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The Journal of Neuroscience, December 15, 2000, 20(24):9277-9283

Neuroplastic Changes Related to Pain Occur at Multiple Levels of the Human Somatosensory System: A Somatosensory-Evoked Potentials Study in Patients with Cervical Radicular Pain

Michele Tinazzi¹, Antonio Fiaschi¹, Tiziana Rosso¹, Franco Faccioli², Johannes Grosslercher², and Salvatore M. Aglioti³

Dipartimenti di Scienze Neurologiche e della Visione, ¹ Sezione di Neurologia Riabilitativa and ² Sezione di Neurochirurgia, Università di Verona, 37134 Verona, Italy, and ³ Dipartimento di Psicologia, Università di Roma "La Sapienza," and Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Santa Lucia, 00179 Rome, Italy

Studies suggest that pain may play a major role in determining cortical rearrangements in the adult human somatosensory system. Most studies, however, have been performed under conditions whereby pain coexists with massive deafferentation (e.g., amputations). Moreover, no information is available on whether spinal and brainstem changes contribute to pain-related reorganizational processes in humans. Here we assess the relationships between pain and plasticity by recording somatosensory-evoked potentials (SEPs) in patients who complained of pain to the right thumb after a right cervical monoradiculopathy caused by compression of the sixth cervical root, but did not present with clinical or neurophysiological signs of deafferentation. Subcortical and cortical potentials evoked by stimulation of digital nerves of the right thumb and middle finger were compared with those obtained after stimulation of the left thumb and middle finger and with those obtained in a control group tested in comparable conditions. Amplitudes of spinal N13, brainstem P14, parietal N20 and P27, and frontal N30 potentials after stimulation of the painful right thumb were greater than those of the nonpainful left thumb and showed a positive correlation with magnitude of pain. This right-left asymmetry was absent after stimulation of the patients' middle fingers and in control subjects. Results suggest that chronic cervical radicular pain is associated with changes in neural activity at multiple levels of the somatosensory system. The absence of correlation between the amplitude of spinal, brainstem, and cortical components of SEPs suggests that enhancement of cortical activity is not a simple amplification of subcortical enhancement.

Key words: pain; upper limb SEPs; somatosensory-evoked potentials; somatosensory system; deafferentation; brain plasticity; cervical radiculopathy

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Copyright © 2000 Society for Neuroscience  0270-6474/00/20249277-07$05.00/0

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