The posterior medial cortex in urologic chronic pelvic pain syndrome

Abstract

Altered resting-state brain activity, as a measure of functional connectivity, is commonly observed in chronic pain. Identifying a reliable signature pattern of altered resting-state activity for chronic pain could provide strong mechanistic insights and serve as a highly beneficial neuroimaging-based diagnostic tool. We collected and analyzed resting-state fMRI data from female patients with urologic chronic pelvic pain syndrome (UCPPS, N = 45) and matched healthy participants (N = 45) as part of a NIDDK funded multicenter project (www.mappnetwork.org). Using dual regression and seed-based analyses, we observed significantly decreased functional connectivity of the default mode network (DMN) to two regions in the posterior medial cortex (PMC): the posterior cingulate cortex (PCC) and left precuneus (TFCE, FWE corrected p<0.05). Further investigation revealed that patients demonstrated increased functional connectivity between the PCC and several brain regions implicated in pain, sensory, motor, and emotion regulation processes (e.g., insular cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus, putamen, amygdala, hippocampus). The left precuneus demonstrated decreased functional connectivity to several regions of pain processing, reward, and higher executive functioning within the prefrontal (orbitofrontal, anterior cingulate, ventromedial prefrontal) and parietal cortices (angular gyrus, superior and inferior parietal lobules). The altered PMC connectivity was associated with several phenotype measures, including pain and urologic symptom intensity, depression, anxiety, quality of relationships and self-esteem levels in patients. Collectively, these findings indicate that in UCPPS patients, regions of the PMC are detached from the DMN, while neurological processes of self-referential thought and introspection may be joined to pain and emotion regulatory processes.

Bladder Distension Increases Blood Flow in Pain Related Brain Structures in Subjects with Interstitial Cystitis

“…Given their symptomatology, one must assume that the sensation of bladder fullness is of high importance to IC subjects and so the results of the present study may simply reflect the mental state of the IC patient. Other studies performed by our group also give evidence of differences between ICs and HCs when connectivity and structural differences are measured 12, 27–30 . Coupled with the present study, these converging lines of evidence give strong support for the assertion that CNS function differs in these two populations.…”

Sex‐based differences in brain alterations across chronic pain conditions

“…Both female- and male-specific studies have demonstrated increased emotional-arousal reactivity (amygdala and hippocampus) and altered connectivity during pain in patients compared to same-sex controls (Gingnell et al 2012; Howard et al 2012; Jensen et al 2012; Kamping et al 2013; Khan et al 2014; Kim et al 2013; Liu et al 2015b; Liu et al 2012; Martucci et al 2015; May et al 1998a; Mayer et al 2005; Qiu et al 2013; Sprenger et al 2006; Wilder-Smith et al 2004). …”

Brain white matter plasticity and functional reorganization underlying the central pathogenesis of trigeminal neuralgia

“…The medial PFC activation in the expectation of pain intensity indicated complex modulation to adjust sensory, cognitive and motor systems for adequate neural and behavioral responses45. As another critical part in the DMN, the precuneus has shown decreased connectivity with several regions of pain processing, reward, and higher executive functioning within the prefrontal and parietal cortices46. The angular gyrus, moreover, is a main part of the inferior parietal lobule (IPL), which is involved in several cognitive domains and important nodes of the DMN.…”