The discovery of areas sensitive to the relief of chronic pain. Both the perception and the treatment of chronic pain involve complex neural and physiological systems. Unfortunately, little is known about human brain activity associated with chronic pain syndromes. However, the emergence of fMRI opens an unprecedented opportunity to test hypotheses about the cortical representations of various types of chronic pain, and to evaluate therapeutics for specific types of pain. Results of our initial investigations confirm that the cessation of chronic pain following a therapeutic treatment such as a nerve block is associated with the elimination of specific cortical activity found outside of the primary sensory areas and may target the specific systems involved in treatment of some types of chronic pain.
Future aims are to identify specific cortical systems involved in the relief of pain.
Application to patient care. The long term goal is to reduce the potential morbidity associated with surgical therapeutics. Pre and post-surgical outcomes are also compared with the fMRI prediction. Approximately 60 patients have been entered on this protocol and the preliminary summaries indicate a strong correspondence with conventional methods and outcomes. Based on the results to date, there is little doubt that, when completed, this comparison of conventional and fMRI brain mapping will document the utility of the methods for improved outcomes in neurosurgical procedures.