For several years, there has been research showing changes in PET scans and functional MRI in association with functional abdominal pain.  A recent article goes a step further showing microstructure  brain changes in patients with chronic pancreatitis (Gut 2011; 60: 1554-62).

This study examined 23 patients with pain due to chronic pancreatitis and 14 controls.  Using a 3T MR scanner, apparent diffusion coefficients (ADC) and ‘fractional anistotropy’ (FA) values were assessed in numerous parts throughout the brain.  This new technology, uses an MRI for diffusion tensor imaging which assesses changes in white and grey matter microstructure not evident with more conventional imaging.  Chronic pancreatitis patients had increased ADC in the amygdala, cingulate cortex, and prefrontal cortex.  In addition, FA values were reduced in the cingulate cortex and secondary sensory cortex.  These areas of the brain with these changes are known to be involved in the processing of visceral pain.  Microstructural changes were correlated to patients’ clinical pain scores.  Some of the changes can be influenced by other factors including alcohol usage, depression, Alzheimer’s or diabetes.

This study echoes findings from others that demonstrate structural reorganization of the brain in association with chronic pain.

Additional references:

• -Gastroenterology 2010; 139: 1310. n=15 IBS women, 12 controls.  IBS pts have emotional modulation of neural responses to visceral stimuli (eg rectal stimulation) –based on functional MRI studies.
• -Gastroenterology 2006; 130: 26 & 34. Functional MRI measured in response to barostat show increased sensitivity in pts c IBS. Also, altered 5-HT signaling in IBS-D & IBS-C.
• -J Pediatr 2001; 139: 838-843. Pts c IBS, RAP more sensitive to visceral perception in rectum and stomach respectively.
• -Gastroenterology 2005; 128: 1819. Brain response to visceral aversive conditioning –>similar cortical responses between actual and anticipated stimuli.
• -Cereb Cortex 2010; 20: 1409-19.  Changes in brain anatomy associated with neuropathic pain following spinal cord injury.
• -J Am Acad Child Adolesc Psychiatry 2010; 49: 173-83.  White matter microstructure changes in adolescents with major depression.