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Abnormal forebrain activity in functional bowel disorder patients with chronic pain.
Neurology. 2005 Oct 25; 65(8):1268-77.Neur

Abstract

BACKGROUND

Abnormal cortical pain responses in patients with fibromyalgia and conversion disorder raise the possibility of a neurobiologic basis underlying so-called "functional" chronic pain.

OBJECTIVE

To use percept-related fMRI to test the hypothesis that patients with a painful functional bowel disorder do not process visceral input or sensations normally or effectively at the cortical level.

METHODS

Eleven healthy subjects and nine patients with irritable bowel syndrome (IBS) underwent fMRI during rectal distensions that elicited either a moderate level of urge to defecate or pain. Subjects continuously rated their rectal stimulus-evoked urge or pain sensations during fMRI acquisition. fMRI data were interrogated for activity related to stimulus presence and to specific sensations.

RESULTS

In IBS, abnormal responses associated with rectal-evoked sensations were identified in five brain regions. In primary sensory cortex, there were urge-related responses in the IBS but not control group. In the medial thalamus and hippocampus, there were pain-related responses in the IBS but not control group. However, pronounced urge- and pain-related activations were present in the right anterior insula and the right anterior cingulate cortex in the control group but not the IBS group.

CONCLUSIONS

Percept-related fMRI revealed abnormal urge- and pain-related forebrain activity during rectal distension in patients with irritable bowel syndrome (IBS). As visceral stimulation evokes pain and triggers unconscious processes related to homeostasis and reflexes, abnormal brain responses in IBS may reflect the sensory symptoms of rectal pain and hypersensitivity, visceromotor dysfunction, and abnormal interoceptive processing.

Authors+Show Affiliations

Institute of Medical Science, University of Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16247056

Citation

Kwan, C L., et al. "Abnormal Forebrain Activity in Functional Bowel Disorder Patients With Chronic Pain." Neurology, vol. 65, no. 8, 2005, pp. 1268-77.
Kwan CL, Diamant NE, Pope G, et al. Abnormal forebrain activity in functional bowel disorder patients with chronic pain. Neurology. 2005;65(8):1268-77.
Kwan, C. L., Diamant, N. E., Pope, G., Mikula, K., Mikulis, D. J., & Davis, K. D. (2005). Abnormal forebrain activity in functional bowel disorder patients with chronic pain. Neurology, 65(8), 1268-77.
Kwan CL, et al. Abnormal Forebrain Activity in Functional Bowel Disorder Patients With Chronic Pain. Neurology. 2005 Oct 25;65(8):1268-77. PubMed PMID: 16247056.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal forebrain activity in functional bowel disorder patients with chronic pain. AU - Kwan,C L, AU - Diamant,N E, AU - Pope,G, AU - Mikula,K, AU - Mikulis,D J, AU - Davis,K D, PY - 2005/10/26/pubmed PY - 2006/4/15/medline PY - 2005/10/26/entrez SP - 1268 EP - 77 JF - Neurology JO - Neurology VL - 65 IS - 8 N2 - BACKGROUND: Abnormal cortical pain responses in patients with fibromyalgia and conversion disorder raise the possibility of a neurobiologic basis underlying so-called "functional" chronic pain. OBJECTIVE: To use percept-related fMRI to test the hypothesis that patients with a painful functional bowel disorder do not process visceral input or sensations normally or effectively at the cortical level. METHODS: Eleven healthy subjects and nine patients with irritable bowel syndrome (IBS) underwent fMRI during rectal distensions that elicited either a moderate level of urge to defecate or pain. Subjects continuously rated their rectal stimulus-evoked urge or pain sensations during fMRI acquisition. fMRI data were interrogated for activity related to stimulus presence and to specific sensations. RESULTS: In IBS, abnormal responses associated with rectal-evoked sensations were identified in five brain regions. In primary sensory cortex, there were urge-related responses in the IBS but not control group. In the medial thalamus and hippocampus, there were pain-related responses in the IBS but not control group. However, pronounced urge- and pain-related activations were present in the right anterior insula and the right anterior cingulate cortex in the control group but not the IBS group. CONCLUSIONS: Percept-related fMRI revealed abnormal urge- and pain-related forebrain activity during rectal distension in patients with irritable bowel syndrome (IBS). As visceral stimulation evokes pain and triggers unconscious processes related to homeostasis and reflexes, abnormal brain responses in IBS may reflect the sensory symptoms of rectal pain and hypersensitivity, visceromotor dysfunction, and abnormal interoceptive processing. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/16247056/Abnormal_forebrain_activity_in_functional_bowel_disorder_patients_with_chronic_pain_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=16247056 DB - PRIME DP - Unbound Medicine ER -