Assessment of a Specific Neurophysiological Brain Pattern in Patients Suffering From Chronic Back Pain
Condition: Back Pain
MeSH terms: Back Pain
Study type: Observational

Summary: 
      The purpose of this study is whether patients suffering from chronic back pain for more than
      one year will show a specific neurophysiological pattern in the EEG. This pattern is referred
      to as Thalamo-Cortical Dysrhythmia (TCD) and consists most likely of a self sustaining loop
      between the Cortex and Thalamus. This pattern has been found before in patients with very
      severe chronic pain. Specific lesions to the Thalamus result in a reduction of this pattern
      and decrease in pain. With this study the investigators will assess whether this pattern can
      be found in back pain patients of different types. Patients will be measured by EEG for the
      existence of TCD and will undergo detailed pain and psychological diagnostic.
    

Detailed description: 
      The neurophysiological processing of chronic pain is despite large efforts in the recent
      years still not well understood. However the so called cortical pain matrix describes
      cortical areas associated with the perception and processing of pain stimuli. Most studies
      identify second somatic area (SII), the insular regions, the anterior cingulated cortex (ACC)
      as well as the contralateral thalamus and the primary somatic area (SI) (Peyron, Laurent &
      Garcia-Larrea, 2000) as areas related to pain processing. In two recent publications by a
      Swiss research group (Sarnthein, Stern, Aufenberg, Rousson & Jeanmonod, 2006; Stern,
      Jeanmonod & Sarnthein, 2006) a dynamical EEG in the cortex pattern is described which is
      obvious related to chronic neurogenic pain. This pattern consists of an increase in EEG power
      and a shift of the dominant peak towards lower frequencies, mainly high theta (6-9 Hz).
      Source localization demonstrates that this overactivation mainly takes place in the areas of
      the cortical pain matrix. The authors argue that this pattern termed thalamocortical
      dysrhythmia is due to a thalamocortical loops initiated from the central lateral nucleus in
      the thalamus. This hypothesis is supported by the effects of a therapeutic lesion within the
      thalamus which led to (a) pain relief of 95% and to (b) the disappearance of the dysrhythmic
      pattern described above.

      The investigators will set out to conduct a observational trial in order to determine pain
      related EEG characteristics in patients suffering from chonic back pain. Twenty four patients
      will be recruited for the study. A 64 channel high-resolution EEG and the following parameter
      will be recorded: Neuropathic Pain Questionnaire (Backonja and Krause 2003), EuroQol, BSI,
      Graded hronic pain scale(Klasen, Hallner, Schaub, Willburger & Hasenbring, 2004)pain (McGill
      Pain Questionnaire, VAS pain), and generic quality of life (Fragebogen zur
      Lebenszufriedenheit, Henrich & Herschbach, 1996).

      An age and sex matched control group of healthy participants will be measured with the same
      method in order to compare whether the patients show a dysrhythmia pattern.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        chronic back pain
      
Keywords: back pain; eeg; chronic pain