Changes in amygdalar functional connectivity following the water load symptom provocation task (WL-SPT) in youth with functional abdominal pain disorders

ABSTRACT Pediatric functional abdominal pain disorders (FAPD) are highly prevalent, difficult to diagnose and challenging to treat. The brain mechanisms supporting FAPD remain poorly understood. This investigation examined the neuromechanisms of FAPD during a well-tolerated visceral pain induction task, the water load symptom provocation task (WL-SPT). Youth between the ages of 11 and 17 years participated. Functional connectivity (FC) was examined via the Blood Oxygenation Level Dependent (BOLD) effect using the left and right amygdala (AMY) as seed regions. Relationships of the time courses within these seeds with voxels across the whole brain were evaluated. Arterial spin labeling (ASL) was used to assess regional brain activation by examining cerebral blood flow. Increased FC between the left AMY with regions associated with nociceptive processing (e.g., thalamus), and right AMY FC changes with areas associated with cognitive functioning (dorsolateral prefrontal cortex) and the default mode network (DMN; parietal lobe) were observed in youth with FAPD following the WL-SPT. These changes were related to changes in pain unpleasantness. AMY FC changes post WL-SPT were also related to changes in pain intensity. AMY FC with the DMN in youth with FAPD also differed from healthy controls. Global CBF changes were also noted between FAPD and controls, but no significant differences in grey matter were detected either between groups or during the WL-SPT in youth with FAPD. Findings confirm youth with FAPD have changes in brain connectivity that could support the development of biomarkers to enhance understanding of the mechanisms of pain and treatment response.