Deconstructing Somatic and Visceral Pain using Multimodal Neurobiological and Clinical Markers

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PROJECT SUMMARY/ABSTRACT Pain can be categorized as being somatic, which emanates from superficial body structures such as the skin and muscles, or visceral, which emanates from internal organs. The central nervous system (CNS) regulates both somatic and visceral pain. The relevant brain circuitry for pain encompasses a distributed set of regions including the cingulate, insular, frontal, and parietal cortices. Using innovative data analytic algorithms, the coordinated activity within this network of brain regions can be modeled as a connectome. The primary focus for the proposed F99 and K00 work is to better understand the shared and distinct features of the pain connectome in somatic vs. visceral pain. The clinical relevance of somatic and visceral pain is timely. Chronic pain is a major burden to society, as pain management in the U.S. remains poor, primarily due to a lack of understanding of CNS mechanisms behind pain. In many somatic pain conditions such as Fibromyalgia (FM), there is a dysfunction within mutliple CNS regions in the absence of any identifiable peripheral injury, leading to symptoms such as widespread body pain, fatigue, sleep problems, and heightened sensory sensitivity. This phenomenon goes by many terms including pain centralization, central sensitization, and nociplastic pain. Over recent years, there is increasing neurobiological evidence of these processes in visceral pain disorders such as Urologic Chronic Pelvic Pain Syndrome (UCPPS), yet there is still much that is unknown. My overall objective is to identify mechanisms in the connectome that contribute to chronic somatic and visceral pain. My short-term scientific and training goal during the F99 phase is to learn and apply connectome- based analytics to functional Magnetic Resonance Imaging (fMRI) data obtained from somatic pain conditions such as FM, and how non-pharmacologic treatment can modify the connectome. This offers a foundational premise for the long-term goal, which I will complete during the K00 phase, which is to investigate neurobiology of visceral pain of urologic origin, in conditions such as UCPPS and Overactive Bladder Syndrome (OAB). For the study of UCPPS and OAB, I will be leveraging data collected from two major NIDDK-funded multisite research initiatives: the Multidisciplinary Approach to the Study of Pelvic Pain (MAPP) Research Network and the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). Combined, the proposed F99 and K00 training plan will allow me to gain expertise and independence as a somatic and visceral pain researcher.