Pahapill Peter A, Chen Guangyu, Arocho-Quinones Elsa V, Nencka Andrew S
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA.
Neuromodulation. 2023 Jul;26(5):1009-1014. doi: 10.1016/j.neurom.2023.04.465. Epub 2023 May 17.
Chronic pain has been associated with alterations in brain connectivity, both within networks (regional) and between networks (cross-network connectivity). Functional connectivity (FC) data on chronic back pain are limited and based on heterogeneous pain populations. Patients with postsurgical persistent spinal pain syndrome (PSPS) type 2 are good candidates for spinal cord stimulation (SCS) therapy. We hypothesize that 1) FC magnetic resonance imaging (fcMRI) scans can be safely obtained in patients with PSPS type 2 with implanted therapeutic SCS devices and that 2) their cross-network connectivity patterns are altered and involve emotion and reward/aversion functions.
Resting-state (RS) fcMRI (rsfcMRI) scans were obtained from nine patients with PSPS type 2 implanted with therapeutic SCS systems and 13 age-matched controls. Seven RS networks were analyzed, including the striatum.
Cross-network FC sequences were safely obtained on a 3T MRI scanner in all nine patients with PSPS type 2 with implanted SCS systems. FC patterns involving emotion/reward brain circuitry were altered as compared with controls. Patients with a history of constant neuropathic pain, experiencing longer therapeutic effects of SCS, had fewer alterations in their connectivity patterns.
To our knowledge, this is the first report of altered cross-network FC involving emotion/reward brain circuitry in a homogeneous population of patients with chronic pain with fully implanted SCS systems, on a 3T MRI scanner. All rsfcMRI studies were safe and well tolerated by all nine patients, with no detectable effects on the implanted devices.
慢性疼痛与大脑连接性的改变有关，包括网络内部（区域）和网络之间（跨网络连接性）。关于慢性背痛的功能连接性（FC）数据有限，且基于异质性疼痛人群。2型术后持续性脊髓疼痛综合征（PSPS）患者是脊髓刺激（SCS）治疗的良好候选者。我们假设：1）对于植入治疗性SCS设备的2型PSPS患者，可以安全地进行FC磁共振成像（fcMRI）扫描；2）他们的跨网络连接模式发生改变，涉及情感和奖赏/厌恶功能。
对9例植入治疗性SCS系统的2型PSPS患者和13例年龄匹配的对照者进行静息态（RS）fcMRI（rsfcMRI）扫描。分析了7个RS网络，包括纹状体。
在3T MRI扫描仪上，所有9例植入SCS系统的2型PSPS患者均安全获得了跨网络FC序列。与对照组相比，涉及情感/奖赏脑回路的FC模式发生了改变。有持续性神经性疼痛病史、SCS治疗效果持续时间较长的患者，其连接模式的改变较少。
据我们所知，这是第一份关于在3T MRI扫描仪上，对植入完全植入式SCS系统的慢性疼痛同质患者群体中，涉及情感/奖赏脑回路的跨网络FC改变的报告。所有rsfcMRI研究对所有9例患者都是安全且耐受性良好的，对植入设备没有可检测到的影响。
