Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 147 No. 3132 (2017)

Therapy-related longitudinal brain perfusion changes in patients with chronic pelvic pain syndrome

DOI
https://doi.org/10.4414/smw.2017.14454
Cite this as:
Swiss Med Wkly. 2017;147:w14454
Published
02.08.2017

Summary

BACKGROUND

The imaging method most frequently employed to identify brain areas involved in neuronal processing of nociception and brain pain perception is blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). Arterial spin labelling (ASL), in contrast, offers advantages when slow varying changes in brain function are investigated. Chronic pelvic pain syndrome (CPPS) is a disorder of, mostly, young males that leads to altered pain perceptions in structures related to the pelvis. We aimed to investigate the potential of ASL to monitor longitudinal cranial blood flow (CBF) changes in patients with CPPS.

METHODS

In a randomised, placebo-controlled, double-blind single centre trial, we investigated treatment effects in CPPS after 12 weeks in patients that underwent sono-electro-magnetic therapy vs placebo. We investigated changes of CBF related to treatment outcome using pseudo-continuous arterial spin labelling (pCASL)-MRI.

RESULTS

We observed CBF downregulation in the prefrontal cortex and anterior cingulate cortex and upregulation in the dorsolateral prefrontal cortex in responders. Nonresponders presented with CBF upregulation in the hippocampus. In patients with a history of CPPS of less than 12 months, there were significant correlations between longitudinal CBF changes and the Chronic Prostatitis Symptom Index pain subscore within the joint clusters anterior cingulate cortex and left anterior prefrontal cortex in responders, and the right hippocampus in nonresponders.

CONCLUSIONS

We demonstrated therapy-related and stimulus-free longitudinal CBF changes in core areas of the pain matrix using ASL. ASL may act as a complementary noninvasive method to functional MRI and single-photon emission computed tomography / positron emission tomography, especially in the longitudinal assessment of pain response in clinical trials. (Trial registration number NCT00688506)

References

  1. Ogawa S, Lee TM, Kay AR, Tank DW. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA. 1990;87(24):9868–72. https://doi.org/10.1073/pnas.87.24.9868
  2. Jensen KB, Regenbogen C, Ohse MC, Frasnelli J, Freiherr J, Lundström JN. Brain activations during pain: a neuroimaging meta-analysis of patients with pain and healthy controls. Pain. 2016;157(6):1279–86. https://doi.org/10.1097/j.pain.0000000000000517
  3. Wang J, Alsop DC, Song HK, Maldjian JA, Tang K, Salvucci AE, et al. Arterial transit time imaging with flow encoding arterial spin tagging (FEAST). Magn Reson Med. 2003;50(3):599–607. https://doi.org/10.1002/mrm.10559
  4. Hodkinson DJ, Krause K, Khawaja N, Renton TF, Huggins JP, Vennart W, et al. Quantifying the test-retest reliability of cerebral blood flow measurements in a clinical model of on-going post-surgical pain: A study using pseudo-continuous arterial spin labelling. Neuroimage Clin. 2013;3:301–10. https://doi.org/10.1016/j.nicl.2013.09.004
  5. Howard MA, Krause K, Khawaja N, Massat N, Zelaya F, Schumann G, et al. Beyond patient reported pain: perfusion magnetic resonance imaging demonstrates reproducible cerebral representation of ongoing post-surgical pain. PLoS One. 2011;6(2):e17096. https://doi.org/10.1371/journal.pone.0017096
  6. Segerdahl AR, Mezue M, Okell TW, Farrar JT, Tracey I. The dorsal posterior insula subserves a fundamental role in human pain. Nat Neurosci. 2015;18(4):499–500. https://doi.org/10.1038/nn.3969
  7. Maleki N, Brawn J, Barmettler G, Borsook D, Becerra L. Pain response measured with arterial spin labeling. NMR Biomed. 2013;26(6):664–73. doi:.https://doi.org/10.1002/nbm.2911
  8. Detre JA, Wang J. Technical aspects and utility of fMRI using BOLD and ASL. Clin Neurophysiol. 2002;113(5):621–34. https://doi.org/10.1016/S1388-2457(02)00038-X
  9. Wiest R, Abela E, Missimer J, Schroth G, Hess CW, Sturzenegger M, et al. Interhemispheric cerebral blood flow balance during recovery of motor hand function after ischemic stroke--a longitudinal MRI study using arterial spin labeling perfusion. PLoS One. 2014;9(9):e106327. https://doi.org/10.1371/journal.pone.0106327
  10. Kessler TM, Mordasini L, Weisstanner C, Jüni P, da Costa BR, Wiest R, et al. Sono-electro-magnetic therapy for treating chronic pelvic pain syndrome in men: a randomized, placebo-controlled, double-blind trial. PLoS One. 2014;9(12):e113368. https://doi.org/10.1371/journal.pone.0113368
  11. Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al., European Association of Urology. EAU guidelines on chronic pelvic pain. Eur Urol. 2010;57(1):35–48. Published online September 08, 2009. https://doi.org/10.1016/j.eururo.2009.08.020
  12. Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, et al.; Chronic Prostatitis Collaborative Research Network. Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med. 2008;359(25):2663–73. Published online December 19, 2008. https://doi.org/10.1056/NEJMoa0803240
  13. Deichmann R, Schwarzbauer C, Turner R. Optimisation of the 3D MDEFT sequence for anatomical brain imaging: technical implications at 1.5 and 3 T. Neuroimage. 2004;21(2):757–67. Published online February 26, 2004. https://doi.org/10.1016/j.neuroimage.2003.09.062
  14. Dai W, Garcia D, de Bazelaire C, Alsop DC. Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med. 2008;60(6):1488–97. https://doi.org/10.1002/mrm.21790
  15. Wu WC, Fernández-Seara M, Detre JA, Wehrli FW, Wang J. A theoretical and experimental investigation of the tagging efficiency of pseudocontinuous arterial spin labeling. Magn Reson Med. 2007;58(5):1020–7. https://doi.org/10.1002/mrm.21403
  16. Federspiel A, Müller TJ, Horn H, Kiefer C, Strik WK. Comparison of spatial and temporal pattern for fMRI obtained with BOLD and arterial spin labeling. J Neural Transm (Vienna). 2006;113(10):1403–15. Published online April 11, 2006. https://doi.org/10.1007/s00702-006-0434-5
  17. Jann K, Koenig T, Dierks T, Boesch C, Federspiel A. Association of individual resting state EEG alpha frequency and cerebral blood flow. Neuroimage. 2010;51(1):365–72. Published online February 17, 2010. https://doi.org/10.1016/j.neuroimage.2010.02.024
  18. Hodkinson DJ, Khawaja N, OʼDaly O, Thacker MA, Zelaya FO, Wooldridge CL, et al. Cerebral analgesic response to nonsteroidal anti-inflammatory drug ibuprofen. Pain. 2015;156(7):1301–10. https://doi.org/10.1097/j.pain.0000000000000176
  19. Price TJ, Inyang KE. Commonalities between pain and memory mechanisms and their meaning for understanding chronic pain. Prog Mol Biol Transl Sci. 2015;131:409–34. https://doi.org/10.1016/bs.pmbts.2014.11.010
  20. Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015;16(7):403–18. https://doi.org/10.1038/nrn3976
  21. Farmer MA, Chanda ML, Parks EL, Baliki MN, Apkarian AV, Schaeffer AJ. Brain functional and anatomical changes in chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2011;186(1):117–24. Published online May 17, 2011. https://doi.org/10.1016/j.juro.2011.03.027
  22. Mordasini L, Weisstanner C, Rummel C, Thalmann GN, Verma RK, Wiest R, et al. Chronic pelvic pain syndrome in men is associated with reduction of relative gray matter volume in the anterior cingulate cortex compared to healthy controls. J Urol. 2012;188(6):2233–7. https://doi.org/10.1016/j.juro.2012.08.043
  23. Martucci KT, Shirer WR, Bagarinao E, Johnson KA, Farmer MA, Labus JS, et al. The posterior medial cortex in urologic chronic pelvic pain syndrome: detachment from default mode network-a resting-state study from the MAPP Research Network. Pain. 2015;156(9):1755–64. https://doi.org/10.1097/j.pain.0000000000000238
  24. Alsop DC, Detre JA, Golay X, Günther M, Hendrikse J, Hernandez-Garcia L, et al. Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: A consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med. 2015;73(1):102–16. https://doi.org/10.1002/mrm.25197
  25. Hashmi JA, Baria AT, Baliki MN, Huang L, Schnitzer TJ, Apkarian AV. Brain networks predicting placebo analgesia in a clinical trial for chronic back pain. Pain. 2012;153(12):2393–402. https://doi.org/10.1016/j.pain.2012.08.008
  26. Tétreault P, Mansour A, Vachon-Presseau E, Schnitzer TJ, Apkarian AV, Baliki MN. Brain Connectivity Predicts Placebo Response across Chronic Pain Clinical Trials. PLoS Biol. 2016;14(10):e1002570. https://doi.org/10.1371/journal.pbio.1002570

Most read articles by the same author(s)