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01-08-2006 | Original Article

Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a ^99mTc-HMPAO rCBF study

Authors: Torbjörn Sundström, Michel Guez, Christer Hildingsson, Göran Toolanen, Lars Nyberg, Katrine Riklund

Published in: European Spine Journal | Issue 8/2006

Abstract

A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiological, or psychological examination. Earlier studies indicate a parieto-occipital hypoperfusion but it is unclear if the hypoperfusion represents a response to chronic pain. The rCBF was monitored in 45 patients with chronic neck pain: 27 cases with chronic whiplash syndrome and 18 age and gender matched cases with non-traumatic chronic neck pain. The rCBF was estimated with single-photon emission computed tomography (SPECT) using technetium-99m hexamethylpropylene amine oxime (HMPAO). The non-traumatic patients displayed rCBF changes in comparison with the whiplash group and the healthy control group. These changes included rCBF decreases in a right temporal region close to hippocampus, and increased rCBF in left insula. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. The present study suggests different pain mechanisms in patients with chronic neck pain of non-traumatic origin compared to those with chronic neck pain due to a whiplash trauma.

Andersson HI, Ejlertsson G, Leden I, Rosenberg C (1993) Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 9:174–182PubMed

Banic B, Petersen-Felix S, Andersen OK, Radanov BP, Villiger PM, Arendt-Nielsen L et al (2004) Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 107:7–15CrossRefPubMed

Barnsley L, Lord S, Bogduk N (1994) Whiplash injury. Pain 58:283–307CrossRefPubMed

Chang LT (1978) A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl-Sci 25:638–643CrossRef

Cloninger CR (1986) A unified biosocial theory of personality and its role in the development of anxiety states. Psychiatr Dev 4:167–226PubMed

Cote P, Cassidy JD, Carroll L (1998) The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 23:1689–1698CrossRefPubMed

Cote P, Cassidy JD, Carroll L (2000) The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 25:1109–1117CrossRefPubMed

Croft PR, Lewis M, Papageorgiou AC, Thomas E, Jayson MI, Macfarlane GJ et al (2001) Risk factors for neck pain: a longitudinal study in the general population. Pain 93:317–325CrossRefPubMed

Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Giani C, Zbinden AM, Radanov BP (2001) Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 17:306–315CrossRefPubMed

10.

Davis KD, Taub E, Duffner F, Lozano AM, Tasker RR, Houle S et al (2000) Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study. J Neurosurg 92:64–69PubMedCrossRef

11.

Derbyshire SW, Jones AK, Creed F, Starz T, Meltzer CC, Townsend DW et al (2002) Cerebral responses to noxious thermal stimulation in chronic low back pain patients and normal controls. Neuroimage 16:158–168CrossRefPubMed

12.

Derbyshire SW, Nichols TE, Firestone L, Townsend DW, Jones AK (2002) Gender differences in patterns of cerebral activation during equal experience of painful laser stimulation. J Pain 3:401–411CrossRefPubMed

13.

Di Piero V, Ferracuti S, Sabatini U, Tombari D, Di Legge S, Pantano P et al (2001) Diazepam effects on the cerebral responses to tonic pain: a SPET study. Psychopharmacology (Berl) 158:252–258CrossRef

14.

Freitag P, Greenlee MW, Wachter K, Ettlin TM, Radue EW (2001) fMRI response during visual motion stimulation in patients with late whiplash syndrome. Neurorehabil Neural Repair 15:31–37PubMedCrossRef

15.

Guez M, Hildingsson C, Nilsson M, Toolanen G (2002) The prevalence of neck pain: a population-based study from northern Sweden. Acta Orthop Scand 73:455–459CrossRefPubMed

16.

Hsieh JC, Meyerson BA, Ingvar M (1999) PET study on central processing of pain in trigeminal neuropathy. Eur J Pain 3:51–65CrossRefPubMed

17.

Iadarola MJ, Max MB, Berman KF, Byas-Smith MG, Coghill RC, Gracely RH et al (1995) Unilateral decrease in thalamic activity observed with positron emission tomography in patients with chronic neuropathic pain. Pain 63:55–64CrossRefPubMed

18.

Jones AK, Derbyshire SW (1997) Reduced cortical responses to noxious heat in patients with rheumatoid arthritis. Ann Rheum Dis 56:601–607PubMed

19.

Kastrup A, Li TQ, Glover GH, Kruger G, Moseley ME (1999) Gender differences in cerebral blood flow and oxygenation response during focal physiologic neural activity. J Cereb Blood Flow Metab 19:1066–1071CrossRefPubMed

20.

Kupers RC, Gybels JM, Gjedde A (2000) Positron emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation. Pain 87:295–302CrossRefPubMed

21.

Kwiatek R, Barnden L, Tedman R, Jarrett R, Chew J, Rowe C et al (2000) Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum 43:2823–2833CrossRefPubMed

22.

Larsson A, Johansson L, Sundstrom T, Ahlstrom KR (2003) A method for attenuation and scatter correction of brain SPECT based on computed tomography images. Nucl Med Commun 24:411–420CrossRefPubMed

23.

Liotti M, Mayberg HS, Brannan SK, McGinnis S, Jerabek P, Fox PT (2000) Differential limbic-cortical correlates of sadness and anxiety in healthy subjects: implications for affective disorders. Biol Psychiatry 48:30–42CrossRefPubMed

24.

Marshall PD, O’Connor M, Hodgkinson JP (1995) The perceived relationship between neck symptoms and precedent injury. Injury 26:17–19CrossRefPubMed

25.

Nakabeppu Y, Nakajo M, Gushiken T, Tsuchimochi S, Tani A, Kanmura Y (2001) Decreased perfusion of the bilateral thalami in patients with chronic pain detected by Tc-99m-ECD SPECT with statistical parametric mapping. Ann Nucl Med 15:459–463PubMed

26.

Newberg AB, Lariccia PJ, Lee BY, Farrar JT, Lee L, Alavi A (2005) Cerebral blood flow effects of pain and acupuncture: a preliminary single-photon emission computed tomography imaging study. J Neuroimaging 15:43–49CrossRefPubMed

27.

Nilsson L-G, Bäckman L, Erngrund K, Nyberg L, Adolfsson R, Bucht G et al (1997) The Betula prospective cohort study: memory, health, and aging. Aging Neuropsychol Cogn 4:1–32CrossRef

28.

Otte A, Ettlin T, Fierz L, Mueller-Brand J (1996) Parieto-occipital hypoperfusion in late whiplash syndrome: first quantitative SPET study using technetium-99m bicisate (ECD). Eur J Nucl Med 23:72–74CrossRefPubMed

29.

Otte A, Ettlin TM, Nitzsche EU, Wachter K, Hoegerle S, Simon GH et al (1997) PET and SPECT in whiplash syndrome: a new approach to a forgotten brain? J Neurol Neurosurg Psychiatry 63:368–372PubMedCrossRef

30.

Otte A, Goetze M, Mueller-Brand J (1998) Statistical parametric mapping in whiplash brain: is it only a contusion mechanism?Eur J Nucl Med 25:306–307PubMed

31.

Otte A, Mueller-Brand J, Fierz L (1995) Brain SPECT findings in late whiplash syndrome. Lancet 345:1513CrossRefPubMed

32.

Petrovic P, Ingvar M, Stone-Elander S, Petersson KM, Hansson P (1999) A PET activation study of dynamic mechanical allodynia in patients with mononeuropathy. Pain 83:459–470CrossRefPubMed

33.

Peyron R, Laurent B, Garcia-Larrea L (2000) Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin 30:263–288PubMedCrossRef

34.

Reiman EM, Raichle ME, Butler FK, Herscovitch P, Robins E (1984) A focal brain abnormality in panic disorder, a severe form of anxiety. Nature 310:683–685CrossRefPubMed

35.

Richter M, Ferrari R, Otte D, Kuensebeck HW, Blauth M, Krettek C (2004) Correlation of clinical findings, collision parameters, and psychological factors in the outcome of whiplash associated disorders. J Neurol Neurosurg Psychiatry 75:758–764CrossRefPubMed

36.

Rodriquez AA, Barr KP, Burns SP (2004) Whiplash: pathophysiology, diagnosis, treatment, and prognosis. Muscle Nerve 29:768–781CrossRefPubMed

37.

Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S et al (1995) Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 20:1S–73SPubMedCrossRef

38.

Sterling M, Jull G, Vicenzino B, Kenardy J (2003) Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 104:509–517CrossRefPubMed

39.

Sugiura M, Kawashima R, Nakagawa M, Okada K, Sato T, Goto R et al (2000) Correlation between human personality and neural activity in cerebral cortex. Neuroimage 11:541–546CrossRefPubMed

40.

Viikari-Juntura E, Martikainen R, Luukkonen R, Mutanen P, Takala EP, Riihimaki H (2001) Longitudinal study on work related and individual risk factors affecting radiating neck pain. Occup Environ Med 58:345–352CrossRefPubMed

41.

Wik G, Fischer H, Bragee B, Kristianson M, Fredrikson M (2003) Retrosplenial cortical activation in the fibromyalgia syndrome. Neuroreport 14:619–621CrossRefPubMed

Title: Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study
Authors: Torbjörn Sundström
Michel Guez
Christer Hildingsson
Göran Toolanen
Lars Nyberg
Katrine Riklund
Publication date: 01-08-2006
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 8/2006
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-005-0040-5

At a glance: The STEP trials

Springer Medicine

Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a ^99mTc-HMPAO rCBF study

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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