Distinct connectivity patterns subserve 2 dimensions of the chronic pain experience

Identifying the neural correlates of chronic pain and their relationship to clinically relevant measures of disease has proven challenging due to high variability in individual patterns of functional brain connectivity and the rarity of ecologically valid scanning paradigms. Here, we address these limitations using data from the Multidisciplinary Approach to the Study of Pelvic Pain Symptom Patterns Study, which recruited a large sample of urologic chronic pain patients (n = 382) imaged repeatedly (range = 2-4) over 36 months. Intrinsic brain connectivity was recorded before and after a naturalistic challenge designed to elicit symptomatic pain and discomfort. Linear mixed-effects models revealed 2 neuroanatomically distinct patterns: pain at the time of scan was linked to connectivity within sensory-discriminative regions, while past-week recalled pain was associated with distributed patterns across regions implicated in memory, salience, and affective processing. These findings emphasize the dynamic roles of brain regions for different aspects of chronic pain.