Derbyshire, Stuart William George; (1995) Neuropsychological measures of pain processing in pain patients and pain free volunteers. A study using positron emission tomography (PET). Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Positron Emission Tomography (PET) has been applied to normal volunteers and patients suffering pain of various aetiologies in order to address three issues: Firstly, which areas of the brain respond specifically to painful stimuli, secondly, to what extent these areas differ across individuals according to the parameters of the stimulus and individual variability, and thirdly, the extent to which resposes within these systems vary with pain pathology. Using blood flow as a marker of neuronal activity, focal cerebral responses to thermal pain were defined in normal volunteers and patients using PET and C15O2 or H215O. Increases in regional cerebral blood flow (rCBF) for the normal volunteers were seen in the thalamus and basal ganglia, and in the anterior cingulate, insula, prefrontal, secondary somatosensory and parieto-temporal cortices. The relative changes in these areas varied across the patient groups studied such that patients with atypical facial pain (AFP) had increased rCBF to the insula and lentiform nucleus, as for the normal volunteers, but comparatively higher flow to the anterior cingulate cortex and lower flow to the prefrontal cortex. Patients with post extraction dental pain demonstrated increased rCBF in the lentiform nucleus and thalamus only, and the rheumatoid arthritis group showed low blood flow in all areas. This variability was discussed in terms of subjects' psychological profile, social context and responses to treatment. The increased anterior cingulate response with AFP was interpreted as an attentional motivational response to pain, possibly facilitated by a lack of prefrontal control. The response patterns in both the dental pain and arthritis patients were interpreted as important adaptive responses within pain networks. The involvement of opioid systems and attention in these adaptive responses were investigated clinically and with PET.

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