# Publications

## 2015

Mittra E, Marx E, Biswal S, Mackey S. Utility of FDG PET/CT in patients with Myofascial Pain Syndrome. J. Nucl. Med. 2015;56(supplement 3):1694-1694.
1694Objectives The mechanism of uptake of 18F-FDG suggests a role in the evaluation of pain. Areas of FDG uptake in muscle are often seen in oncology PET scans but of unknown etiology. To understand this better, we examined a group of patients with significant focal muscle pain with FDG PET/CT.Methods Patients with a diagnosis of Myofascial Pain Syndrome (MPS) and active trigger points were prospectively recruited from the Stanford University Pain Management Center and scanned with a whole-body 18F-FDG PET/CT. Patients with a history of cancer, recent surgery, or recent trigger point injections were excluded. Medications that may decrease FDG uptake were temporarily stopped. The location of the patients pain were identified by a physician, as well as the by the patient, and recorded on a standard whole-body diagram. The PET/CT scans were reviewed without knowledge of the location of the patient s pain, then correlated.Results Eight subjects included 5 women and 3 men, with an average age of 49 years. The average pain score was 7.5/10. The sites of pain primarily included the neck and back. The physician and patient reported sites of pain agreed in all cases. Only 1 out of the 8 patients studied had any abnormal 18F-FDG uptake seen on their PET/CT scan; all other scans were negative, both qualitatively and qualitatively. That one patient (see figure) had abnormal focal FDG uptake in the right T9/10 intervertebral space, which correlated with the radicular distribution of his pain along the right mid-back. Ultimately, an osteid osteoma was removed from this site with subsequent pain resolution.Conclusions Our hypothesis that FDG would show focal areas of muscle activity in patients with MPS was not borne out. These results suggest that increased glucose utilization is either not associated with muscle pain, or the degree of uptake is below the sensitivity for PET. As such, this study does not support the use of FDG PET for MPS. Other types of painful conditions may have different findings and should be studied.
Sturgeon JA, Tieu MM, Jastrzab LE, McCue R, Gandhi V, Mackey SC. Nonlinear Effects of Noxious Thermal Stimulation and Working Memory Demands on Subjective Pain Perception. Pain Med. 2015;16(7):1301-1310.
The 2011 Institute of Medicine report Relieving Pain in America estimates that 100 million adult Americans are affected by chronic pain, costing a staggering \$560 billion to \$635 billion annually. In the context of this immense personal and socioeconomic burden, it is essential that all stakeholders, including providers, patients, third-party payers, and policy makers, understand the necessities of appropriate, accurate assessment and treatment of patients with chronic pain. This review examines the psychosocial consequences of pain and existing disparities in treatment. Particular emphasis is given to the challenge of using prescription opioids in the treatment of chronic noncancer pain, given the ongoing epidemic of deaths from prescription opioid overdose. Strategies for initial risk assessment and ongoing monitoring are discussed for detecting opioid misuse, abuse, and addiction. In addition, the challenges of treating patients with comorbid pain and substance use disorder are reviewed, and the role of the addiction specialist is highlighted. The biopsychosocial model of pain is reviewed as a framework for the interdisciplinary, multimodal approach to pain management, which is often necessary to treat patients with complex chronic pain conditions and comorbid psychiatric diagnoses. An interdisciplinary team consisting of pain specialists, mental health providers, physical/occupational therapists, nurses, and primary care providers is necessary not only for ongoing assessment of multiple relevant outcomes but also for overseeing the delivery of multimodal treatments (e.g., medications, interventions, physical/occupational therapy, and psychosocial education). To move toward personalized treatment of patients with pain, future needs in research, clinical care, and education are discussed.