Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study

Abstract

Studies have suggested chronic pain syndromes are associated with neural reorganization in specific regions associated with perception, processing, and integration of pain. Urological chronic pelvic pain syndrome (UCPPS) represents a collection of pain syndromes characterized by pelvic pain, namely Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), that are both poorly understood in their pathophysiology, and treated ineffectively. We hypothesized patients with UCPPS may have microstructural differences in the brain compared with healthy control subjects (HCs), as well as patients with irritable bowel syndrome (IBS), a common gastrointestinal pain disorder. In the current study we performed population-based voxel-wise DTI and super-resolution track density imaging (TDI) in a large, two-center sample of phenotyped patients from the multicenter cohort with UCPPS (N = 45), IBS (N = 39), and HCs (N = 56) as part of the MAPP Research Network. Compared with HCs, UCPPS patients had lower fractional anisotropy (FA), lower generalized anisotropy (GA), lower track density, and higher mean diffusivity (MD) in brain regions commonly associated with perception and integration of pain information. Results also showed significant differences in specific anatomical regions in UCPPS patients when compared with IBS patients, consistent with microstructural alterations specific to UCPPS. While IBS patients showed clear sex related differences in FA, MD, GA, and track density consistent with previous reports, few such differences were observed in UCPPS patients. Heat maps illustrating the correlation between specific regions of interest and various pain and urinary symptom scores showed clustering of significant associations along the cortico-basal ganglia-thalamic-cortical loop associated with pain integration, modulation, and perception. Together, results suggest patients with UCPPS have extensive microstructural differences within the brain, many specific to syndrome UCPPS versus IBS, that appear to be localized to regions associated with perception and integration of sensory information and pain modulation, and seem to be a consequence of longstanding pain.

Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network

“…Other MAPP analyses examining cross-sectional clinical and neuroimaging data have also found more similarity than differences across men and women with UCPPS 5, 2930 . Also, neither income level (as a marker of social economic status) nor UCPPS chronicity were significant predictors of outcome.…”

Resting-state functional connectivity predicts longitudinal pain symptom change in urologic chronic pelvic pain syndrome: a MAPP network study

“…Recently, several changes in brain structure and function have been identified in patients with UCPPS compared to healthy individuals [3; 10; 17; 19; 22; 27; 46], but it is unknown whether there are brain features that predict longitudinal symptom change in symptoms of UCPPS. Here, we begin the process of identifying such brain features by examining the ability of functional connectivity measures derived from resting state functional MRI (rs-fMRI).…”

Chronic prostatitis/chronic pelvic pain syndrome is associated with previous colonoscopy

“…A combination of alterations to the nervous system with endocrine, psychosocial, or immunological abnormalities leads to the chronic state of CP/CPPS. 4,[7][8][9][10] Colonoscopy is a common procedure for diagnosing a wide range of conditions and symptoms, including chronic abdominal or pelvic pain, neoplasms, and colitis. Numerous studies indicated that the colonoscopic examination itself may induce abdominal pain and transient bacterial infections.…”