technetium-tc-99m-bicisate and Pain

The aim of this study was to determine whether the follow-up of pain processing recovery in hyperalgesic fibromyalgia (FM) could be objectively evaluated with brain perfusion ethyl cysteinate dimer single photon computerized tomography (ECD-SPECT) after administration of ketamine.. We enrolled 17 hyperalgesic FM women patients (48.5 +/- 11 years, range 25-63). After treatment with subcutaneous ketamine, 11 patients were considered as "good responders", with a decrease in pain intensity, evaluated by visual analog scale (VAS), greater than 50%. On the other hand, six patients were considered as "poor responders". A voxel-based analysis of regional cerebral blood flow (rCBF) was conducted (p (voxel) < 0.001uc), in the two subgroups of patients, before and after treatment, in comparison to a group of ten healthy subjects, matched for age and gender.. In comparison to baseline brain SPECT, midbrain rCBF showed a greater increase after ketamine in the responder group than in the nonresponder group (p (cluster) = 0.016c). In agreement with the clinical response, the change in midbrain rCBF after ketamine was highly correlated with the reduction of VAS pain score (r = 0.7182; p = 0.0041).. This prospective study suggests that blockade of facilitatory descending modulation of pain with ketamine can be evaluated in the periaqueductal grey with brain perfusion SPECT.

Topics: Adult; Aged; Anesthetics, Dissociative; Brain; Cysteine; Female; Fibromyalgia; Follow-Up Studies; Humans; Hyperalgesia; Ketamine; Male; Middle Aged; Organotechnetium Compounds; Pain; Pain Measurement; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The aim of this study is to investigate the efficacy of 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) on acute pain induced by intradermal capsaicin injection and to elucidate its mechanisms by single-photon emission computed tomography (SPECT). We compared time courses of a subjective scale of pain induced by intradermal capsaicin injection in seven normal subjects under three different conditions: rTMS over M1, sham stimulation, and control condition (natural course of acute pain without any stimulation). In ten normal subjects, using SPECT, we also studied differences in regional cerebral blood flow (rCBF) after capsaicin injection between two conditions: rTMS over M1 and the control condition. rTMS over M1 induced earlier recovery from acute pain compared with the sham or control conditions. Under rTMS over the right M1 condition compared with the control condition, the SPECT study demonstrated a significant relative rCBF decrease in the right medial prefrontal cortex (MPFC) corresponding to Brodmann area (BA) 9, and a significant increase in the caudal part of the right anterior cingulate cortex (ACC) corresponding to BA24 and the left premotor area (BA6). A region-of-interest analysis showed significant correlation between pain reduction and rCBF changes in both BA9 and BA24. We conclude that rTMS over M1 should have beneficial effects on acute pain, and its effects must be caused by functional changes of MPFC and caudal ACC.

Topics: Adult; Analysis of Variance; Brain Mapping; Capsaicin; Cerebrovascular Circulation; Cysteine; Electric Stimulation; Electric Stimulation Therapy; Functional Laterality; Humans; Male; Motor Cortex; Organotechnetium Compounds; Pain; Pain Management; Pain Measurement; Radiopharmaceuticals; Regional Blood Flow; Statistics as Topic; Time Factors; Tomography, Emission-Computed, Single-Photon; Transcranial Magnetic Stimulation

The purpose of this study was to examine whether the Tc-99m-ECD SPECT can detect any difference between the brain perfusion in patients with chronic pain and normal controls by means of the Statistical Parametric Mapping (SPM96). The subjects were twelve patients with chronic pain (CP group) and twelve normal controls (NC group). After informed consent was obtained, 720 MBq of Tc-99m-ECD was intravenously injected as a bolus. The SPECT data were acquired once for 20 mins from 5 mins after i.v. injection of Tc-99m-ECD, with a triple-head rotating gamma camera. The SPECT data were transformed into a standard stereotactic space, and group comparisons between CP and NC groups were performed on a voxel-by-voxel basis. The subset of voxels exceeding a threshold of p < 0.001 in omnibus comparisons and remaining significant after correction for multiple comparison (p < 0.05) was displayed as a volume image rendered in three orthogonal projections. There was a significant decrease in perfusion in the bilateral thalami in the CP group, suggesting that perfusion in the thalamus generally decreases in patients with chronic pain. Tc-99m-ECD SPECT with SPM96 may be useful for studies of the mechanisms of chronic pain.

Topics: Adult; Algorithms; Chronic Disease; Cysteine; Female; Humans; Image Enhancement; Male; Organotechnetium Compounds; Pain; Radionuclide Imaging; Radiopharmaceuticals; Thalamus

This study aimed at determining the functional neuroanatomy of mental pain, a hitherto neglected symptom in the study of depression, which according to DSM-IV is stronglylinked with suicide. Mental pain (measured with the Orbach & Mikulincer Mental Pain Scale), suicidal ideation (measured using the Hamilton Rating Scale for Depression), hopelessness (measured using Beck's Hopelessness Scale), and regional cerebral blood flow as measured with single photon emission computed tomography were assessed in 39 depressed individuals. Levels of mental pain were significantly and positively associated with suicidal ideation and levels of hopelessness. When compared with patients with low levels of mental pain, those with high levels of mental pain showed relatively increased perfusion in the right dorsolateral prefrontal cortex, occipital cortex and inferior frontal gyrus and in the left inferior temporal gyrus, and relatively decreased perfusion at the medulla. The findings indicate that mental pain in depressed patients is associated with an increased risk of suicide and that high levels of mental pain are associated with changes in perfusion in brain areas that are involved in the regulation of emotions. Further study is warranted to understand whether this association reflects increased emotional processing or decreased cognitive control over mental pain in depressed individuals.

Topics: Adolescent; Adult; Aged; Brain Mapping; Cysteine; Depression; Female; Functional Laterality; Humans; Male; Middle Aged; Organotechnetium Compounds; Pain; Psychiatric Status Rating Scales; Tomography, Emission-Computed, Single-Photon; Young Adult

The clinical relationship between pain and depression has been extensively reported. The purpose of this study was to compare the cerebral blood flow (CBF) of patients with major depressive disorder (MDD) during stimulation with experimental pain tolerance or sham stimulation, before and after 2 weeks of at least partially effective antidepressant treatment (ADT), in order to determine the cerebral regions associated with pain processing in the two clinical states.. Twenty-four antidepressant-free outpatients diagnosed with MDD (DSM-IV), without any pain complaints and a basal score>or=20 points on the Hamilton Rating Scale for Depression were included. Cerebral SPECTs were performed before and after ADT. Patients were stimulated with pain pressure tolerance (PT) or sham stimulation during the radiotracer cerebral uptake time.. The comparison between PT and sham stimulation before ADT showed an increase of CBF of PT stimulated patients in right temporal gyrus, left amygdale, right anterior cingulated cortex, bilateral medial frontal gyrus, bilateral insula, lingual gyrus, right precentral gyrus and left postcentral gyrus. Equal comparison after ADT showed an increase of CBF of PT stimulated patients only in left middle frontal gyrus.. The sample includes exclusively outpatients with mild-moderate depression.. CBF before ADT increases in brain areas related with the affective and cognitive components of pain; in contrast, after ADT increases only in cognitive pain related areas. These results offer new avenues to investigate the cerebral substrate of the common relationship between pain and depression.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Brain; Brain Mapping; Cerebral Cortex; Cysteine; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Functional Laterality; Humans; Male; Organotechnetium Compounds; Pain; Pain Threshold; Physical Stimulation; Pressure; Psychiatric Status Rating Scales; Regional Blood Flow; Tomography, Emission-Computed, Single-Photon

Photon scatter is one of the most important factors degrading the quantitative accuracy of SPECT images. Many scatter correction methods have been proposed. The single isotope method was proposed by us.. We evaluate the scatter correction method of improving the quality of images by acquiring emission and transmission data simultaneously with single isotope scan.. To evaluate the proposed scatter correction method, a contrast and linearity phantom was studied. Four female patients with fibromyalgia (FM) syndrome and four with chronic back pain (BP) were imaged. Grey-to-cerebellum (G/C) and grey-to-white matter (G/W) ratios were determined by one skilled operator for 12 regions of interest (ROIs) in each subject.. The linearity of activity response was improved after the scatter correction (r = 0.999). The y-intercept value of the regression line was 0.036 (p < 0.0001) after scatter correction and the slope was 0.954. Pairwise correlation indicated the agreement between nonscatter corrected and scatter corrected images. Reconstructed slices before and after scatter connection demonstrate a good correlation in the quantitative accuracy of radionuclide concentration. G/C values have significant correlation coefficients between original and corrected data.. The transaxial images of human brain studies show that the scatter correction using single isotope in simultaneous transmission and emission tomography provides a good scatter compensation. The contrasts were increased on all 12 ROIs. The scatter compensation enhanced details of physiological lesions.

Topics: Back Pain; Brain; Cerebellum; Cysteine; Female; Fibromyalgia; Humans; Image Processing, Computer-Assisted; Organotechnetium Compounds; Pain; Perception; Phantoms, Imaging; Radiopharmaceuticals; Regional Blood Flow; Regression Analysis; Scattering, Radiation; Tomography, Emission-Computed, Single-Photon