The Brain in Chronic Pain: Clinical Implications

Abstract

SUMMARY This article examines the present, and potential future, impact of brain imaging on chronic pain. It is argued that novel theories of chronic pain are coming to the fore, specifically through brain imaging of the human brain in chronic pain. Such studies show that the brain reorganizes in relation to chronic pain, in a pattern specific to the type of clinical pain, and that brain networks and receptor targets are being identified and reverse translated to animal studies of their efficacy and mechanisms. Future studies need to integrate across human brain imaging techniques, as well as more intensive reverse translational methods.

Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain

“…Modern imaging techniques have demonstrated the extensive functional and anatomical con-nections traveling to, from, and through this region, which underlie these diverse processes. 3,8,93,103,108,109,117,118,131,137,150 In 1962, Foltz and White published their seminal paper, "Pain 'Relief' by Frontal Cingulumotomy," which ignited interest in discovering the role of cingulotomy in the treatment of chronic refractory pain. 51 Drawing on lessons from early psychiatric neurosurgery, and particularly on observations made of the effect of lobotomy on pain perception and autonomic function, Foltz and White hypothesized that transection of the cingulum bundle might benefit those patients with a disproportionally large affective component to their pain.…”

“…3,4,23,104,106,148 Although execution and analysis of chronic pain imaging is complicated by heterogeneity of the clinical entities under study and inability to control experimental features, evidence for unique yet overlapping neurosignatures of various chronic pain disorders is amassing. A recent review by Apkarian discussed the findings of neuroimaging studies devoted to elucidating chronic pain states published over the past decade.…”

Age-Related Decline in Cognitive Pain Modulation Induced by Distraction: Evidence From Event-Related Potentials

“…33 Impaired pain modulation is a risk factor in the development of chronic pain 1,52 and therefore may contribute to the frequency of chronic pain in the elderly.…”

Neuroimagen de la fibromialgia: una enfermedad del cerebro

“…Los probables mecanismos que contribuyen al fenómeno de sensibilización del SNC son variados, considerándose el fenómeno de sumación temporal (wind up), la hiperactivación funcional de la matriz neural del dolor, la probable alteración del sistema inhibitorio endógeno descendente y una alteración del procesamiento sensorial (3,5,6,11,12,15,21,33). Dichos fenómenos se han ido progresivamente identificando con múltiples estudios de neuroimagen funcional y estructural, invasivos y no invasivos, que han llevado a un mayor conocimiento y entendimiento del procesamiento cerebral de la experiencia dolorosa (36,39). Los primeros estudios de neuroimagen funcional en pacientes con FM se remontan a la década de 1990 con la Tomografía Computarizada por Emisión Monofotónica (SPECT), técnica invasiva que al requerir la inyección de un trazador radioactivo y a su poca resolución espacio-temporal no ha sido ampliamente utilizada (15,36), y con unos primeros resultados no concluyentes (11,36).…”