Abstract
BACKGROUND CONTEXT Pain perception seems to be highly individual and diverse, depending on multiple factors. Musculoskeletal pain, and especially back pain, has great socio-economic impact, as it often leads to prolonged periods of sick leave and an increased use of analgesic medicine, especially opioids. PURPOSE Using FDG-PET/CT, this study tries to visualize and quantify basal ganglia activity in the brain and subsequently correlate with patient pain perception and clinical outcome. STUDY DESIGN/SETTING Consecutive series of patients from a cingle-center, multisurgeon, teritiary spine practice. PATIENT SAMPLE Consecutive series of patients scheduled for spine surgery. OUTCOME MEASURES Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D), Visual Analog Scale (VAS) for back and leg pain (0 to100), Cold Pressor Test (CPT), Pressure Pain Respons (PPR) and Chemical Pain Response with Saline Injection. METHODS A total of 28 patients aged 40-65years, found eligible for surgery due to first-time lumbar disc herniation (LDH) were included in an ongoing study, where FDG-PET/CT was performed preoperatively and 6 weeks and 6 months following operation. Using a standardized protocol for quantitative sensory testing (QST), patients’ pain perception and tolerance was also collected. All patients followed normal surgical procedure and postoperative regime. The thalamus was selected as region of interest and marked using both ROVER (ABX, Radeberg, Germany) and OsiriX (Pixmeo SARL, Bernex, Switzerland) software. Cerebellum was used as reference to eliminate inter-scan variability. Comparison was made between the three time points and lateralization was evaluated. Correlations between quantitative measures of the thalamus and clinical data (PROM and QST) were also made. RESULTS Patients with LDH often present with unilateral radiating pain, and, therefore, a lateralization pattern in the shape of increased FDG uptake in the contralateral thalamus was expected. Using quantitative measures of thalamic activity, we found distinct lateralization of activity corresponding with the side of radicular pain (p-value .01). Preoperatively, patients with a higher lateralization of SUVmean in thalamus had a decreased tolerance to pain perception in the lumbar area (correlation coefficient 0.40, p-value .05). Six weeks postoperatively, patients presenting with a higher level of lateralization had significantly decreased pain tolerability over a wide variety of stimuli, and their ability to tolerate temperature stimulus was also decreased (correlation coefficient −0.47, p-value .02). The same pattern was found 6 months postoperatively with multiple significant correlations. CONCLUSIONS FDG-PET/CT may be used to some degree to correlate pain perception and distinct cerebral changes in metabolism; however, current methods of measurement do not yet allow for clinical application. Measures on pain perception and cerebral changes in metabolism may – with further development of modalities – have something to offer in the clinical setting.
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