Extended reports
Reduced cortical responses to noxious heat in patients with
rheumatoid arthritis
a Human Physiology and Pain Research Laboratory,
University of Manchester Rheumatic Diseases Centre, Hope Hospital,
Salford , b PET Facility, Department of Radiology, University of
Pittsburgh Medical Centre, Pittsburgh, USA
Correspondence to: Dr A K P Jones, Human Physiology and Pain Research Laboratory, University of Manchester Rheumatic Diseases Centre, The Clinical Sciences Building, Hope Hospital, Salford M6 8HD.
Accepted for publication 30 June 1997
OBJECTIVES
To test the hypothesis that patients
with chronic inflammatory pain develop adaptive cortical responses to
noxious stimulation characterised by reduced anterior cingulate responses.
METHODSPositron emission tomography was used to
measure changes in regional cerebral blood flow (rCBF) in response to
an acute experimental pain stimulus in six patients with rheumatoid
arthritis (RA) in comparison to six age and sex matched controls. A
standardised and reproducible non-painful and painful phasic heat
stimulus was delivered by a thermal probe to the back of the right hand during six two minute periods during which time rCBF measurements were
made. The effects of non-painful heat were subtracted from those of
painful heat to weight the analysis towards the non-discriminatory or
`suffering' components of pain processing. Significance maps of pain
processing were generated and compared in each group and contrasted
with results obtained in a group of patients with atypical facial pain
(AFP) that have been previously published.
RESULTSThe RA patients showed remarkably damped
cortical and subcortical responses to pain compared with the control
group. Significant differences between the two groups were observed in
the prefrontal (BA 10) and anterior cingulate (BA 24 ) and
cingulofrontal transition cortical (BA 32) areas. The reduced anterior
cingulate responses to standardised heat pain were compared with the
increased cingulate responses seen in patients with psychogenically
maintained pain (AFP) who had both lower pain tolerance and mood than
the RA group.
CONCLUSIONSMajor cortical adaptive responses to
standardised noxious heat can be measured and contrasted in patients
with different types of chronic pain. The different pattern of
cingulate and frontal cortical responses in the patients with
inflammatory and non-nociceptive pain suggest that different mechanisms
are operating, possibly at a thalamocortical level. Implications for
treatment strategies for chronic pain are discussed.
© 1997 by Annals of the Rheumatic Diseases
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