Volume 132, Issue 4, Pages 1546-1556 (April 2007) Pain in Chronic Pancreatitis: The Role of Reorganization in the Central Nervous System  Georg Dimcevski, Saber A.K. Sami, Peter Funch–Jensen, Domenica Le Pera, Massimiliano Valeriani, Lars Arendt–Nielsen, Asbjørn M. Drewes  Gastroenterology  Volume 132, Issue 4, Pages 1546-1556 (April 2007) DOI: 10.1053/j.gastro.2007.01.037 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 The referred pain areas to painful electrical stimulation of the esophagus, stomach, and duodenum. The mean referred pain areas at the pain threshold to stimuli in the esophagus/stomach/duodenum were larger in the patients with CP, who also had greater individual differences in the referred pain location, compared with the healthy controls. Gastroenterology 2007 132, 1546-1556DOI: (10.1053/j.gastro.2007.01.037) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Grand mean averages of the brain potentials from the vertex evoked from painful electrical stimulation of the esophagus, stomach, and duodenum in patients with CP (solid lines) and healthy controls (stippled lines). The early components (N1, P1, and N2) are labeled. There were differences in the latencies between the potentials from the 2 groups (see Table 1). Gastroenterology 2007 132, 1546-1556DOI: (10.1053/j.gastro.2007.01.037) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 (A) The main topographic distribution (frontal [f], central [c], or occipital [o]) of the early components (N1, P1, and N2) of the evoked brain potentials to painful electrical stimulation of the esophagus (e), stomach (s), and duodenum (d). The numbers show the amount of healthy controls or patients with CP with a predominant activation in the given area. (B) To illustrate how the table was made, the topographic maps of the components N1, P1, and N2 to painful electrical stimulation of the esophagus in a typical control subject and in a typical patient with CP are shown. Gastroenterology 2007 132, 1546-1556DOI: (10.1053/j.gastro.2007.01.037) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Locations of dipoles fitting evoked brain potentials to painful esophagus, stomach, and duodenum stimulation (grand mean average of all subjects) in patients with CP and in healthy controls. The dipolar coordinates were projected onto brain representations issued from the Talairach and Tournoux atlas. (A) Dipole sources localized in the anterior cingulate gyrus. Note that in healthy subjects the cingulate dipoles to stomach and duodenum stimulations superimpose each other. (B) Middle bilateral generators in the secondary somatosensory area. (C) Bilateral dipoles corresponding to the insular regions. The insular dipoles differed between the groups for stimulation of all gut segments. Gastroenterology 2007 132, 1546-1556DOI: (10.1053/j.gastro.2007.01.037) Copyright © 2007 AGA Institute Terms and Conditions