PET Imaging of Chronic Pain Syndromes

Study Overview
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Brief Summary
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Central nervous system (CNS) changes associated with pain have been difficult to measure until the development of functional neuroimaging techniques such as positron emission tomography (PET). We have previously observed asymmetry in the thalamus associated with chronic pain that altered during acupuncture therapy. Imaging studies of therapeutic techniques for chronic pain in animals and humans have been quite limited. This study will be the first to utilize FDG PET-MRI imaging of both the brain and body in order to assess CNS changes and peripheral body changes related to chronic pain and its potential management.

Detailed Description
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The proposed study is based on our growing understanding of chronic pain and our ability to use functional brain imaging to study in vivo neurophysiologic processes. It is important to understand the brain and body mechanisms of chronic pain in order to better determine therapeutic interventions to reduce pain. Part of the difficulty in treating chronic pain is to determine how better to diagnose what specific issues are affecting the brain and body that result in chronic pain. Participants will undergo a small battery of diagnostic tests that include magnetic resonance imaging (MRI), positron emission tomography (PET). A secondary goal of this study is to determine if undergoing chiropractic care alters body or brain physiology in patients with chronic pain.

Official Title
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PET Imaging of Chronic Pain Syndromes

Conditions
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Chronic Pain Syndrome

Intervention / Treatment
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* Other: Chiropractic Group
* Other: Healthy Control Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Chronic Pain Patients: Age greater than 18 years old. Have chronic pain symptoms for >3 months; Have moderate pain (>3/10) in 2 or more areas for more than 5 out of 7 days Is planning on undergoing chiropractic care for the clinical management of the chronic pain. May be on pain medications provided that they are on a stable dose for at least 1 month Patients have no other pre-existing and active significant medical, neurological, or psychological disorders. Minor, stable health problems that should have no substantial effect on cerebral blood flow will be allowed (i.e. controlled hypertension, medication controlled diabetes). Patients will be allowed to be taking medications or supplements at the initial intake, but they must be on a stable dose regimen for at least 1 month. Able to give informed consent and willing to complete the study at Thomas Jefferson University and Marcus Institute of Integrative Health. Inclusion Criteria for Healthy Controls: No significant current active medical conditions. Stable medical conditions as determined by the PI are allowed. No brain or body abnormalities that would affect the acquisition or analysis of the scan. Exclusion Criteria for Chronic Pain Patients and Healthy Controls: Pregnant or breast feeding Enrollment in active clinical trial/ experimental therapy within the prior 30 days. Subject is unable or unwilling to lie still in the scanner (i.e. due to claustrophobia or weight) Subject has metal in their body or other reason that they cannot undergo magnetic resonance imaging.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chiropractic Group<br>Participants receiving a chiropractic care technique Neuro Emotive Technique (NET) will complete initial pain evaluations and questionnaires for chronic pain symptoms. After approximately 8 weeks participants will receive follow evaluation for pain. Pre and Post PET-MRI scan will be conducted to evaluate changes. | Other: Chiropractic Group<br>* Participants will receive approximately 8 weeks of chiropractic care.<br>|
| Healthy Control Group<br>Participants will receive initial evaluations and questionnaires followed by a PET-MRI scan. | Other: Healthy Control Group<br>* Participants will not receive any interventions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use combined PET/MRI to define pain activity pattern and inflammation. | To use PET-MRI to define abnormal brain and body activity and evaluate changes in inflammation in painful regions in patients with chronic pain syndromes. | Baseline and 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use combined PET/MRI to demonstrate brain and body activity in responders and non-responders. | Patterns will be compared between those who respond and those who do not respond to chiropractic care. | Baseline and 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic Pain Syndrome, Chronic Pain, Chiropractic, PET, MRI, Positron emission tomography, Magnetic resonance imaging, Neuro Emotive Technique (NET)