Basic–liver, pancreas, and biliary tractPain in Chronic Pancreatitis: The Role of Reorganization in the Central Nervous System
Section snippets
Subjects
Seventy patients who potentially could be enrolled in the study were included from the medical and surgical departments at Aalborg, Herning, and Aarhus hospitals in Denmark. The Marseille-Rome/Cambridge diagnostic criteria for CP were used.24 The patients were all well known by the researchers, but most suffered from diseases with the potential to confound the experiment such as long-lasting diabetes or low back pain, or they used analgesics or had intermittent alcohol intake, and so forth.
Pain Intensity and Description
All subjects reported painful sensations from the electrical stimulation in all 3 gut segments. The impedance between the stimulation electrodes was less than 2 KΩ in all experiments. The mean current intensities for the controls in the esophagus, stomach, and duodenum were 12.8 ± 3.9, 24.9 ± 8.2, and 23.1 ± 12.1 mA, respectively. For the patients the mean current intensities were 10.2 ± 1.2, 24.4 ± 11.9, and 16.3 ± 7.6 mA, respectively. Between controls and patients there were no statistical
Discussion
This article addresses cortical reorganization in patients suffering from pain caused by a well-defined organic GI disease. The stimulation technique allowed us to stimulate 3 regions of the upper GI tract with the same methodology. The evoked brain potentials differed in latency and topographic distribution between patients with CP and controls. The dipolar sources in the cingulate cortex and in the insula also differed between the groups. The neuronal sources in the insula were changed most
Conclusions
The pathogenesis of pain in CP is poorly understood. There is a growing body of evidence that neuroplastic changes such as those seen in neuropathic pain and other chronic pain disorders may be of importance. The current findings of cortical reorganization in the insula together with reduced EP latency support the theory that cortical reorganization is a mechanism involved in patients with CP. This insight may lead to changes in the current concept for treatment of pain originating from the
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Supported by the Danish Technical Research Council and “Nordjyllands Amts Forskningsfond.”