PMID- 26373920 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20220210 IS - 1525-1403 (Electronic) IS - 1094-7159 (Linking) VI - 19 IP - 2 DP - 2016 Feb TI - Spinal Cord Stimulation (SCS) and Functional Magnetic Resonance Imaging (fMRI): Modulation of Cortical Connectivity With Therapeutic SCS. PG - 142-53 LID - 10.1111/ner.12346 [doi] AB - INTRODUCTION: The neurophysiological basis of pain relief due to spinal cord stimulation (SCS) and the related cortical processing of sensory information are not completely understood. The aim of this study was to use resting state functional magnetic resonance imaging (rs-fMRI) to detect changes in cortical networks and cortical processing related to the stimulator-induced pain relief. METHODS: Ten patients with complex regional pain syndrome (CRPS) or neuropathic leg pain underwent thoracic epidural spinal cord stimulator implantation. Stimulation parameters associated with "optimal" pain reduction were evaluated prior to imaging studies. Rs-fMRI was obtained on a 3 Tesla, Philips Achieva MRI. Rs-fMRI was performed with stimulator off (300TRs) and stimulator at optimum (Opt, 300 TRs) pain relief settings. Seed-based analysis of the resting state functional connectivity was conducted using seeds in regions established as participating in pain networks or in the default mode network (DMN) in addition to the network analysis. NCUT (normalized cut) parcellation was used to generate 98 cortical and subcortical regions of interest in order to expand our analysis of changes in functional connections to the entire brain. We corrected for multiple comparisons by limiting the false discovery rate to 5%. RESULTS: Significant differences in resting state connectivity between SCS off and optimal state were seen between several regions related to pain perception, including the left frontal insula, right primary and secondary somatosensory cortices, as well as in regions involved in the DMN, such as the precuneus. In examining changes in connectivity across the entire brain, we found decreased connection strength between somatosensory and limbic areas and increased connection strength between somatosensory and DMN with optimal SCS resulting in pain relief. This suggests that pain relief from SCS may be reducing negative emotional processing associated with pain, allowing somatosensory areas to become more integrated into default mode activity. CONCLUSION: SCS reduces the affective component of pain resulting in optimal pain relief. Study shows a decreased connectivity between somatosensory and limbic areas associated with optimal pain relief due to SCS. CI - (c) 2015 International Neuromodulation Society. FAU - Deogaonkar, Milind AU - Deogaonkar M AD - Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. FAU - Sharma, Mayur AU - Sharma M AD - Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. FAU - Oluigbo, Chima AU - Oluigbo C AD - Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA. FAU - Nielson, Dylan M AU - Nielson DM AD - Department of Psychology, The Ohio State University, Columbus, OH, USA. FAU - Yang, Xiangyu AU - Yang X AD - Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. FAU - Vera-Portocarrero, Louis AU - Vera-Portocarrero L AD - Neuromodulation Research, Medtronic Inc., Minneapolis, MN, USA. FAU - Molnar, Gregory F AU - Molnar GF AD - Neuromodulation Research, Medtronic Inc., Minneapolis, MN, USA. FAU - Abduljalil, Amir AU - Abduljalil A AD - Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. FAU - Sederberg, Per B AU - Sederberg PB AD - Department of Psychology, The Ohio State University, Columbus, OH, USA. FAU - Knopp, Michael AU - Knopp M AD - Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. FAU - Rezai, Ali R AU - Rezai AR AD - Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150916 PL - United States TA - Neuromodulation JT - Neuromodulation : journal of the International Neuromodulation Society JID - 9804159 SB - IM CIN - Neuromodulation. 2016 Feb;19(2):227-8. PMID: 26890017 MH - Adult MH - Brain Mapping/methods MH - Cerebral Cortex/*physiology MH - Complex Regional Pain Syndromes/*therapy MH - Female MH - Humans MH - Image Processing, Computer-Assisted MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Neural Pathways/*physiology MH - Neuralgia/*therapy MH - *Spinal Cord Stimulation OTO - NOTNLM OT - Connectivity OT - functional MRI OT - neural networks OT - neuromodulation OT - neuropathic pain EDAT- 2015/09/17 06:00 MHDA- 2016/12/15 06:00 CRDT- 2015/09/17 06:00 PHST- 2015/06/24 00:00 [received] PHST- 2015/08/03 00:00 [revised] PHST- 2015/08/05 00:00 [accepted] PHST- 2015/09/17 06:00 [entrez] PHST- 2015/09/17 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - S1094-7159(21)05854-2 [pii] AID - 10.1111/ner.12346 [doi] PST - ppublish SO - Neuromodulation. 2016 Feb;19(2):142-53. doi: 10.1111/ner.12346. Epub 2015 Sep 16.