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Chronic Pain and Evoked Responses in the Brain a Magnetoencephalographic Study in Patients with Complex Regional Pain Syndrome I and II

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Chronic Pain and Evoked Responses in the Brain a Magnetoencephalographic Study in Patients with Complex Regional Pain Syndrome I and II Chronic pain and evoked responses in the brain A magnetoencephalographic study in patients with Complex Regional Pain syndrome I and II 慢性疼痛和大脑的诱发反应 脑磁图的研究 复杂区域疼痛综合征I和II 患者 Colophon Chronic pain and evoked responses in the brain A magnetoencephalographic study in patients with Complex Regional Pain syndrome I and II Peter J. Theuvenet Utrecht: University Utrecht, Faculteit Geneeskunde, Thesis Utrecht University With a summary in Dutch © 2012 Peter J. Theuvenet, Alkmaar, the Netherlands Copyright. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without permission in writing of the author, or, when appropriate of the publishers of the publications. ISBN/EAN: 978-90-70655-76-1 Printed by Number 58, Total Communications, Alkmaar, the Netherlands Lay-out thesis: R.M. Blom (DPT department) Medical Center of Alkmaar, the Netherlands Lay-out and graphics: P.J. Theuvenet, Medical Center of Alkmaar, the Netherlands Part of the research conducted for this thesis was made possible by: The University of Twente, Low Temperature Division, Hengelo, the Netherlands Medtronic (Tolochenaz), Switzerland The Royal Academy of Sciences, Amsterdam, the Netherlands Production of the thesis was supported by The Pieter van Foreest Institute, Alkmaar, the Netherlands Front cover: “A very cold place on earth”. The lowest temperature ever recorded at the surface of the earth was −89.2 °C (184.0 K) at the Soviet Vostok Station in Antarctica July 21, 1983. Back cover: “The coldest place on earth”. In 1908 Kamerlingh Onnes at the University of Leiden, Dept. of Physics, managed to lower the temperature to less than four degrees above absolute zero, to −269 °C (4.15˚ Kelvin). The absolute zero is set by international agreement at -273.15 degrees Celsius. Photo with permission form Leiden University. Chronic pain and evoked responses in the brain A magnetoencephalographic study in patients with Complex Regional Pain Syndrome I and II Chronische pijn en opgewekte activiteit in de hersenen Een magnetoencephalografische studie bij patiënten met Complex Regional Pain Syndrome I en II (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. G.J. van der Zwaan, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op woensdag 25 april 2012 des middags te 12.45 uur door Peter Johan Theuvenet geboren op 17 december 1948 te Mataram, Lombok, Indonesië Promotoren: Prof.dr. J.M. van Ree Prof.dr. A.C. Chen Co-promotor: Dr. J.C. de Munck “Vocatus, atque non vocatus, Deus aderit” (Geroepen, en zelfs niet geroepen, God zal aanwezig zijn) (Carl Gustav Jung 1875-1961) In deep gratitude to my parents Contributing authors Prof. Dr. A.C. Chen Human Brain Mapping and Cortical Imaging Laboratory, SMI, Aalborg University, Denmark (1998 – 2005) Center for Higher Brain Functions, Capital Medical University, Beijing, China (2005 – present) Prof. Dr. Z. Dunajski Institute of Metrology and Biomedical Engineering, Warschaw University of Technology, Warschaw, Poland Dr. J.C. de Munck VU University Medical Center, Department of Physics and Medical Technology, Amsterdam, the Netherlands Prof. Dr. F.L. Lopes da Silva Swammerdam Institute for Life Sciences, Center of Neuroscience, University of Amsterdam, the Netherlands Mevr. Prof. Dr. M.J. Peters University of Twente, Low Temperature Division, the Netherlands Drs. P.J. Theuvenet Pain Clinic, Medical Center of Alkmaar, Alkmaar, the Netherlands Dr. B.W. van Dijk, MEG Center, VU University Medical Center, Amsterdam, the Netherlands Prof. Dr. J.M. van Ree Rudolf Magnus Institute of Neuroscience, Utrecht University and University Medical Center Utrecht, the Netherlands Paranimphen Dr. M.H. Hovingh, Reeuwijk, the Netherlands Mrs. M.A. Dekkers, MSc, Alkmaar, the Netherlands Table of contents Chapter 1 INTRODUCTION Chapter 2 SOMATOSENSORY PROCESSING AND PAIN 2.1 The peripheral receptor 2.2 The afferent pathways 2.3 Central processing 2.4 Neural plasticity and reorganization 2.5 Complex Regional Pain Syndrome Chapter 3 MATERIALS AND METHODS 3.1. Magnetoencephalography (MEG) 3.1.1 The generation of cortical responses 3.1.2 Cortical human brain mapping 3.1.3 Functional non-invasive neuroimaging techniques 3.2 Introduction 3.2.1 Organization of the measurements 3.2.2 Measuring setup and registration of the data 3.2.3 Collection and processing of the data 3.2.4 Statistical analysis Studies Chapter 4 Responses to Median and Tibial Nerve Stimulation in Patients with Chronic Neuropathic Pain. Theuvenet PJ, Dunajski Z, Peters MJ, van Ree JM. Brain Topography 1999; 11: 305-313 Chapter 5 Whole head MEG analysis of cortical spatial organization from unilateral stimulation of median nerve in both hands: No complete hemispheric homology. Theuvenet PJ, van Dijk BW, Peters MJ, van Ree JM, Lopes da Silva FL, Chen ACN. NeuroImage 2005; 28: 314-325 Chapter 6 Hemispheric Discrimination in MEG between median versus ulnar nerve in unilateral stimulation of left and right hand. Theuvenet PJ, van Dijk BW, Peters MJ, van Ree JM, Lopes da Silva FL, Chen ACN. Brain Topography, 2006; 19: 29-42 Chapter 7 Sensory handedness is not reflected in cortical responses after basic nerve stimulation. A MEG study. Chen ACN, Theuvenet PJ, de Munck JC, Peters MJ, van Ree JM, Lopes da Silva FL. Brain Topography, 2011 Nov 12 [Epub ahead of print]. Chapter 8 Anesthetic Block of Pain-related Cortical Activity in Patients with Peripheral Nerve Injury Measured by Magnetoencephalography. Theuvenet PJ, de Munck JC, Peters MJ, van Ree JM, Lopes da Silva FL, Chen ACN. Anesthesiology 2011; 115; 375-386 Chapter 9 Cortically evoked responses and 3D mapping in Complex regional Pain Syndrome I and II. Peter J. Theuvenet, MD, J.C. de Munck, PhD, Maria J. Peters, PhD, Jan M. van Ree, PhD, Fernando L. Lopes da Silva, PhD and Andrew CN. Chen, PhD. Submitted for publication Chapter 10 Discussion Acknowledgements Curriculum Summary in Dutch Acronyms 11 1 CHAPTER 1 INTRODUCTION 11 chapter 1 The use of electrical energy to treat some types of pain dates back to Scribonius Largus, the Roman physician under the rule of emperor Claudius. In A.D 47 he described the use of electrical energy to treat some forms of pain by using the torpedo fish. Torpedo stems from Latin “torpere”, meaning “paralyzing or stiffening” and refers to the effects after human contact with the fish. The fish was used by the Greek to treat pain during childbirth and operations (Lazorthes et al., 1985; Bullock et al., 2005). Neuromodulation is a recognized invasive therapy since its introduction in 1967 (Shealy et al., 1967). Two types are recognized in chronic non- oncological pain patients: Spinal Cord Stimulation (SCS) or Dorsal Column Stimulation (DCS), and the intrathecal administration of morphine (Spincemaille et al., 2004; Theuvenet et al., 2005). Torpedo fish (Genus Torpedinidae) Our clinical observation that after electrical dorsal traumatic peripheral nerve injury produces sensory column stimulation in some patients with chronic disturbances and a volley of impaired afferent non-oncological pain, the pain alleviating effect information (Woolf, 1993; Dellemijn, 1997; Woolf diminished over time, triggered this research and Mannion, 1999), had to have demonstrable project. Besides the well known causes like scar functional cortical effects. The study of both issues tissue around the electrode, electrode migration started in 1993. The first magnetoencephalograph and change in the course of the underlying (MEG) in The Netherlands was manufactured disease, the therapy failed in some patients for and made available for research at the Low unknown reasons. Temperature Division of the Twente University, and the first MEG was measured on the 3rd of Secondly, the fact that neuropathic pain due to May, 1976. 12 13 introduction 1 General aims of the study In Chapter 2.1-2.4, an introduction into the The general aim of the study was to investigate neural circuitry involved in afferent information the cortically evoked responses after standard processing in the somatosensory nervous system electrical median and ulnar nerve stimulation in is presented, including a short overview of two patient groups with either a Complex Regional neural plasticity changes and the body schema. Pain Syndrome (CRPS) type I or II, and compare In Chapter 2.5 an introduction is presented the results with those in healthy subjects using of CRPS I and II. Chapter 3.1 introduces and identical measuring procedures. Five specific outlines magnetoencephalograph (MEG) as a investigations were executed. neuroimaging and brain mapping technique. Chapter 3.2 presents the set up of the study, the Specific investigations materials and methods. Chapter 4 describes the I. to examine the stability and repeatability results of the study in a group of patients with of evoked responses after standard a peripheral nerve injury and chronic pain using electrical median, ulnar and posterior MEG and EEG. Chapter 5 describes the cortical tibial nerve stimulation in the cortex of evoked characteristics of a group of healthy the brain in two studies of patients with subjects after standard median nerve stimulation. a unilateral peripheral nerve injury and Chapter 6 describes the cortical evoked magnetic neuropathic pain. responses after median and ulnar nerve stimulation II. to study the characteristics of the in healthy subjects. Chapter 7 dealt with the cortically evoked magnetic responses in question whether, like in motor handedness and healthy subjects after electrical median lateralization, sensory handedness could be and ulnar nerve stimulation as a frame demonstrated. Chapters 5, 6 and 7 present the of reference for the measurements in the results after measuring healthy subjects and are two patient groups. to be considered as a normative database to this III. to examine the characteristics of the study. Chapter 8 describes the results of the study cortically evoked responses in two patient of patients with a proven peripheral nerve injury groups: CRPS I and CRPS II.
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