Subacute Pain after Traumatic Brain Injury Is Associated with Lower Insular N-Acetylaspartate Concentrations

JOURNAL OF NEUROTRAUMA, 2016 · DOI: 10.1089/neu.2015.4098 · Published: July 15, 2016

Simple Explanation

This study investigates the connection between brain chemistry and pain after a traumatic brain injury (TBI). Researchers used a special brain scan (magnetic resonance spectroscopy or MRS) to measure levels of a substance called N-acetylaspartate (NAA), which indicates healthy brain cells. The study found that people with TBI who experienced more severe neuropathic pain symptoms had lower levels of NAA in a specific brain region called the insula. This suggests that damage or dysfunction in brain areas involved in pain processing may contribute to pain after TBI. These findings could help in developing new treatments for pain after TBI by targeting specific brain areas and mechanisms.

Study Duration

Not specified

Participants

45 subjects with mild to severe TBI and 45 age- and sex-matched control subjects

Evidence Level

Not specified

Key Findings

1
Subjects with Moderate Neuropathic Pain had significantly lower insular NAA than the Low or no Neuropathic Pain group.
2
Pain severity was significantly predicted by a combination of lower insular NAA/Creatine, lower right insular gray matter fractional volume, female sex, and older age.
3
The insular NAA concentration was inversely significantly correlated with Pain Severity.

Research Summary

The study investigated the relationship between neuropathic pain symptoms, pain severity, and N-acetylaspartate (NAA) levels in brain areas involved in pain processing among individuals with subacute traumatic brain injury (TBI). The research found that lower NAA concentrations in the insula, a brain region involved in pain perception and modulation, were associated with greater severity of neuropathic pain symptoms in TBI patients. The findings suggest that neuronal dysfunction in brain areas involved in pain processing is associated with pain after TBI, potentially offering targets for future pain management strategies.

Practical Implications

Biomarker Identification

Reduced insular NAA/Cr can be a biomarker for neuropathic pain.

Therapeutic Target

The insula may be a key therapeutic target for managing pain after TBI.

Personalized Medicine

Consider sex and age as factors influencing pain perception and treatment strategies.

Study Limitations

1
Lack of pain status information in the control group.
2
The subacute nature of the pain experienced by the TBI subjects.
3
No follow-up on pain ratings to confirm the reversibility of brain changes with pain relief.

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