Autopsy analysis of the safety, efficacy and cartography of electrical stimulation of the central gray in humans

Baskin, David S.; Mehler, William R.; Hosobuchi, Yoshio; Richardson, Donald E.; Adams, John E.; Flitter, Marc A.

doi:10.1016/0006-8993(86)90358-6

Cited by 77 publications

(37 citation statements)

References 16 publications

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“…4) level, we observed areas of activation within the brainstem, the locality of which correlate with regions known to be involved in pain processing in animals (Traub et al, 1996;Rodella et al, 1998;Millan, 2002;Monnikes et al, 2003) and human studies (Boivie and Meyerson, 1982;Baskin et al, 1986;Tracey et al, 2002). The spatial pattern of activation was very similar for visceral and somatic pain; however, greater quantitative bilateral NCF activity during visceral pain compared with somatic was found.…”

Section: Rvm: Dorsolateral Pons Correlation Of Activationmentioning

confidence: 68%

“…In a pivotal study, Reynolds (1969) highlighted the role of the periaqueductal gray (PAG) in the nocifensive response: electrical stimulation of the PAG in rats allowed abdominal surgery without the use of general anesthesia. This inhibition of the normal pain response through stimulation of discrete brainstem centers such as the PAG [stimulus-produced analgesia (SPA)] was subsequently described in humans (Boivie and Meyerson, 1982;Baskin et al, 1986).…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Visceral and Somatic Pain Processing in the Human Brainstem Using Functional Magnetic Resonance Imaging

Dunckley¹,

Wise²,

Fairhurst³

et al. 2005

J. Neurosci.

236

159

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Evidence from both human and animal studies has demonstrated a key role for brainstem centers in the control of ascending nociceptive input. Nuclei such as the rostral ventromedial medulla and periaqueductal gray (PAG) are able to both inhibit and facilitate the nociceptive response. It has been proposed that altered descending modulation may underlie many of the chronic pain syndromes (both somatic and visceral). We used functional magnetic resonance imaging to image the neural correlates of visceral and somatic pain within the brainstem. Ten healthy subjects were scanned twice at 3 tesla, during which they received matched, moderately painful, electrical stimuli to either the midline lower abdomen or rectum. Significant activation was observed in regions consistent with the PAG, nucleus cuneiformis (NCF), ventral tegmental area/substantia nigra, parabrachial nuclei/nucleus ceruleus, and red nucleus bilaterally to both stimuli. Marked spatial similarities in activation were observed for visceral and somatic pain, although significantly greater activation of the NCF (left NCF, p ϭ 0.02; right NCF, p ϭ 0.01; Student's paired t test, two-tailed) was observed in the visceral pain group compared with the somatic group. Right PAG activity correlated with anxiety during visceral stimulation (r ϭ 0.74; p Ͻ 0.05, Pearson's r, two-tailed) but not somatic stimulation. We propose that the differences in NCF and right PAG activation observed may represent a greater nocifensive response and greater emotive salience of visceral over somatic pain.

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Section: Rvm: Dorsolateral Pons Correlation Of Activationmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

A Comparison of Visceral and Somatic Pain Processing in the Human Brainstem Using Functional Magnetic Resonance Imaging

Dunckley¹,

Wise²,

Fairhurst³

et al. 2005

J. Neurosci.

236

159

View full text Add to dashboard Cite

show abstract

“…For instance, studies suggest that stimulation of specific regions of the midbrain, PAG and surrounding areas could inhibit pain responses to noxious stimulation in both animal studies [27,35] and patients suffering from pain disorders [1,10]. It has been hypothesized that acupuncture may somehow trigger this descending inhibition system to produce an analgesic effect.…”

Section: Discussionmentioning

confidence: 99%

A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia

Dougherty

Kong

Webb

et al. 2008

Behavioural Brain Research

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Functional neuroimaging studies suggest that a lateral network in the brain is associated with the sensory aspects of pain perception while a medial network is associated with affective aspects. The highest concentration of opioid receptors is in the medial network. There is significant evidence that endogenous opioids are central to the experience of pain and analgesia. We applied an integrative multimodal imaging approach during acupuncture. We found functional magnetic resonance imaging signal changes in the orbitofrontal cortex, insula, and pons and [11C]diprenorphine positron emission tomography signal changes in the orbitofrontal cortex, medial prefrontal cortex, insula, thalamus, and anterior cingulate cortex. These findings include brain regions within both the lateral and medial pain networks.

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“…Tolerance is not caused by tissue changes; neither gliosis nor parenchymal reactions to the electrodes have been shown in autopsy specimens of DBS patients who died for unrelated reasons [6]. Tolerance was thought to be mediated by chronic, DBS-induced release of opioid peptides in the CSF.…”

Section: Discussionmentioning

confidence: 99%

Patient-Controlled Deep Brain Stimulation Can Overcome Analgesic Tolerance

Romanelli

Heit²

2004

Stereotact Funct Neurosurg

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We report a technique based on patient-controlled stimulation to restore analgesia after development of tolerance to deep brain stimulation (DBS). A 45-year-old female with neurogenic pain after cerebellar stroke underwent DBS implantation in the right ventralis caudalis (VC) thalamus with excellent stimulus-controlled analgesia for 29 months, followed by development of tolerance and loss of analgesia. Analgesia was restored when a stimulation module that allowed patient-controlled stimulation was implanted.

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Autopsy analysis of the safety, efficacy and cartography of electrical stimulation of the central gray in humans

Cited by 77 publications

References 16 publications

A Comparison of Visceral and Somatic Pain Processing in the Human Brainstem Using Functional Magnetic Resonance Imaging

A Comparison of Visceral and Somatic Pain Processing in the Human Brainstem Using Functional Magnetic Resonance Imaging

A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia

Patient-Controlled Deep Brain Stimulation Can Overcome Analgesic Tolerance

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