RESEARCH ARTICLE


Alterations of Contralateral Thalamic Perfusion in Neuropathic Pain



Takahiro Ushida*, 1, 3, Mitsutaka Fukumoto2, Carlos Binti3, Tatsunori Ikemoto1, Shinichirou Taniguchi, Masahiko Ikeuchi1, Makoto Nishihara3, Toshikazu Tani1
1 Department of Orthopaedic Surgery Kochi Medical School, Kochi, Japan
2 Department of Radiology, Kochi Medical School, Kochi, Japan
3 Multidisciprinary Pain Center, Aichi Medical University, Aichi, Japan


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© Ushida et al; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Multidisciplinary Pain Center, Aichi Medical University, 21 Karimata, Yazako, Nagakute, Aichi , Japan; Tel.: + 81 0561-62-5004; Fax: + 81 0561-62-5004; E-mail: ushidat-koc@umin.ac.jp


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.

Keywords: Brain imaging, regional cerebral blood flow, reflex sympathetic dystrophy, pain.