Plastic Changes in Pain and Motor Network Induced by Chronic Burn Pain

Abstract

Musculoskeletal diseases with chronic pain are difficult to control because of their association with both central as well as the peripheral nervous system. In burn patients, chronic pain is one of the major complications that cause persistent discomfort. The peripheral mechanisms of chronic pain by burn have been greatly revealed through studies, but the central mechanisms have not been identified. Our study aimed to characterize the cerebral plastic changes secondary to electrical burn (EB) and non-electrical burn (NEB) by measuring cerebral blood volume (CBV). Sixty patients, twenty with electrical burn (EB) and forty with non-electrical burn (NEB), having chronic pain after burn, along with twenty healthy controls, participated in the study. Voxel-wise comparisons of relative CBV maps were made among EB, NEB, and control groups over the entire brain volume. The CBV was measured as an increase and decrease in the pain and motor network including postcentral gyrus, frontal lobe, temporal lobe, and insula in the hemisphere associated with burned limbs in the whole burn group. In the EB group, CBV was decreased in the frontal and temporal lobes in the hemisphere associated with the burned side. In the NEB group, the CBV was measured as an increase or decrease in the pain and motor network in the postcentral gyrus, precentral gyrus, and frontal lobe of the hemisphere associated with the burn-affected side. Among EB and NEB groups, the CBV changes were not different. Our findings provide evidence of plastic changes in pain and motor network in patients with chronic pain by burn.

Effect of the Application of Virtual Reality on Pain Reduction and Cerebral Blood Flow in Robot-Assisted Gait Training in Burn Patients

“…There is sufficient evidence regarding changes in the sensory and motor areas of the brain in patients experiencing pain. Modulation of these sensory and motor areas has been proven to be effective for pain control [20]. Reducing attention to pain can decrease pain perception.…”

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

“…All MRIs were performed using a 3.0 T magnetic resonance scanner (MAGNETOM Skyra, Siemens; Erlangen, Germany) and an established steady-state gadolinium-enhanced MRI technique [ 18 , 29 ]. Two high-resolution T1-weighted images were acquired for each participant: one before a standard intravenous administration of gadolinium contrast agent (0.1 mmol/kg gadoterate meglumine) and the second at 4 min after the gadolinium administration.…”

“…Two high-resolution T1-weighted images were acquired for each participant: one before a standard intravenous administration of gadolinium contrast agent (0.1 mmol/kg gadoterate meglumine) and the second at 4 min after the gadolinium administration. T2-weighted and diffusion-weighted MRI images were taken to exclude patients with suspected parenchymal injury [ 18 ]. A single-shot diffusion-weighted echo planar imaging sequence was taken in the same manner as Joo et al to assess the CBV changes caused by the burn-related chronic pain [ 18 ].…”

“…T2-weighted and diffusion-weighted MRI images were taken to exclude patients with suspected parenchymal injury [ 18 ]. A single-shot diffusion-weighted echo planar imaging sequence was taken in the same manner as Joo et al to assess the CBV changes caused by the burn-related chronic pain [ 18 ]. Processing of the CBV mapping data was performed using SPM12 software ( , accessed on 8 May 2022), as previously described [ 21 , 30 ].…”

“…However, chronic pain in this setting is also related to a mechanism that cannot be explained by peripheral causes alone; recent reports indicate that changes in the cerebral pain network occur in cases of musculoskeletal diseases with chronic pain [ 15 , 16 , 17 ]. Brain imaging studies have been conducted on the mechanisms of chronic pain aggravation and pain improvement after pain treatment [ 16 , 18 , 19 , 20 ]. The cerebral blood volume (CBV) is a hemodynamic variable that represents the fraction of the cerebral tissue volume occupied by blood at a given time point, which is highly correlated with oxygen metabolism.…”