Altered cerebral blood flow in the anterior cingulate cortex is associated with neuropathic pain

Keisuke Watanabe, Shigeki Hirano, Kazuho Kojima, Kengo Nagashima, Hiroki Mukai, Takatoshi Sato, Minoru Takemoto, Koji Matsumoto, Takashi Iimori, Sagiri Isose, Shigeki Omori, Kazumoto Shibuya, Yukari Sekiguchi, Minako Beppu, Hiroshi Amino, Tomoki Suichi, Koutaro Yokote, Takashi Uno, Satoshi Kuwabara, Sonoko Misawa

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Objective To assess the cerebral blood flow (CBF) in patients with diabetic neuropathic pain, and its changes after duloxetine therapy. Methods Using iodine-123-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (IMP-SPECT), we performed a cross-sectional study of 44 patients with diabetes, and compared CBF in those with (n = 24) and without neuropathic pain (n = 20). In patients with neuropathic pain, we also longitudinally assessed changes in CBF 3 months after treatment with duloxetine. Results IMP-SPECT with voxel-based analyses showed a significant increase in cerebral blood flow in the right anterior cingulate cortex and a decrease in the left ventral striatum in patients with neuropathic pain, compared with those without pain. After duloxetine treatment, volume of interest analyses revealed a decrease in cerebral blood flow in the anterior cingulate cortex in patients with significant pain relief but not in non-responders. Furthermore, voxel-based whole brain correlation analyses demonstrated that greater baseline CBF in the anterior cingulate cortex was associated with better pain relief on the numerical rating scale. Conclusions Our results suggest that the development of neuropathic pain is associated with increased activity in the anterior cingulate cortex, and greater baseline activation of this region may predict treatment responsiveness to pharmacological intervention. Trial registration number UMIN000017130;Results.

Original languageEnglish
Pages (from-to)1082-1087
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number10
Publication statusPublished - 1 Oct 2018
Externally publishedYes


  • cerebral blood flow
  • diabetic neuropathy


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