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 Volume 57, Number 10, November 27, 2001
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Neurology 2001;57:1817-1824
© 2001 American Academy of Neurology
Articles

Experimental brush-evoked allodynia activates posterior parietal cortex

N. Witting, MD PhD;, R. C. Kupers, PhD, P. Svensson, DDS Dr.Odont;, L. Arendt–Nielsen;, A. Gjedde, MD and T. S. Jensen, MD

From the Department of Neurology (Dr. Witting and Prof. Jensen), PET center (Dr. Witting and Profs. Kupers and Gjedde), and Danish Pain Research Center (Dr. Witting, Prof. Jensen, and Asst. Prof. Kupers), Aarhus University Hospital; Center for Sensory–Motor Interaction (Dr. Svensson and Prof. Arendt–Nielsen), Aalborg University; and Department of Prosthetic Dentistry and Stomatognathic Physiology (Dr. Svensson), Royal Dental College, Aarhus, Denmark.

Address correspondence and reprint requests to Dr. Nanna Witting, Danish Pain Research Center, Aarhus University Hospital, Building 1A, Noerrebrogade 44, DK-8000 Aarhus C; e-mail: nanna{at}akhphd.au.dk

Objective:— To study the brain activation pattern of coexisting experimental ongoing pain and brush-evoked allodynia (pain evoked by innocuous brush) with the use of PET.

Background:— Neuropathic pain usually has two essential phenomena: ongoing pain and brush-evoked allodynia, which coexist and may influence each other. Capsaicin induces both ongoing pain and brush-evoked allodynia.

Methods:— Eight healthy right-handed volunteers participated in eight H215O PET scans with two blocks of four randomized conditions: 1) rest, 2) brush, 3) capsaicin pain, and 4) capsaicin pain + brush (brush-evoked allodynia). Capsaicin was injected intradermally on the nondominant forearm and the subjects rated pain intensity and unpleasantness on 100-mm visual analogue scales.

Results:— Pain intensity and unpleasantness were significantly higher during brush-evoked allodynia (74 ± 4 and 67 ± 4 mm) compared with capsaicin pain alone (60 ± 4 and 51 ± 5 mm). Brush-evoked allodynia, but not capsaicin pain alone, increased blood flow significantly in the contralateral right sensory association cortex Brodmann area (BA) 5/7, and in bilateral prefrontal cortex BA 9/10/47 and insula. No significant activity was seen in thalamus or primary somatosensory cortex (SI). Direct comparison between capsaicin pain and brush-evoked allodynia revealed significant increase in contralateral BA 5/7 only.

Conclusions:— The specific activation of contralateral BA 5/7 indicates that this brain region is important to the processing of brush-evoked allodynia. The involvement of BA 5/7 in brush-evoked allodynia is claimed to reflect multisensory input to this region, its role in conscious pain perception, and its neuroplastic properties.




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