WOBIB: 101 - Adler, et al. (1997) Regional brain activit ...
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L. J. Adler; F. E. Gyulai; D. J. Diehl; M. A. Mintun; P. M. Winter; L. L. Firestone. Regional brain activity changes associated with fentanyl analgesia elucidated by positron emission tomography. Anesthesia & Analgesia 84(1):120-126, 1997. PMID: 8989012. WOBIB: 101.

Recent positron emission tomography (PET) studies have demonstrated areas of pain processing in the human brain. Given the inhibitory effects of opioids on neuronal activity, we predicted that fentanyl's analgesic effects would be associated with suppression of pain-evoked responses in these distinct brain areas. To test this, PET was used to measure cerebral blood flow responses, as reflections of regional neuronal activity, to painful and nonpainful thermal stimuli both in the absence and presence of fentanyl in humans. During each PET scan in nine healthy volunteers a tonic heat source was placed against the subject's left forearm, delivering a preset temperature of either 40 degrees C (nonpainful) or 47-48 degrees C (painful). Subjects underwent eight blood flow studies, each consisting of 50 mCi [15O]water injection and a PET scan. The first four studies were performed during placebo administration in the stimulus sequence: nonpainful, painful, painful, nonpainful. This sequence was then repeated during intravenous (i.v.) administration of fentanyl 1.5 micrograms/kg [corrected]. Significant differences in regional cerebral blood flow (rCBF) between the placebo and the fentanyl conditions during nonpainful and painful stimuli were identified using statistical parametric mapping. It was found that pain increased rCBF in the anterior cingulate, ipsilateral thalamus, prefrontal cortex, and contralateral supplementary motor area. Fentanyl increased rCBF in the anterior cingulate and contralateral motor cortices, and decreased rCBF in the thalamus (bilaterally) and posterior cingulate during both stimuli. During combined pain stimulation and fentanyl administration, fentanyl significantly augmented pain-related rCBF increases in the supplementary motor area and prefrontal cortex. This activation pattern was associated with decreased pain perception, as measured on a visual analog scale. In contrast to our hypothesis, these data indicate that fentanyl analgesia involves augmentation of pain-evoked cerebral responses in certain areas, as well as both activation and inhibition in other brain regions unresponsive to pain stimulation alone.

Asymmetry: 0.00000 (left: -1, right: +1)

VRML2 file (79 Kb)

1 Heat pain on left volar forearm. 47-48 degrees Celsius hot pain on the volar forearm with fentanyl or placebo versus 40 degrees hot stimulus. WOEXP: 314.
2 Warmth on left volar forearm versus heat pain. 40 degrees Celsius warmth on the volar forearm with fentanyl or placebo versus 47-48 hot pain. WOEXP: 315.
3 Fentanyl during heat and warm stimulus on left arm. Fentanyl administration during 40 degrees Celsius warmth or 47-48 degrees hot pain on the volar forearm versus placebo with stimulus. WOEXP: 316.
4 Placebo during heat and warm stimulus on left arm. Placebo administration during 40 degrees Celsius warmth or 47-48 degrees hot pain on the volar forearm versus fentanyl with stimulus. WOEXP: 317.

corner cube of WOBIB_101

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