Assessment of pain due to lumbar spine diseases using MR spectroscopy: a preliminary report
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ORIGINAL ARTICLE
Assessment of pain due to lumbar spine diseases using MR spectroscopy: a preliminary report Shoji Yabuki • Shin-ichi Konno • Shin-ichi Kikuchi
Received: 29 May 2012 / Accepted: 14 January 2013 / Published online: 27 February 2013 Ó The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Background data There is a considerable difference in pain perception among individuals. In patients with chronic pain, recent studies using fMRI, PET and SPECT have shown that functional changes mainly occurred in the anterior cingulate cortex (ACC), prefrontal cortex (PFC) and thalamus. Brain magnetic resonance spectroscopy (MRS) can evaluate brain chemistry by measuring metabolites such as N-acetyl aspartate (NAA). The purpose of this study was to analyze whether brain MRS could assess pain due to lumbar spine diseases. Methods NAA levels were determined relative to the concentration of creatine/phosphocreatine complex (Cr) and choline (Cho), which is commonly used as an internal standard. The NAA/Cr and NAA/Cho ratios in the ACC, PFC and thalamus were compared between six patients with unilateral pain (left side) and six control patients without pain. Results In the right thalamus (contralateral side to symptom), the NAA/Cr in the patients with pain was statistically significantly lower compared with the control patients (p \ 0.05). Also, in the right thalamus, the NAA/ Cho in pain patients was significantly lower compared with controls (p \ 0.01). When considering just the right thalamus, there were statistically significant correlations between the numerical rating scale for pain (NRS) and NAA values.
S. Yabuki (&) S. Konno S. Kikuchi Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan e-mail: [email protected]
Conclusions Lumbar pain can be assessed indirectly by analyzing the decrease in NAA concentration in the thalamus.
Introduction Pain is one of the most frequent symptoms in lumbar spine diseases, as evaluated using a numerical rating scale (NRS), visual analog scale (VAS) and/or faces pain scale [1, 2]. However, there is a considerable difference in pain perception among individuals. Patients with lumbar spine diseases sometimes complain of severe pain that cannot be explained by physical findings or imaging studies. If pain is measured objectively, the pathogenesis of lumbar spine diseases and/or therapeutic efficacy may be evaluated more accurately. Thus, when considering that the pain pathway for objective pain measurement is ultimately recognized in the brain [3], cerebral imaging and/or metabolic studies can be useful. Recent brain imaging such as functional MRI (fMRI) showed morphological and functional changes in the brain of patients with chronic pain [4–8]. Single-voxel proton magnetic resonance spectroscopy (MRS) is a non-invasive examination determining the cell metabolism of tissues and organs. A number of studies indicate that MRS can detect biochemical changes asso
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