Abstract
Objective
To investigate changes in the pain network associated with phantom limb pain, magnetic
resonance imaging (MRI) was used to measure cerebral blood volume (CBV) in patients
who had undergone unilateral arm amputation after electrical injury.
Design
Case-controlled exploratory MRI study of CBV via MRI.
Setting
University hospital.
Participants
Participants (N=26) comprised patients with phantom limb pain after unilateral arm
amputation (n=10) and healthy, age-matched persons (n=16).
Interventions
Not applicable.
Main Outcome Measures
The intensity of phantom limb pain was measured using the visual analog scale (VAS).
Depressive mood was assessed using the Hamilton Depression Rating Scale, and cognitive
function was assessed using the Korean version of the Mini-Mental State Examination.
Voxel-wise comparisons of relative CBV maps were made between amputees and controls
over the entire brain volume. The relationship between individual participant CBV
(measured in voxels) and VAS score was also examined.
Results
Compared with control participants, amputees exhibited greater degrees of depression;
significantly higher CBV in the bilateral medial frontal area (orbitofrontal cortex
[OFC] and pregenual anterior cingulate cortex [pACC]); and significantly lower CBV
in the right midcingulate cortex, posterior cingulate cortex, and primary somatosensory
cortex. CBV increased in the contralateral and ipsilateral hemispheres of the amputated
arm, regardless of the amputation side. This CBV increase in the OFC and pACC was
strongly correlated with pain intensity in all amputees.
Conclusions
We observed increased CBV in regions associated with emotion in the cerebral pain
network of patients who had undergone unilateral arm amputation after electrical injury.
This study suggests that CBV changes were related to neuroplasticity associated with
phantom limb pain.
Keywords
List of abbreviations:
ACC (anterior cingulate cortex), CBV (cerebral blood volume), HDRS (Hamilton Depression Rating Scale), MCC (midcingulate cortex), MMSE-K (Korean version of the Mini-Mental State Examination), MRI (magnetic resonance imaging), OFC (orbitofrontal cortex), pACC (pregenual anterior cingulate cortex), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 06, 2017
Footnotes
Supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (grant no. 2014R1A1A1006893), the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI15C1486), and the Hallym University Research Fund 2013 (grant no. HURF-2013-29).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
