Do patients with functional chest pain have neuroplastic reorganization of the pain matrix? A diffusion tensor imaging study

Author:

Frøkjær Jens Brøndum1,Boldea Andra Sorina1,Hoff Dag Arne Lihaug2,Krarup Anne Lund3,Hatlebakk Jan Gunnar4,Dimcevski Georg4,Drewes Asbjørn Mohr25

Affiliation:

1. Mech-Sense, Department of Radiology , Aalborg University Hospital , Aalborg , Denmark

2. Dept. of Medicine, Div. of Gastroenterology and Hepatology , Aalesund Hospital , Aalesund , Norway

3. Mech-Sense, Department of Gastroenterology & Hepatology , Aalborg University Hospital , Aalborg 9100 , Denmark

4. Department of Medicine, Div. of Gastroenterology and Hepatology , Haukeland University Hospital , Bergen , Norway

5. Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology , Aalborg University , Aalborg , Denmark

Abstract

Abstract Background and aims In functional chest pain (FCP) of presumed esophageal origin central nervous system hyperexcitability is generally believed to play an important role in pain pathogenesis. However, this theory has recently been challenged. Using magnetic resonance diffusion tensor imaging, the aim was to characterize any microstructural reorganization of the pain neuromatrix in FCP patients. Methods 13 FCP patients and 20 matched healthy controls were studied in a 3T MR scanner. Inclusion criteria were relevant chest pain, normal coronary angiogram and normal upper gastrointestinal evaluation. Apparent diffusion coefficient (ADC) (i.e. mean diffusivity of water) and fractional anisotropy (FA) (i.e. directionality of water diffusion as a measure of fiber organization) values were assessed in the secondary sensory cortex, cingulate cortex, insula, prefrontal cortex, and amygdala. Results Overall, including all regions, no difference in ADC and FA values was found between the patients and controls (P = 0.79 and P = 0.23, respectively). Post-hoc tests revealed no difference in ADC and FA values of the individual regions. However, a trend of patients having increased ADC in the mid insula grey matter and increased FA in the mid insula white matter was observed (both P = 0.065). Conclusions This explorative study suggests that microstructural reorganization of the central pain neuromatrix may not be present in well-characterized FCP patients. Implications This finding, together with recent neurophysiologal evidence, challenges the theory of visceral hypersensitivity due to changes in the central nervous system in FCP patients.

Publisher

Walter de Gruyter GmbH

Subject

Anesthesiology and Pain Medicine,Clinical Neurology

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