Tools
Tools
Wanigasekera, V, Wartolowska, K, Huggins, J P, Duff, E P, Vennart, W, Whitlock, M, Massat, N, Pauer, L, Rogers, P, Hoggart, B and Tracey, I (2018) Disambiguating pharmacological mechanisms from placebo in neuropathic pain using functional neuroimaging. British journal of anaesthesia, 120 (2). pp. 299-307. ISSN 1471-6771. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Full text not available from this repository.Abstract
BACKGROUND
A lack of objective outcome measures and overreliance on subjective pain reports in early proof-of-concept studies contribute to the high attrition of potentially effective new analgesics. We studied the utility of neuroimaging in providing objective evidence of neural activity related to drug modulation or a placebo effect in a double-blind, randomized, placebo-controlled, three-way crossover trial.
METHODS
We chronically administered pregabalin or tramadol (first-line and second-line analgesics, respectively), recommended for neuropathic pain, in 16 post-traumatic neuropathic pain patients. We measured subjective pain reports, allodynia-evoked neural activity, and brain resting state functional connectivity from patients during the three sessions and resting state data at baseline from patients after washout of their current medication. All data were collected using a 3 T MRI scanner.
RESULTS
When compared with placebo only, pregabalin significantly suppressed allodynia-evoked neural activity in several nociceptive and pain-processing areas of the brain, despite the absence of behavioural analgesia. Furthermore, placebo significantly increased functional connectivity between the rostral anterior cingulate and the brainstem, a core component of the placebo neural network.
CONCLUSIONS
Functional neuroimaging provided objective evidence of pharmacodynamic efficacy in a proof-of-concept study setting where subjective pain outcome measures are often unreliable. Additionally, we provide evidence confirming the neural mechanism underpinning placebo analgesia as identified in acute experimental imaging studies in patients during the placebo arm of a clinical trial. We explore how brain penetrant active drugs potentially interact with this mechanism.
CLINICAL TRIAL REGISTRATION
NCT0061015.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs |
| Subjects: | WL Nervous system. Neurology > WL800 Pain WO Surgery > WO500 Anaesthesia |
| Divisions: | Clinical Support > Anaesthetics |
| Related URLs: | |
| Depositing User: | Mrs Caroline Tranter |
| Date Deposited: | 13 Feb 2018 14:35 |
| Last Modified: | 13 Feb 2018 14:35 |
| URI: | http://www.repository.uhblibrary.co.uk/id/eprint/1594 |
Actions (login required)
 |
View Item |
