The Role of the Cerebellum in Pain Perception: A Brain SPECT Perfusion Study in Patients with Burn Injuries.
Pain
cerebellum
virtual reality
Journal
Journal of neuroimaging : official journal of the American Society of Neuroimaging
ISSN: 1552-6569
Titre abrégé: J Neuroimaging
Pays: United States
ID NLM: 9102705
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
09
04
2020
revised:
28
06
2020
accepted:
29
06
2020
pubmed:
8
7
2020
medline:
4
6
2021
entrez:
8
7
2020
Statut:
ppublish
Résumé
Virtual reality (VR) is a promising tool for distraction analgesia. This study aims to compare brain perfusion patterns while patients were undergoing burn wound care in two conditions-VR distraction and control (NoVR). With IRB approval, four patients hospitalized for acute burn care (three males and one female) participated in the study. All patients underwent wound care on two consecutive days; 1 day with standard analgesia and adjunctive VR, and the other day with standard analgesia alone, otherwise the wound care was very similar. Tc-99m ethyl cysteinate dimer was injected during wound care at the time of peak pain. Subjective patient reports on a 0-10 scale of pain intensity, time spent thinking about pain, and "fun" as well as opioid equivalent usage were analyzed. Voxel by voxel subtraction analysis of brain perfusion Single Photon Emission Computed Tomography (SPECT) images was performed at the group level. Statistical significance threshold was defined as P < .05. Mean group subjective scores (VR, NoVR, statistical significance, and P-value) were observed for maximal pain intensity (9.0, 8.8, insignificant, and P = .809), time spent thinking about pain (5.2, 10.0, significant, and P = .015), and fun (6.0, 2.5, significant, and P = .012). Subtraction group analysis demonstrated VR-induced modulation of brain activity with statistically significant relative suppression of cerebellar activation in the VR compared to intense cerebellar activation in the NoVR environments. Relative decrease in cerebellar perfusion based on stringent statistical threshold in the VR environment combined with improved subjective pain experience supports the hypotheses on the role of cerebellum in perception of noxious stimuli.
Sections du résumé
BACKGROUND AND PURPOSE
Virtual reality (VR) is a promising tool for distraction analgesia. This study aims to compare brain perfusion patterns while patients were undergoing burn wound care in two conditions-VR distraction and control (NoVR).
METHODS
With IRB approval, four patients hospitalized for acute burn care (three males and one female) participated in the study. All patients underwent wound care on two consecutive days; 1 day with standard analgesia and adjunctive VR, and the other day with standard analgesia alone, otherwise the wound care was very similar. Tc-99m ethyl cysteinate dimer was injected during wound care at the time of peak pain. Subjective patient reports on a 0-10 scale of pain intensity, time spent thinking about pain, and "fun" as well as opioid equivalent usage were analyzed. Voxel by voxel subtraction analysis of brain perfusion Single Photon Emission Computed Tomography (SPECT) images was performed at the group level. Statistical significance threshold was defined as P < .05.
RESULTS
Mean group subjective scores (VR, NoVR, statistical significance, and P-value) were observed for maximal pain intensity (9.0, 8.8, insignificant, and P = .809), time spent thinking about pain (5.2, 10.0, significant, and P = .015), and fun (6.0, 2.5, significant, and P = .012). Subtraction group analysis demonstrated VR-induced modulation of brain activity with statistically significant relative suppression of cerebellar activation in the VR compared to intense cerebellar activation in the NoVR environments.
CONCLUSION
Relative decrease in cerebellar perfusion based on stringent statistical threshold in the VR environment combined with improved subjective pain experience supports the hypotheses on the role of cerebellum in perception of noxious stimuli.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
815-821Subventions
Organisme : NIDA NIH HHS
ID : R01 DA026438
Pays : United States
Organisme : NIGMS NIH HHS
ID : R01 GM042725
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR054115
Pays : United States
Informations de copyright
© 2020 American Society of Neuroimaging.
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