Defining Central Circuits of Pain
Defining Central Circuits of Pain
The purpose of the study is to use functional Magnetic Resonance Imaging (MRI) to help us
 understand what parts of the subject's brain are involved when he experiences visceral pain,
 or pain in the gut. To stimulate the brain, he will be infused with a liquid meal (Ensure)
 into his stomach until he is maximally full. Magnetic resonance imaging (MRI) is a technique
 for making images (pictures) of the brain; it uses magnetic fields and radio waves and is not
 harmful. This study uses a new investigational technique called functional MRI (fMRI), which
 is a very fast MRI technique that will allow the investigators to evaluate changes in how
 blood flows to parts of his brain.
Dyspepsia, a condition characterized by upper abdominal discomfort, is one of the most common
 types of pains in clinical practice and is one of the most common reasons for visits to
 primary care physicians and gastroenterologists. But relative to somatic pain, little
 fundamental information is known about visceral pain syndromes such as dyspepsia and
 irritable bowel syndrome. Recent exciting advances in neuroimaging such as functional
 magnetic resonance imaging (fMRI) have allowed investigators to interrogate neural signal
 changes in humans in a wide variety of pain conditions. But to date neuroimaging has not
 provided details of activation in specific neural circuits that are important in visceral
 pain. In these experiments we will focus on specific regions of interest (ROI's) that have
 shown to be relevant in animal models of pain circuitry including the dorsal column nuclei,
 the thalamus, the hypothalamus, the amygdala and the periaqueductal gray.

 The specific aims of our proposed project are:

 1. To measure fMRI signal in primary visceral afferent pain pathways (dorsal column nuclei
 and thalamus) in normal human subjects and in patients with dyspepsia following
 instilling a liquid meal at a fixed rate into the stomach until maximal satiety, a
 surrogate model of dyspepsia.

 2. To measure fMRI signal in autonomic pathways (hypothalamus and amygdala) and in
 endogenous analgesic pathways (periaqueductal gray/PAG) in normal human subjects and in
 patients with dyspepsia using the above model.

 3. To correlate physiological parameters (heart rate, skin conductance, respiratory rate)
 to hedonic ratings (ratings on a visual analogue scale of satiety, nausea, bloating, and
 pain) during the liquid meal stimulus in normal human subjects and patients with
 dyspepsia.

 In all these experiments we will correlate alterations in psychophysical measures which have
 traditional measures of pain response (e.g., pain and other hedonic ratings, physiological
 monitoring such as heart rate, etc) with the changes in fMRI signal in specific areas of the
 brain.
Inclusion Criteria:

 -  Right handed men and non-pregnant women ages 18 to 64

 Exclusion Criteria:

 -  Diabetes

 -  History of aspiration or severe respiratory complications linked to gastrointestinal
 disease

 -  Use of any over the counter medications within 7 days of the study

 -  Current or previous history of gastric surgery

 -  Use of any medications which may alter gastrointestinal motility