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The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study

BACKGROUND: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood problems. Recently, occipital nerve field stimulation (ONS) has been proposed as an effective potential treatment for fibromyalgia-related pain. The aim of...

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Autores principales: Ahmed, Shaheen, Plazier, Mark, Ost, Jan, Stassijns, Gaetane, Deleye, Steven, Ceyssens, Sarah, Dupont, Patrick, Stroobants, Sigrid, Staelens, Steven, De Ridder, Dirk, Vanneste, Sven
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233518/
https://www.ncbi.nlm.nih.gov/pubmed/30419855
http://dx.doi.org/10.1186/s12883-018-1190-5
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author Ahmed, Shaheen
Plazier, Mark
Ost, Jan
Stassijns, Gaetane
Deleye, Steven
Ceyssens, Sarah
Dupont, Patrick
Stroobants, Sigrid
Staelens, Steven
De Ridder, Dirk
Vanneste, Sven
author_facet Ahmed, Shaheen
Plazier, Mark
Ost, Jan
Stassijns, Gaetane
Deleye, Steven
Ceyssens, Sarah
Dupont, Patrick
Stroobants, Sigrid
Staelens, Steven
De Ridder, Dirk
Vanneste, Sven
author_sort Ahmed, Shaheen
collection PubMed
description BACKGROUND: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood problems. Recently, occipital nerve field stimulation (ONS) has been proposed as an effective potential treatment for fibromyalgia-related pain. The aim of this study is to unravel the neural mechanism behind occipital nerve stimulation’s ability to suppress pain in fibromyalgia patients. MATERIALS AND METHODS: Seven patients implanted with subcutaneous electrodes in the C2 dermatoma were enrolled for a Positron Emission Tomography (PET) H(2)(15)O activation study. These seven patients were selected from a cohort of 40 patients who were part of a double blind, placebo-controlled study followed by an open label follow up at six months. The H(2)(15)O PET scans were taken during both the “ON” (active stimulation) and “OFF” (stimulating device turned off) conditions. Electroencephalogram (EEG) data were also recorded for the implanted fibromyalgia patients during both the “ON” and “OFF” conditions. RESULTS: Relative to the “OFF” condition, ONS stimulation resulted in activation in the dorsal lateral prefrontal cortex, comprising the medial pain pathway, the ventral medial prefrontal cortex, and the bilateral anterior cingulate cortex as well as parahippocampal area, the latter two of which comprise the descending pain pathway. Relative deactivation was observed in the left somatosensory cortex, constituting the lateral pain pathway as well as other sensory areas such as the visual and auditory cortex. The EEG results also showed increased activity in the descending pain pathway. The pregenual anterior cingulate cortex extending into the ventral medial prefrontal cortex displayed this increase in the theta, alpha1, alpha2, beta1, and beta2 frequency bands. CONCLUSION: PET shows that ONS exerts its effect via activation of the descending pain inhibitory pathway and the lateral pain pathway in fibromyalgia, while EEG shows activation of those cortical areas that could be responsible for descending inhibition system recruitment. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number NCT00917176 (June 10, 2009).
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spelling pubmed-62335182018-11-20 The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study Ahmed, Shaheen Plazier, Mark Ost, Jan Stassijns, Gaetane Deleye, Steven Ceyssens, Sarah Dupont, Patrick Stroobants, Sigrid Staelens, Steven De Ridder, Dirk Vanneste, Sven BMC Neurol Research Article BACKGROUND: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood problems. Recently, occipital nerve field stimulation (ONS) has been proposed as an effective potential treatment for fibromyalgia-related pain. The aim of this study is to unravel the neural mechanism behind occipital nerve stimulation’s ability to suppress pain in fibromyalgia patients. MATERIALS AND METHODS: Seven patients implanted with subcutaneous electrodes in the C2 dermatoma were enrolled for a Positron Emission Tomography (PET) H(2)(15)O activation study. These seven patients were selected from a cohort of 40 patients who were part of a double blind, placebo-controlled study followed by an open label follow up at six months. The H(2)(15)O PET scans were taken during both the “ON” (active stimulation) and “OFF” (stimulating device turned off) conditions. Electroencephalogram (EEG) data were also recorded for the implanted fibromyalgia patients during both the “ON” and “OFF” conditions. RESULTS: Relative to the “OFF” condition, ONS stimulation resulted in activation in the dorsal lateral prefrontal cortex, comprising the medial pain pathway, the ventral medial prefrontal cortex, and the bilateral anterior cingulate cortex as well as parahippocampal area, the latter two of which comprise the descending pain pathway. Relative deactivation was observed in the left somatosensory cortex, constituting the lateral pain pathway as well as other sensory areas such as the visual and auditory cortex. The EEG results also showed increased activity in the descending pain pathway. The pregenual anterior cingulate cortex extending into the ventral medial prefrontal cortex displayed this increase in the theta, alpha1, alpha2, beta1, and beta2 frequency bands. CONCLUSION: PET shows that ONS exerts its effect via activation of the descending pain inhibitory pathway and the lateral pain pathway in fibromyalgia, while EEG shows activation of those cortical areas that could be responsible for descending inhibition system recruitment. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number NCT00917176 (June 10, 2009). BioMed Central 2018-11-12 /pmc/articles/PMC6233518/ /pubmed/30419855 http://dx.doi.org/10.1186/s12883-018-1190-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ahmed, Shaheen
Plazier, Mark
Ost, Jan
Stassijns, Gaetane
Deleye, Steven
Ceyssens, Sarah
Dupont, Patrick
Stroobants, Sigrid
Staelens, Steven
De Ridder, Dirk
Vanneste, Sven
The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title_full The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title_fullStr The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title_full_unstemmed The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title_short The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study
title_sort effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water pet and eeg imaging study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233518/
https://www.ncbi.nlm.nih.gov/pubmed/30419855
http://dx.doi.org/10.1186/s12883-018-1190-5
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