fMRI in patients with lumbar disc disease: a paradigm to study patients over time

Abstract

Low back pain is a common human ailment. It is estimated that over 70% of the population will experience low back pain that will require medication and/or medical attention. There are many causes for low back pain, one being herniation of the discs of the lumbar spine. Treatment options are very limited. Why patients develop chronic pain especially when there is no known organic cause or when the offending painful stimulus has been removed remains poorly understood. Functional magnetic resonance imaging (fMRI) is a technique that allows researchers to image which regions of the brain that are activated during motor, cognitive, and sensory experiences. Using fMRI to study pain has revealed new information about how the brain responds to painful stimuli and what regions of the brain are activated during pain. However, many of the paradigms used do not replicate the subject’s pain or use painful stimuli in volunteers without pain. Also, following patients from their acute phase of pain to the chronic phase with serial fMRI has not been performed. In this study we developed a paradigm that would allow studying patients with low back pain and leg pain including lumbar radiculopathy to better mimic a clinical pain syndrome and to have a method of following patients with this type of pain over time.

New possibilities of treatment of low back pain

“…В настоящее время имеются сведения о том, что вследствие активизации процессов воспаления грыжи межпозвонковых дисков могут подвергаться инволюции [10]. В ряде случаев грыжа межпозвонкового диска несет в себе опасность нарушения функций невральных структур, однако нередко даже значительных размеров грыжа, выявленная при радиологическом обследовании, не является основной причиной ПБ [11]. Далеко не всегда наблюдается соответствие между размерами и локализацией грыжи межпозвонкового диска и наличием и характером ПБ.…”

Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study

“…For example, a study by Giesecke et al (2004) demonstrated that patients with cLBP had more extensive neuronal activation in pain-related brain cortical areas than healthy controls in response to the application of pressure with a thumbnail. Another study by Sharma et al (2011) used a straight leg raise maneuver to stimulate pain during fMRI and detected increased brain activity within the anterior cingulate gyrus, bilateral insular regions, right thalamus, basal ganglia, and sensorimotor regions. In addition, published literature has also provided evidence for increased brain activation in several brain regions after the application of mechanical stimuli to the low back area (Kobayashi et al, 2009;Manchikanti et al, 2009).…”

Brain functional connectivity changes by low back extension pain model in low back pain patients

“…Although there have been many attempts to devise experimental pain models of LBP, which applied mechanical [8,9], thermal [7,10], chemical [11] stimulations on the back or limbs, these methods hardly induce pain akin to the endogenous back pain [12,13]. Nevertheless, the straight leg raise (SLR) maneuver has been considered as a sensitive test to diagnose lumbar disc herniation (sensitivity = 0.91) [14,15], and previous neuroimaging researches have reported that the SLR maneuver activates brain regions of the pain processing by exacerbating LBP [7,16,17,18].…”