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

Harish A Sharma, Rajarsi Gupta, William Olivero, Harish A Sharma, Rajarsi Gupta, William Olivero

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.

Keywords: chronic pain; functional magnetic resonance imaging; low back pain; pain syndrome.

Figures

Figure 1
Figure 1
Straight leg raise maneuver during fMRI measurement.
Figure 2
Figure 2
Demonstrates the activated regions of the patients during the SLR maneuver. There is activation in the leg sensory motor region S1 (A), anterior cingulate gyrus (B), thalamus and caudate (C), and insular regions (D). Abbreviation: SLR, straight leg raise.
Figure 3
Figure 3
Demonstrates no activity in the pain regions (A) of the controls during the SLR maneuver. There is activation in the leg sensory motor region S1 (B) and anterior cerebellum (C). Abbreviation: SLR, straight leg raise.

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Source: PubMed

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