NÖROPATİK AĞRISI OLAN HASTALARDA KANTİTATİF DUYU TESTİ(QST) PARAMETRELERİ İLE FONKSİYONEL MANYETİK REZONANS GÖRÜNTÜLEME(FMRG) PATERNLERİNİN İLİŞKİSİ
Project no. 20708 · Status: Kapanmış · 2019
Summary
Objectives: The aim of this study is to determine QST and fMRG changes and show their possible relationships in cervical radiculopathy patients with neuropathic pain. Another aim of the study is to evaluate whether there is a difference in fMRI findings in patients who are determined as hyperalgesic or hypoesthetic according to the QST assessment. Materials and methods: 66 participants were included in the study, including neuropathic pain (NA) (n: 20), non-neuropathic neck-arm pain (NNA) (n: 9) and healthy volunteers (n: 37). After obtaining the socio-demographic and clinical data of the participants, the PainDetect (PD) questionnaire was performed, followed by QST analysis and fMRI examination, which included sensory stimulation of both extremities in a total of 40 patients. Results: Analyses between painful and non-painful extremities yielded no differences in CDT (Cold detection threshold), HDT (Hot detection threshold), VDT (Vibration detection threshold) and HPT (Heat pain threshold) with QST, in all groups (p> 0.05). CDT, HDT and VDT tests, which showed sensory thresholds, were found to be higher in the NA and NNA groups compared to healthy volunteers, and HPT 0.5 test was found to be lower in the tests showing pain threshold (p <0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. In patients who described left-sided NA in the fMRI results, a lower BOLD response was observed in the frontal pol and superior frontal gyrus regions compared to healthy volunteers (p <0.05). In the hypoesthetic NA group, a lower somatosensory cortex activity was found in non-painful limbs compared to healthy volunteers (p <0.05). In the unilateral hyperalgesic NA group a lower somatosensory cortex activity was found on the painful side, and if the hyperalgesia was bilateral, a lower BOLD activity was also found in the operculum and insular cortex (p <0.05). Conclusion: The QST values of NA and NNA patients were shown to be different compared to healthy volunteers. An increased fMRI activity was detected in regions associated with chronic pain in patients with bilateral hyperalgesia, but no significant difference was observed in the intergroup analyses including all patients, regardless of the QST findings. While changes in the quantitative sensory tests in patients with NA were accompanied by central functional changes, these changes were not observed in NNA patients. These findings suggest that central mechanisms also play a role in neuropathic pain causing sensory changes. This study reveals that peripheral and central changes associated with neuropathic pain in patients with cervical radiculopathy. However, more studies are needed to clarify these fine and detailed mechanisms.