Impaired insula functional connectivity associated with persistent pain perception in patients with complex regional pain syndrome

PLoS One. 2017 Jul 10;12(7):e0180479. doi: 10.1371/journal.pone.0180479. eCollection 2017.

Abstract

Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology*
  • Complex Regional Pain Syndromes / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neural Pathways / pathology
  • Neural Pathways / physiopathology*
  • Pain Perception / physiology*
  • Rest
  • Young Adult

Grants and funding

This study was funded by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2014R1A1A1004553) and Aspiring Researcher Program through Seoul National University (SNU) in 2014. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.