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Neuroimage Clin. 2015 Jun 5;8:493-502. doi: 10.1016/j.nicl.2015.05.013. eCollection 2015.

Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP: Research Network Neuroimaging Study.

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Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
Physical Therapy Department, Loma Linda University, Loma Linda, CA, USA.
Department of Psychology, University of Southern California, Los Angeles, CA, USA.
Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Division of Pain Medicine, Stanford, CA, USA.
Departments of Radiology and Anesthesiology, Birmingham Medical Center, University of Alabama, Birmingham, AL, USA.
Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA.
National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA.


Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing.

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