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Altered brain microstructure assessed by diffusion tensor imaging in patients with chronic pancreatitis
  1. Jens Brøndum Frøkjær1,2,
  2. Søren Schou Olesen1,
  3. Mikkel Gram1,
  4. Yousef Yavarian2,
  5. Stefan A W Bouwense3,
  6. Oliver H G Wilder-Smith4,
  7. Asbjørn Mohr Drewes1
  1. 1Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
  2. 2Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
  3. 3Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands
  4. 4Pain and Nociception Neuroscience Research Group, Department of Anaesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, The Netherlands
  1. Correspondence to Jens Brøndum Frøkjær, Mech-Sense, Department of Radiology, Aalborg Hospital, Aarhus University Hospital, PO Box 365, DK-9100 Aalborg, Denmark; jf{at}mech-sense.com

Abstract

Objective In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised and these findings were correlated to clinical pain scores.

Methods 23 patients with CP pain and 14 controls were studied in a 3T MR scanner. Apparent diffusion coefficient (ADC) (ie, diffusivity of water) and fractional anisotropy (FA) (ie, organisation of fibres) values were assessed in the amygdala, cingulate cortex, insula, prefrontal cortex and secondary sensory cortex. Daily pain scores and the Brief Pain Inventory Short Form were collected 1 week before the investigation.

Results In grey matter, patients had increased ADC values in amygdala, cingulate cortex, insula and prefrontal cortex, as well as decreased FA values in cingulate cortex and secondary sensory cortex. In white matter, patients had increased ADC values in insula and prefrontal cortex, and decreased FA values in insula and prefrontal cortex (all p values <0.05). An effect modification from the pain pattern (attacks vs continuous pain) was seen in the insula and secondary sensory cortex (p values <0.05), but no effect modifications from diabetes, alcoholic aetiology and opioid treatment were seen (all p values >0.05). Microstructural changes in cingulate and prefrontal cortices were correlated to patients' clinical pain scores.

Conclusion The findings suggest that microstructural changes of the brain accompany pain in CP. The changes are likely to be a consequence of ongoing pain and structural reorganisation of the neuromatrix as also seen in other diseases characterised by chronic pain.

  • MRI
  • pain
  • neuroplasticity
  • reorganisation
  • chronic pancreatitis
  • visceral nociception

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Footnotes

  • Funding The Karen Elise Jensen Foundation, SparNord Foundation, the Obelske Family Foundation and a Heinrich Kopp's Grant.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethical Committee for Region North Jutland in Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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