title: Pain-associated adaptive cortical reorganisation in chronic pancreatitis.
abstract: OBJECTIVE
  In various chronic pain conditions cortical reorganisation seems to play a role in the symptomatology. The aims of this study were to investigate cortical reorganisation in patients with pain caused by chronic pancreatitis (CP) and to correlate putative cortical reorganisation to clinical pain scores.
  
  
  METHODS
  24 patients suffering from CP and 14 healthy volunteers were included. Patients' daily experience of pain was recorded in a pain diary. The sigmoid was stimulated electrically with simultaneous recording of evoked brain potentials (EPs). The brain source localisations reflecting direct neuronal activity were fitted by a five-dipole model projected to magnetic resonance imaging of the individual brains.
  
  
  RESULTS
  Patients showed prolonged latencies of the EPs confined to the frontal region of the brain (p < 0.01). The corresponding brain sources were located in the bilateral insula, cingulate gyrus and bilateral secondary somatosensory area. The insular dipoles were localised more posterior in the patients than in healthy subjects (p < 0.01). The shift in insular dipole localisation was negatively correlated with the patients' clinical pain scores (p < 0.05).
  
  
  CONCLUSIONS
  The findings indicate that sustained pain in CP leads to functional reorganisation of the insular cortex. We suggest its physiological correlate to be an adaptive response to chronic pain. and IAP.
authors.affiliation: Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
authors.forename: Søren Schou
authors.initials: SS
authors.lastname: Olesen
authors.forename: Jens Brøndum
authors.initials: JB
authors.lastname: Frøkjær
authors.forename: Dina
authors.initials: D
authors.lastname: Lelic
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Valeriani
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000503:physiopathology; D000222:Adaptation, Physiological; D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D004386:Duodenum / Q000294:innervation; D004558:Electric Stimulation; D004947:Esophagus / Q000294:innervation; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010179:Pancreas; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000503:physiopathology; D013153:Splanchnic Nerves / Q000503:physiopathology; D013270:Stomach / Q000294:innervation; D055815:Young Adult