TY - JOUR
T1 - Analgesia by electrostimulation of the trigeminal ganglion in patients with trigeminopathic pain
T2 - A PET activation study
AU - Willoch, Frode
AU - Gamringer, Ulrich
AU - Medele, Ralph
AU - Steude, Ulrich
AU - Tölle, Thomas Rudolf
N1 - Funding Information:
The authors are grateful for the logistic and intellectual support of the institutional directors, Professor M. Schwaiger and Professor B. Conrad, and thank the staff at the RDS 112 cyclotron unit for reliable supply of [ 15 O]water, the technical staff for their assistance and E. Ratti Moberg for careful review of the manuscript. This work has been supported by the Deutsche Forschungsgesellschaft (SFB 391) and the Norwegian Research Council (project no. 123170/320).
PY - 2003/5
Y1 - 2003/5
N2 - Electrostimulation of the trigeminal ganglion (TGES) has shown good results in treatment of trigeminopathic pain in selected patients. To map the mechanisms of TGES analgesia, we determined changes in relative regional cerebral blood flow (rCBF) in ten patients with trigeminopathic pain using positron emission tomography. The patients were scanned before stimulation (habitual pain), after short-term stimulation (1 min, stTGES) and after long-term stimulation (ltTGES). Highly significant pain alleviation was reported after ltTGES. Relative rCBF changes after stTGES, which was without significant pain relief, were attributed mainly to intrinsic TGES effects. A statistical comparison of the subtraction images of ltTGES and stTGES disclosed significant rCBF increases after ltTGES in rostral parts of anterior cingulate cortex (ACC) and neighboring orbitofrontal and medial frontal cortices. Regression analysis of rCBF changes and subjective ratings of pain revealed an inverse relationship in the ipsilateral rostral ACC, and only rCBF changes in the caudal part of the contralateral ACC were consistent with the encoding of pain. The present study provides evidence for a pain modulating role of the rostral ACC, critically important in electrostimulation-induced analgesia, and identifies the caudal ACC as a region encoding pain sensation.
AB - Electrostimulation of the trigeminal ganglion (TGES) has shown good results in treatment of trigeminopathic pain in selected patients. To map the mechanisms of TGES analgesia, we determined changes in relative regional cerebral blood flow (rCBF) in ten patients with trigeminopathic pain using positron emission tomography. The patients were scanned before stimulation (habitual pain), after short-term stimulation (1 min, stTGES) and after long-term stimulation (ltTGES). Highly significant pain alleviation was reported after ltTGES. Relative rCBF changes after stTGES, which was without significant pain relief, were attributed mainly to intrinsic TGES effects. A statistical comparison of the subtraction images of ltTGES and stTGES disclosed significant rCBF increases after ltTGES in rostral parts of anterior cingulate cortex (ACC) and neighboring orbitofrontal and medial frontal cortices. Regression analysis of rCBF changes and subjective ratings of pain revealed an inverse relationship in the ipsilateral rostral ACC, and only rCBF changes in the caudal part of the contralateral ACC were consistent with the encoding of pain. The present study provides evidence for a pain modulating role of the rostral ACC, critically important in electrostimulation-induced analgesia, and identifies the caudal ACC as a region encoding pain sensation.
KW - Brain activation
KW - Electrostimulation
KW - Neuropathy
KW - Pain
KW - Positron emission tomography
KW - Region cerebral blood flow
UR - https://www.scopus.com/pages/publications/0038582343
U2 - 10.1016/s0304-3959(02)00423-2
DO - 10.1016/s0304-3959(02)00423-2
M3 - Article
C2 - 12749966
AN - SCOPUS:0038582343
SN - 0304-3959
VL - 103
SP - 119
EP - 130
JO - Pain
JF - Pain
IS - 1-2
ER -