title: The posterior medial cortex in urologic chronic pelvic pain syndrome: detachment from default mode network-a resting-state study from the MAPP Research Network.
abstract: Altered resting-state (RS) brain activity, as a measure of functional connectivity (FC), is commonly observed in chronic pain. Identifying a reliable signature pattern of altered RS activity for chronic pain could provide strong mechanistic insights and serve as a highly beneficial neuroimaging-based diagnostic tool. We collected and analyzed RS functional magnetic resonance imaging data from female patients with urologic chronic pelvic pain syndrome (N = 45) and matched healthy participants (N = 45) as part of an NIDDK-funded multicenter project (www.mappnetwork.org). Using dual regression and seed-based analyses, we observed significantly decreased FC of the default mode network to 2 regions in the posterior medial cortex (PMC): the posterior cingulate cortex (PCC) and the left precuneus (threshold-free cluster enhancement, family-wise error corrected P < 0.05). Further investigation revealed that patients demonstrated increased FC between the PCC and several brain regions implicated in pain, sensory, motor, and emotion regulation processes (eg, insular cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus, putamen, amygdala, hippocampus). The left precuneus demonstrated decreased FC to several regions of pain processing, reward, and higher executive functioning within the prefrontal (orbitofrontal, anterior cingulate, ventromedial prefrontal) and parietal cortices (angular gyrus, superior and inferior parietal lobules). The altered PMC connectivity was associated with several phenotype measures, including pain and urologic symptom intensity, depression, anxiety, quality of relationships, and self-esteem levels in patients. Collectively, these findings indicate that in patients with urologic chronic pelvic pain syndrome, regions of the PMC are detached from the default mode network, whereas neurological processes of self-referential thought and introspection may be joined to pain and emotion regulatory processes.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, CA, USA Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA Department of Physiology, Northwestern University, Chicago, IL, USA Department of Medicine, David Geffen School of Medicine, Division of Digestive Diseases, University of California, Los Angeles, CA, USA Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA Department of Anesthesiology, University of Michigan Ann Arbor, Ann Arbor, MI, USA.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Martucci
authors.forename: William R
authors.initials: WR
authors.lastname: Shirer
authors.forename: Epifanio
authors.initials: E
authors.lastname: Bagarinao
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Johnson
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Farmer
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Labus
authors.forename: A Vania
authors.initials: AV
authors.lastname: Apkarian
authors.forename: Georg
authors.initials: G
authors.lastname: Deutsch
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Emeran A
authors.initials: EA
authors.lastname: Mayer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.forename: Michael D
authors.initials: MD
authors.lastname: Greicius
authors.forename: Sean C
authors.initials: SC
authors.lastname: Mackey
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology*; D059350:Chronic Pain / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009434:Neural Pathways / Q000502:physiology; D017699:Pelvic Pain / Q000209:etiology / Q000473:pathology*; D025341:Principal Component Analysis; D012146:Rest; D014570:Urologic Diseases / Q000150:complications; D055815:Young Adult