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PLoS One. 2015 Oct 13;10(10):e0140250. doi: 10.1371/journal.pone.0140250. eCollection 2015.

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.

Author information

1
Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
2
Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
3
Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
4
Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
5
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
6
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America.
7
Department of Physiology, Northwestern University, Chicago, Illinois, United States of America.
8
Department of Neurology, Stanford University, Palo Alto, California, United States of America.
9
Department of Anesthesiology, University of Alabama, Birmingham, Alabama, United States of America.
10
Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
11
Department of Radiology, University of Alabama, Birmingham, Alabama, United States of America.
12
Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America.
13
Division of Kidney, Urologic, and Hematologic Diseases; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health, Bethesda, Maryland, United States of America.
14
Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America; Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.

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.

PMID:
26460744
PMCID:
PMC4604194
DOI:
10.1371/journal.pone.0140250
[Indexed for MEDLINE]
Free PMC Article

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