H-MR Spectroscopy of the Anterior Cingulated Cortex: Usefulness in the Prediction of Patients That Will Benefit from a Cognitive Behavioural Therapy in the Treatment of Chronic Pain

Anterior cingulated cortex (ACC) is involved in “the state in which patients do not care much about pain despite its presence” which is a goal of psychosomatic treatment. To investigate the absolute concentration of N-acetylaspartate (NAA) in the anterior cingulated cortex (ACC) as predictors of patients that may benefit from cognitive behavioural therapy in the treatment of chronic pain. Proton magnetic resonance spectroscopy (H-MRS) was performed with a 1.5 T MR system on a voxel in the bilateral ACC in 85 chronic pain patients and 20 age-matched normal control subjects. Eighteen out of 24 (75.0%) patients whose NAA concentration decreased significantly in the ACC, respectively, compared to the mean NAA concentration of the normal control subjects, needed cognitive behavioural therapy. Our results suggest that decreased NAA concentration in the ACC is associated with the necessity of cognitive behavioural therapy. H-MRS may serve as a useful non-invasive tool for evaluating chronic pain patients.