The posterior medial cortex in urologic chronic pelvic pain syndrome: Detachment from default mode network - A resting-state study from the MAPP Research Network

Katherine T. Martucci, William R. Shirer, Epifanio Bagarinao, Kevin A. Johnson, Melissa A. Farmer, Jennifer S. Labus, A. Vania Apkarian, Georg Deutsch, Richard E. Harris, Emeran A. Mayer, Daniel J. Clauw, Michael D. Greicius, Sean C. Mackey*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Altered resting-state (RS) brain activity, as a measure of functional connectivity (FC), is commonly observed in chronic pain. Identifying a reliable signature pattern of altered RS activity for chronic pain could provide strong mechanistic insights and serve as a highly beneficial neuroimaging-based diagnostic tool. We collected and analyzed RS functional magnetic resonance imaging data from female patients with urologic chronic pelvic pain syndrome (N 45) and matched healthy participants (N 45) as part of an NIDDK-funded multicenter project ( Using dual regression and seed-based analyses, we observed significantly decreased FC of the default mode network to 2 regions in the posterior medial cortex (PMC): the posterior cingulate cortex (PCC) and the left precuneus (threshold-free cluster enhancement, family-wise error corrected P < 0.05). Further investigation revealed that patients demonstrated increased FC between the PCC and several brain regions implicated in pain, sensory, motor, and emotion regulation processes (eg, insular cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus, putamen, amygdala, hippocampus). The left precuneus demonstrated decreased FC to several regions of pain processing, reward, and higher executive functioning within the prefrontal (orbitofrontal, anterior cingulate, ventromedial prefrontal) and parietal cortices (angular gyrus, superior and inferior parietal lobules). The altered PMC connectivity was associated with several phenotype measures, including pain and urologic symptom intensity, depression, anxiety, quality of relationships, and self-esteem levels in patients. Collectively, these findings indicate that in patients with urologic chronic pelvic pain syndrome, regions of the PMC are detached from the default mode network, whereas neurological processes of self-referential thought and introspection may be joined to pain and emotion regulatory processes.

Original languageEnglish (US)
Pages (from-to)1755-1764
Number of pages10
Issue number9
StatePublished - Sep 1 2015


  • Bladder pain syndrome
  • DMN
  • Default mode network
  • Dual regression
  • Interstitial cystitis
  • Posterior cingulate cortex
  • Precuneus
  • Resting state
  • fMRI

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'The posterior medial cortex in urologic chronic pelvic pain syndrome: Detachment from default mode network - A resting-state study from the MAPP Research Network'. Together they form a unique fingerprint.

Cite this