Functional MR imaging analysis of pain-related brain activation after acute mechanical stimulation.

BACKGROUND AND PURPOSE Most studies concerning imaging of pain processing have used thermal, chemical, or electrical nociceptive stimulation. The aim of the present study was to determine the cortical representation of mechanical pain. For this, using functional MR (fMR) imaging at 1.5 T, we compared activation patterns during painful and nonpainful tonic mechanical stimulation in healthy volunteers. METHODS Eleven right-handed subjects ranging in age from 21 to 46 years underwent gradient-echo echo-planar fMR imaging while quantified tonic pressure was applied to the first metacarpophalangeal joint. Imaging parameters were 3,000/60 (TR/TE) with a 5-mm section thickness in a 7.30-minute sequence with 2 x 90 seconds of painful stimulation interleaved with 3 x 90 seconds of nonpainful stimulation. Functional images were processed using dedicated IDL software. RESULTS Mechanical tonic nociceptive pressure was associated with activation of the primary somatosensory cortex contralateral to the hand stimulated and variable, often bilateral activation of the secondary somatosensory, temporal, anterior and posterior cingulate, insular, and prefrontal cortexes. Thalamic activation was inconsistent and always contralateral to stimulation. CONCLUSION The interindividual variability found in this fMR imaging study calls for repetitive single-subject analysis or more extensive studies of large groups of patients. Either may be based on fMR imaging analysis of brain activation after tonic mechanically induced pain, which leads to deep pain sensation similar to patients' painful sensations most commonly encountered in clinical practice.