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Real-time Video Projection in an MRI for Characterization of Neural Correlates Associated with Mirror Therapy for Phantom Limb Pain
Published on: April 20, 2019
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Detangling the Structural Neural Correlates Associated with Resting versus Dynamic Phantom Limb Pain Intensity Using
Camila B Pinto1, Kevin Pacheco-Barrios1,2, Faddi G Saleh Velez3
1Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, United States.
Pain Medicine (Malden, Mass.)
|December 30, 2022
Summary
Phantom limb pain (PLP) severity is linked to gray matter volume (GMV) in specific brain areas like the insula. Responders to neuromodulation treatments showed greater GMV in somatosensory regions before treatment.
Area of Science:
- Neuroscience
- Medical Imaging
- Pain Management
Background:
- Phantom limb pain (PLP) management remains challenging due to incomplete understanding of its neurophysiological basis.
- Structural neuroimaging features show potential as biomarkers for PLP.
- Few studies have explored the link between brain structure, PLP severity, and treatment outcomes.
Purpose of the Study:
- To investigate the association between brain gray matter volume (GMV) and phantom limb pain severity.
- To explore the relationship between GMV and improvement in PLP following neuromodulatory treatments.
- To identify potential neuroimaging biomarkers for PLP and treatment response.
Main Methods:
- Voxel-based morphometry (VBM) was employed to analyze brain GMV in 24 lower limb amputees with PLP.
- Functional decoding using a reverse inference term-based meta-analytic approach was utilized.
- Participants underwent neuromodulatory treatments including transcranial direct current stimulation and mirror therapy.
Main Results:
- Cortical GMV alterations correlated with PLP severity, specifically in the non-affected insula, prefrontal cortex, and bilateral thalamus (insula cluster remained significant after adjustments).
- The insula cluster was functionally connected to contralateral insula and premotor cortices, associated with "rating," "sustained attention," "impulsivity," and "suffering."
- Neuromodulatory treatment responders exhibited higher baseline GMV in affected hemisphere somatosensory areas (S1 and S2) compared to non-responders.
Conclusions:
- Brain gray matter volume in specific regions, particularly the insula, is associated with phantom limb pain severity.
- Baseline GMV in somatosensory areas may predict response to neuromodulatory treatments for PLP.
- Structural neuroimaging offers potential for understanding PLP mechanisms and guiding treatment strategies.
