title: Anticipation of thermal pain in diverticular disease.
abstract: The relative importance of peripheral nerve injury or central pain processing in painful diverticular disease (DD) is unclear. Functional magnetic resonance imaging (fMRI) has demonstrated that dysfunctional central pain processing predominates in irritable bowel syndrome (IBS). This study aims to identify anticipatory changes in symptomatic DD (SDD) compared to asymptomatic DD (ADD) and IBS patients.
  
  
  
  Gastrointestinal symptoms and somatization were evaluated via the Patient Health Question-12 Somatic Symptom and the SDD group divided into low (≤6 [LSDD]) and high (≥7 [HSDD]) somatization. Cued painful cutaneous thermal stimuli were delivered to the left hand and foot during fMRI. Fixed effect group analysis of the 'cued' anticipatory phase was performed.
  
  
  
  Within the right posterior insula, greater deactivation was found in the ADD compared to other groups. In emotion processing centers, anterior and middle insula, greater activation was identified in all patient compared to the ADD group, and in LSDD compared to IBS and HSDD groups. In comparison, amygdala deactivation was greater in ADD than the IBS and HSDD groups, and in LSDD vs HSDD groups. Descending nociceptive control centers, such as the superior medial frontal and orbitofrontal cortex, also showed greater deactivation in the ADD and LSDD compared to the HSDD and IBS groups.
  
  
  
  The HSDD group have altered anticipatory responses to thermal pain, similar to IBS group. The LSDD are similar to ADD group. This suggests underlying differences in pain pathophysiology, and the need for individualized treatment strategies to target the cause of their chronic pain.
authors.affiliation: Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Smith
authors.affiliation: Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.|Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Marciani
authors.affiliation: Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.|Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Humes
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: S T
authors.initials: ST
authors.lastname: Francis
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Gowland
authors.affiliation: Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.|Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Spiller
mesh_terms: D000328:Adult; D000368:Aged; D059031:Anticipation, Psychological / Q000502:physiology; D058070:Asymptomatic Diseases / Q000523:psychology*; D001921:Brain / Q000000981:diagnostic imaging; D000076385:Diverticular Diseases / Q000000981:diagnostic imaging / Q000523:psychology*; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000000981:diagnostic imaging / Q000523:psychology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000523:psychology*; D017288:Pain Threshold / Q000502:physiology
keywords: anticipation; diverticular disease; functional MRI; pain