Follow-up of pain processing recovery after ketamine in hyperalgesic fibromyalgia patients using brain perfusion ECD-SPECT |
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Authors: | Eric Guedj Serge Cammilleri Cécile Colavolpe Catherine de Laforte Jean Niboyet Olivier Mundler |
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Institution: | 1.Service Central de Biophysique et de Médecine Nucléaire,Assistance Publique des H?pitaux de Marseille, Centre Hospitalo-Universitaire de la Timone,Marseille,France;2.Unité d’Etude et de Traitement de la Douleur,Clinique La Phocéanne,Marseille,France |
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Abstract: | Purpose The aim of this study was to determine whether the follow-up of pain processing recovery in hyperalgesic fibromyalgia (FM)
could be objectively evaluated with brain perfusion ethyl cysteinate dimer single photon computerized tomography (ECD-SPECT)
after administration of ketamine.
Materials and methods We enrolled 17 hyperalgesic FM women patients (48.5 ± 11 years, range 25–63). After treatment with subcutaneous ketamine,
11 patients were considered as “good responders”, with a decrease in pain intensity, evaluated by visual analog scale (VAS),
greater than 50%. On the other hand, six patients were considered as “poor responders”. A voxel-based analysis of regional
cerebral blood flow (rCBF) was conducted (p
voxel < 0.001uc), in the two subgroups of patients, before and after treatment, in comparison to a group of ten healthy subjects,
matched for age and gender.
Results In comparison to baseline brain SPECT, midbrain rCBF showed a greater increase after ketamine in the responder group than
in the nonresponder group (p
cluster = 0.016c). In agreement with the clinical response, the change in midbrain rCBF after ketamine was highly correlated with
the reduction of VAS pain score (r = 0.7182; p = 0.0041).
Conclusion This prospective study suggests that blockade of facilitatory descending modulation of pain with ketamine can be evaluated
in the periaqueductal grey with brain perfusion SPECT. |
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Keywords: | Brain SPECT Voxel-based analysis Pain Fibromyalgia Ketamine |
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