Brain Imaging: a Promising Biomarker for Pain
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 3
Abstract
Clinicians and researchers have the problem of objectively assessing the intensity and characteristics of pain. Furthermore, the widespread use of Visual-Analogue scales during the past decade highlights the need for a reliable and quantitative biological marker of pain. Mono- and multidimensional measures of pain, based on the activity of one or more brain regions involved in the quantification of painful inputs, have become the focus of extensive research. The growing availability of non-invasive functional imaging has in fact fueled a revolution in the field: a novel multiparametric pain signature was recently introduced and tested in patients, and proven effective in evaluating the intensity of painful inputs, and the effects of analgesics on those stimuli. The recent growing interest in quantitative and reproducible biological markers for pain has prompted investigators to examine imaging techniques to detect and evaluate the cerebral representation of noxious stimuli[1,2]. Historically pain has been quantified with the help of Visual-Analogue Scales (VAS) that report the subjective experience as stated by the patient. The intrinsic variability and differing perceptive sensitivities in people unable to verbally communicate or among patients with disabilities have historically constituted a significant limitation to this tool[3,4].In recent years, MRI-based analysis of brain activation and local cerebral blood flow (CBF) has brought new hope to this field. By identifying the physiologic patterns of cortical/subcortical activation, investigators are beginning to uncover the contribution of single areas to pain perception[5-7].The sensory-discriminative, cognitive, and affective aspects of painful stimuli are in fact elaborated by six interconnected regions: the thalamus, the primary and secondary somatosensory cortices (SI-SII), the anterior cingulate cortex (ACC), the insular cortex (IC), and the prefrontal cortex (PFC)[8]. A variety of imaging techniques have been employed to study the changes in function and anatomy of these areas. Blood-oxygen-level-dependent (BOLD) MRI contrast imaging is currently the most widespread method utilized, and its temporal resolution makes it a logical candidate to examine for acute pain syndromes[9,10].Alternatively, arterial spin labeling (ASL) MRI techniques represent ongoing clinical pain and are employed as indicators of chronic pain and migraine[11,12]. Other approaches include diffusion tensor imaging (DTI) and structural MRI: the first provides information regarding the network that underlies pain management and perception[13], while the second uses voxel-base morphometry to quantify changes in white and grey matter[14,15]. Positron-emission tomography (PET), electroencephalogram (EEG), diffuse optical tomography (DOT) and Magnetic Encephalography (MEG) have also been employed, but the high cost, low precision, and the necessity to shield the magnetic field limit their diffusion[16].
Authors and Affiliations
Riccardo Serra, Noah Leviton Gorelick, Betty Tyler, Michael Guarnieri
Keywords
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- EP ID EP592361
- DOI 10.26717/BJSTR.2018.06.001369
- Views 185
- Downloads 0
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