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Pain. 2017 Oct;158(10):1979-1991. doi: 10.1097/j.pain.0000000000001001.

Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study.

Author information

1
aDivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USAbDepartment of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USAcOppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USAdDepartment of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USAeDepartment of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA, USAfDepartments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USAgDepartment of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USAhDepartment of Urology, University of Southern California, Los Angeles, CA, USAiDepartment of Urology, University of Iowa, Iowa City, IA, USAjCollege of Medicine, Washington State University, Seattle, WA, USAkDepartment of Urology, Washington University, Saint Louis, MO, USAlNational Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USAmDepartment of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USAnDepartment of Urology, University of Michigan, Ann Arbor, MI, USA.

Abstract

Chronic pain is often measured with a severity score that overlooks its spatial distribution across the body. This widespread pain is believed to be a marker of centralization, a central nervous system process that decouples pain perception from nociceptive input. Here, we investigated whether centralization is manifested at the level of the brain using data from 1079 participants in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network (MAPP) study. Participants with a clinical diagnosis of urological chronic pelvic pain syndrome (UCPPS) were compared to pain-free controls and patients with fibromyalgia, the prototypical centralized pain disorder. Participants completed questionnaires capturing pain severity, function, and a body map of pain. A subset (UCPPS N = 110; fibromyalgia N = 23; healthy control N = 49) underwent functional and structural magnetic resonance imaging. Patients with UCPPS reported pain ranging from localized (pelvic) to widespread (throughout the body). Patients with widespread UCPPS displayed increased brain gray matter volume and functional connectivity involving sensorimotor and insular cortices (P < 0.05 corrected). These changes translated across disease diagnoses as identical outcomes were present in patients with fibromyalgia but not pain-free controls. Widespread pain was also associated with reduced physical and mental function independent of pain severity. Brain pathology in patients with centralized pain is related to pain distribution throughout the body. These patients may benefit from interventions targeting the central nervous system.

PMID:
28692006
PMCID:
PMC5964335
DOI:
10.1097/j.pain.0000000000001001
[Indexed for MEDLINE]
Free PMC Article

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