Breaking News: Brain Imaging Tracks Clinical Action of Pregabalin

This good news is so new that it’s dated in the future: Dec 1, 2013.

Brain imaging reveals dynamic changes caused by pain medicines | University of Michigan Health System

The implication is that at least one factor in chronic pain can now be visualized by computer imaging.  Pregabalin (Lyrica) soothes the insula, and the changes in insula activity and corresponding decreasing pain levels were made visible for the first time.

So far, we only had static images of brains to compare those of people with chronic pain with those who are pain-free, but now we can watch the changes as they are happening in a single individual.

A study in the December issue of Anesthesiology suggests a role for brain imaging in the assessment and potential treatment of chronic pain. …use brain imaging procedures to track the clinical action of pregabalin, a drug known by the brand name Lyrica® that is prescribed to patients suffering from fibromyalgia and neuropathic pain.

Previous research has shown that fibromyalgia patients may have heightened neural activity in a region of the brain involved in processing pain and emotion called the insula, and that this excess activity may be related to elevated levels of the excitatory neurotransmitter glutamate.

Brain imaging conducted at the U-M Health System suggests pregabalin works in part by reducing the concentration of glutamate within the insula, which is consistent with animal studies. These reductions in glutamate were also accompanied by decreases in insula connectivity and reductions in clinical pain ratings.

This type of brain activity imaging may help in the development of new pain medicines and personalized chronic pain treatment.

“The significance of this study is that it demonstrates that pharmacologic therapies for chronic pain can be studied with brain imaging,”

Reference: Pregabalin Rectifies Aberrant Brain Chemistry, Connectivity, and Functional Response in Chronic Pain Patients” Vol. 119, Issue 6, December 2013, Anesthesiology, the Journal of the American Society of Anesthesiologists.

The online journal page is excellent (no longer available 9/1/17).  It clearly outlines the main points and also includes these highly useful sections:

What We Already Know about This Topic

  • Both brain insular glutamate and insular connectivity to the default mode network (a constellation of brain regions to which is attributed self-referential thinking and autobiographical memory) have been implicated as pathologic factors in chronic pain

What This Article Tells Us That Is New

  • Using three complementary imaging techniques (proton magnetic resonance spectroscopy, functional magnetic resonance imaging, and functional connectivity magnetic resonance imaging) in chronic pain patients with fibromyalgia, it was shown that pregabalin treatment reduced brain insula glutamate levels and was associated with decreased connectivity of this structure to the default mode network
  • These factors were associated with the clinical analgesic response to this drug

It goes on to give an extensive background on chronic pain and the role of pregabalin, before diving into the details of the study.

However Pfizer, the company that makes Lyrica (pregabalin) funded this stody:

Funding: Pfizer Incorporated, Groton, CT

Conflicts of interest: Authors REH and DJC have previously consulted for Pfizer Inc., DJC was a consultant for Pfizer at the time of the study, and LP and JPH were employed by Pfizer and were shareholders at the time of this study.


1 thought on “Breaking News: Brain Imaging Tracks Clinical Action of Pregabalin

  1. Katarina

    Reblogged this on Painfully Aware and commented:
    Fascinating! This is a great summary of an interesting article. I think the connection between physical pain and emotional/affective responses in the brains of people living with chronic pain is really interesting. It’s amazing that they are imaging the effect of a drug on this connection, and showing it leads to analgesic effects. I take Lyrica and find it helps with tingling and chills and some sensitivity to pain. Personally I have found long acting tramadol to be more effective for the pain side of things but it’s so individual when it comes to pain.



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