Korean J Pain.  2019 Oct;32(4):271-279. 10.3344/kjp.2019.32.4.271.

Increased white matter diffusivity associated with phantom limb pain

• Seo CH
• Park CH
• Jung MH
• Baek S
• Song J
• Cha E
• Ohn SH

• KMID: 2462837
• DOI: http://doi.org/10.3344/kjp.2019.32.4.271

Abstract

BACKGROUND
We utilized diffusion tensor imaging (DTI) to evaluate the cerebral white matter changes that are associated with phantom limb pain in patients with unilateral arm amputation. It was anticipated that this would complement previous research in which we had shown that changes in cerebral blood volume were associated with the cerebral pain network.
METHODS
Ten patients with phantom limb pain due to unilateral arm amputation and sixteen healthy age-matched controls were enrolled. The intensity of phantom limb pain was measured by the visual analogue scale (VAS) and depressive mood was assessed by the Hamilton depression rating scale. Diffusion tensor-derived parameters, including fractional anisotropy, mean diffusivity, axial diffusivity (AD), and radial diffusivity (RD), were computed from the DTI.
RESULTS
Compared with controls, the cases had alterations in the cerebral white matter as a consequence of phantom limb pain, manifesting a higher AD of white matter in both hemispheres symmetrically after adjusting for individual depressive moods. In addition, there were associations between the RD of white matter and VAS scores primarily in the hemispheres related to the missing hand and in the corpus callosum.
CONCLUSIONS
The phantom limb pain after unilateral arm amputation induced plasticity in the white matter. We conclude that loss of white matter integrity, particularly in the hemisphere connected with the missing hand, is significantly correlated with phantom limb pain.

Keyword

Amputation; Brain; Chronic Pain; Diffusion Tensor Imaging; Magnetic Resonance Imaging; Neuronal Plasticity; Phantom limb; White Matter

MeSH Terms

Amputation
Anisotropy
Arm
Blood Volume
Brain
Chronic Pain
Complement System Proteins
Corpus Callosum
Depression
Diffusion
Diffusion Tensor Imaging
Hand
Humans
Magnetic Resonance Imaging
Neuronal Plasticity
Phantom Limb*
Plastics
White Matter*
Complement System Proteins
Plastics

Figure

• 

  Fig. 1 Mapping of axial diffusivity (AD) in patients vs. controls. The images show the distributions of white matter structures in which the AD values were higher in patients with phantom limb pain than in healthy controls without pain, adjusted for depressive symptoms. A: anterior, P: posterior, S: superior, In: inferior, I: hemisphere associated with intact hand, M: hemisphere associated with missing hand.

• 

  Fig. 2 Mapping of radial diffusivity (RD) correlates by phantom limb pain severity in the patient group. The distribution of white matter structures in which RD values were positively correlated with visual analogue scale scores in patients with phantom limb pain, when the Hamilton depression rating scale scores were included as a nuisance covariate. A: anterior, P: posterior, S: superior, In: inferior, I: hemisphere associated with intact hand, M: hemisphere associated with missing hand.

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