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Randomized Controlled Trial
. 2015 Jun;15(5):423-32.
doi: 10.1111/papr.12202. Epub 2014 May 2.

Investigation of central nervous system dysfunction in chronic pelvic pain using magnetic resonance spectroscopy and noninvasive brain stimulation

Marcel Simis  1   2   3 , Jay S Reidler  1 , Debora Duarte Macea  1 , Ingrid Moreno Duarte  1 , Xiaoen Wang  4 , Robert Lenkinski  4 , John C Petrozza  5 , Felipe Fregni  1   6
Affiliations
Randomized Controlled Trial

Investigation of central nervous system dysfunction in chronic pelvic pain using magnetic resonance spectroscopy and noninvasive brain stimulation

Marcel Simis et al. Pain Pract. 2015 Jun.

Abstract

Background: Recent studies demonstrate that chronic pelvic pain is associated with altered afferent sensory input resulting in maladaptive changes in the neural circuitry of pain. To better understand the central changes associated with chronic pelvic pain, we investigated the contributions of critical pain-related neural circuits using single-voxel proton magnetic resonance spectroscopy (MRS) and transcranial direct current stimulation (tDCS).

Methods: We measured concentrations of neural metabolites in 4 regions of interest (thalamus, anterior cingulate cortex, primary motor, and occipital cortex [control]) at baseline and after 10 days of active or sham tDCS in patients with chronic pelvic pain. We then compared our results to those observed in healthy controls, matched by age and gender.

Results: We observed a significant increase in pain thresholds after active tDCS compared with sham conditions. There was a correlation between metabolite concentrations at baseline and quantitative sensory assessments. Chronic pelvic pain patients had significantly lower levels of NAA/Cr in the primary motor cortex compared with healthy patients.

Conclusions: tDCS increases pain thresholds in patients with chronic pelvic pain. Biochemical changes in pain-related neural circuits are associated with pain levels as measured by objective pain testing. These findings support the further investigation of targeted cortical neuromodulatory interventions for chronic pelvic pain.

Keywords: brain stimulation; chronic pelvic pain; magnetic resonance spectroscopy; tDCS; transcranial direct current stimulation.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
MRS spectra from the primary motor cortex of a pelvic pain patient. Chemical shifts are indicated in parts per million (ppm).
See this image and copyright information in PMC

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