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Identifying Musculoskeletal Pain Generators Using Clinical PET.

Daehyun Yoon1, Feliks Kogan1, Garry E Gold1

  • 1Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California.

Seminars in Musculoskeletal Radiology
|September 29, 2020
PubMed
Summary

Positron emission tomography (PET) imaging offers a promising way to objectively pinpoint pain sources by measuring cellular and molecular changes. Combining PET with MRI enhances accuracy in identifying pain drivers for better clinical diagnosis.

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Area of Science:

  • Nuclear Medicine
  • Radiology
  • Pain Management

Background:

  • Pain identification is challenging due to its subjective nature, influenced by individual thresholds and psychological factors.
  • Quantifying pain may involve assessing nociception and pro-nociceptive inflammation at cellular and molecular levels.
  • Objective measurement of pain generators is crucial for effective clinical diagnosis and treatment.

Purpose of the Study:

  • To explore the potential of positron emission tomography (PET) imaging in objectively identifying peripheral pain generators.
  • To review current clinical PET imaging approaches for quantifying pain sources.
  • To highlight the synergistic benefits of combining PET with magnetic resonance imaging (MRI) for enhanced pain driver identification.

Main Methods:

  • Utilizing targeted, sensitive, and specific PET radiotracers to measure local density of receptors, ion channels, mediators, and immune cells.
  • Employing clinical PET imaging to quantify target concentration as a readout for pain generation sites.
  • Integrating PET with MRI to leverage spatial and contrast resolution for improved accuracy.

Main Results:

  • Clinical PET imaging approaches are emerging as viable tools for objective pain source identification.
  • Specific PET radioligands (e.g., fluorine-18 fluorodeoxyglucose, fluorine-18 sodium fluoride, sigma-1 receptor, translocator protein) show promise.
  • Combined PET-MRI offers superior accuracy and confidence in identifying pain drivers.

Conclusions:

  • PET imaging represents a significant advancement in objectively localizing the source of pain.
  • The integration of PET with MRI provides a powerful multimodal approach for pain diagnostics.
  • Further development and application of clinical PET imaging will revolutionize pain management.