT) is derived from diffusion tensor imaging. It has allowed visualization and estimation of neural tract injury, which may be associated with the pathogenesis of neuropathic pain (NP). The aim of the present study was to review DTT studies that demonstrated the relationship between neural injuries and NP and to describe the potential use of DTT in the evaluation of neural injuries that are involved in the pathophysiological process of NP. A PubMed search was conducted for articles published until July 3, 2020, which used DTT to investigate the association between neural injuries and NP. The key search phrase for identifying potentially relevant articles was (diffusion tensor tractography AND pain). The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies in which DTT was applied for the evaluation of NP. Review articles were excluded. Altogether, 108 potentially relevant articles were identified. After reading the titles and abstracts and assessment of eligibility based on the full-text articles, 46 publications were finally included in our review. The results of the included studies suggested that DTT may be beneficial in identifying the pathophysiological mechanism of NP of various origins including central pain caused by brain injuries, trigeminal neuralgia, sciatica, and some types of headache. Further studies are needed to validate the efficacy of DTT in investigating the pathophysiology of other types of NP.
Highlights
Neuropathic pain is a localized sensation of unpleasant discomfort that results from a lesion or a disease of the peripheral or the central somatosensory system (Zhang et al, 2020)
Based on the results of studies included in our review, we suggest that Diffusion tensor tractography (DTT) may be an additive diagnostic method for visualizing neural injuries in patients with various types of neuropathic pain (NP)
It is yet insufficient to conclude that DTT is a definite diagnostic tool for NP, but overall, DTT seems to have potential to be useful for defection of underlying pathophysiology of NP
Summary
Neuropathic pain is a localized sensation of unpleasant discomfort that results from a lesion or a disease of the peripheral or the central somatosensory system (Zhang et al, 2020). Common symptoms of NP include abnormal sensations (dysesthesia) and pain from non-painful stimuli (allodynia). DTT in Neuropathic Pain amplified pain responses after noxious or non-noxious stimuli (Baron et al, 2010). Some of the common syndromes of NP are stroke-related central pain, TN, sciatica, and some types of headache. Medication is often applied initially for the treatment of NP, but NP tends to be refractory to conventional analgesics such as non-steroidal anti-inflammatory drugs, antidepressants, and opioids. Interdisciplinary approach, including neuromodulation treatments such as rTMS, transcranial direct current stimulation, and deep brain stimulation, is often needed for the treatment of NP. Identifying the pathophysiological mechanism of NP is important, as it can lead to a more effective and specific mechanism-based treatment approach
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