Follow-up of pain processing recovery after ketamine in hyperalgesic fibromyalgia patients using brain perfusion ECD-SPECT.

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.

• Authors: Eric Guedj, Serge Cammilleri, Cécile Colavolpe, Catherine de Laforte, Jean Niboyet, Olivier Mundler
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 34 Issue 12 Pg. 2115-9 (Dec 2007) ISSN: 1619-7070 [Print] Germany
• PMID: 18278530 (Publication Type: Controlled Clinical Trial, Journal Article)

Chemical References

• Anesthetics, Dissociative
• Organotechnetium Compounds
• Radiopharmaceuticals
• Ketamine
• technetium Tc 99m bicisate
• Cysteine

Topics

• Adult
• Aged
• Anesthetics, Dissociative (therapeutic use)
• Brain (diagnostic imaging)
• Cysteine (analogs & derivatives)
• Female
• Fibromyalgia (diagnostic imaging, drug therapy)
• Follow-Up Studies
• Humans
• Hyperalgesia (diagnostic imaging, prevention & control)
• Ketamine (therapeutic use)
• Male
• Middle Aged
• Organotechnetium Compounds
• Pain (diagnostic imaging, prevention & control)
• Pain Measurement (drug effects, methods)
• Radiopharmaceuticals
• Tomography, Emission-Computed, Single-Photon (methods)
• Treatment Outcome