Becerra L, Schwartzman R J, Kiefer R T, Rohr P, Moulton E A, Wallin D, Pendse G, Morris S, Borsook David
Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
Drexel University College of Medicine, Department of Neurology, Philadelphia, Pennsylvania, USA.
Pain Med. 2015 Dec;16(12):2368-85. doi: 10.1111/pme.12939.
Previous reports have indicated that ketamine anesthesia may produce significant improvement if not complete recovery of patients with complex regional pain syndrome (CRPS).
Here we report on a patient who had CRPS affecting mainly the right side of her body who underwent functional magnetic resonance imaging (fMRI) scans prior to and in the months following apparent successful treatment with anesthetic doses of ketamine.
The patient underwent two imaging sessions: one during her pain state (CRPS+) and 1 month after her ketamine treatment in her pain-free state (CRPS-). Both spontaneous and evoked (brush, cold, and heat) pain scores decreased from 7–9/10 on a visual analog scale prior to the treatment to 0–1 immediately following and for months after the treatment. For each imaging session, the identical mechanical (brush) and thermal (cold and heat) stimuli were applied to the same location (the skin of the dorsum of the right hand).
Comparison of CRPS+ vs CRPS- for the three stimuli showed significant changes throughout the cerebral cortex (frontal, parietal, temporal, cingulate, and hippocampus), in subcortical regions such as caudate nucleus, and in the cerebellum. In addition, resting state network analysis showed a reversal of brain network state, and the recovered state paralleled specific default networks in healthy volunteers.
The observed changes in brain response to evoked stimuli provide a readout for the subjective response.
Future studies of brain function in these patients may provide novel insight into brain plasticity in response to this treatment for chronic pain.
先前的报告表明，氯胺酮麻醉可能会使复杂性区域疼痛综合征（CRPS）患者即使不能完全恢复，也会有显著改善。
在此，我们报告一名主要身体右侧患有CRPS的患者，在使用麻醉剂量的氯胺酮进行明显成功治疗之前及之后数月接受了功能磁共振成像（fMRI）扫描。
该患者接受了两次成像检查：一次是在疼痛状态下（CRPS+），另一次是在氯胺酮治疗后1个月处于无痛状态时（CRPS-）。自发痛和诱发痛（刷擦、冷刺激和热刺激）评分从治疗前视觉模拟量表上的7 - 9/10降至治疗后立即及数月后的0 - 1。每次成像检查时，相同的机械（刷擦）和热（冷刺激和热刺激）刺激应用于同一位置（右手背皮肤）。
对三种刺激的CRPS+与CRPS-比较显示，整个大脑皮层（额叶、顶叶、颞叶、扣带回和海马体）、尾状核等皮层下区域以及小脑均有显著变化。此外，静息态网络分析显示脑网络状态发生逆转，恢复状态与健康志愿者的特定默认网络相似。
观察到的大脑对诱发刺激反应的变化为主观反应提供了一种解读。
对这些患者脑功能的未来研究可能会为慢性疼痛这种治疗方法所引发的脑可塑性提供新的见解。
