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Van Damme S, Lorenz J, Eccleston C, Koster EHW, De Clercq A, Crombez G. Fear-conditioned cues of impending pain facilitate attentional engagement. Neurophysiol Clin 2004; 34:33-9. [PMID: 15030798 DOI: 10.1016/j.neucli.2003.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Revised: 11/17/2003] [Accepted: 11/17/2003] [Indexed: 11/25/2022] Open
Abstract
AIMS OF STUDY Selective attention to signals of impending pain allows the avoidance of bodily harm. In order to identify the attentional components involved in the selection of pain signals over competing demands, we used an emotional modification of an exogenous cueing task. METHODS Fifty-two pain-free volunteers detected visual targets of which the location was correctly or incorrectly predicted by a spatial cue. Cues were emotionally modulated using differential classical conditioning. The conditioned cue (CS+) was sometimes followed by an electrocutaneous stimulus (UCS), thus becoming a pain signal, whereas the UCS never followed the other cue (CS-), referred to as safety signal. RESULTS Analyses of response times showed that pain signals facilitated the directing of attention to their location in comparison to safety signals. In contrast, pain signals did not impair disengagement of attention from their location in comparison to safety signals. CONCLUSION It is concluded that attention is more strongly engaged to a signal of impending pain compared with a cue signalling its absence. We explore why disengagement from the pain signal is not impaired compared to the safety signal. The findings are discussed in terms of the defensive importance of pain anticipation.
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102
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Critchley HD, Wiens S, Rotshtein P, Ohman A, Dolan RJ. Neural systems supporting interoceptive awareness. Nat Neurosci 2004; 7:189-95. [PMID: 14730305 DOI: 10.1038/nn1176] [Citation(s) in RCA: 2217] [Impact Index Per Article: 110.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Accepted: 11/26/2003] [Indexed: 12/30/2022]
Abstract
Influential theories of human emotion argue that subjective feeling states involve representation of bodily responses elicited by emotional events. Within this framework, individual differences in intensity of emotional experience reflect variation in sensitivity to internal bodily responses. We measured regional brain activity by functional magnetic resonance imaging (fMRI) during an interoceptive task wherein subjects judged the timing of their own heartbeats. We observed enhanced activity in insula, somatomotor and cingulate cortices. In right anterior insular/opercular cortex, neural activity predicted subjects' accuracy in the heartbeat detection task. Furthermore, local gray matter volume in the same region correlated with both interoceptive accuracy and subjective ratings of visceral awareness. Indices of negative emotional experience correlated with interoceptive accuracy across subjects. These findings indicate that right anterior insula supports a representation of visceral responses accessible to awareness, providing a substrate for subjective feeling states.
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Affiliation(s)
- Hugo D Critchley
- Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, and Autonomic Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals, UK.
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103
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Kern M, Hofmann C, Hyde J, Shaker R. Characterization of the cerebral cortical representation of heartburn in GERD patients. Am J Physiol Gastrointest Liver Physiol 2004; 286:G174-81. [PMID: 14512287 DOI: 10.1152/ajpgi.00184.2003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although symptoms arising from the esophagus such as heartburn and pain can at times become challenging clinical problems, esophageal viscerosensation, especially with regard to chemical stimulation in humans, is incompletely understood. Our aims were 1) to characterize and ascertain the reproducibility of cerebral cortical registration of heartburn and 2) to elucidate the differences between these findings and those of esophageal subliminal acid stimulation in asymptomatic controls. We studied 11 gastroesophageal reflux disease (GERD) patients (9 males, 30-55 yr) and 15 healthy controls (8 males, 21-49 yr). Cerebral cortical functional magnetic resonance imaging (fMRI) activity was recorded twice in each subject, during two 5-min intervals of 0.1 N HCl, separated by 5 min of NaCl perfusion. Time from onset of acid perfusion to instant of fMRI signal increase and first report of heartburn averaged 1.60 +/- 0.80 and 1.85 +/- 0.60 min, respectively. Average maximum percent signal increase in the GERD patients (16.3 +/- 3.5%) was significantly greater than that of healthy controls (3.8 +/- 0.9%; P < 0.01). Temporal fMRI signal characteristics during heartburn were significantly different from those of subliminal acid stimulation in controls (P < 0.01). Activated cortical regions included sensory/motor, parieto-occipital, cingulate and prefrontal regions, and the insula. There was 92% concordance between the activated Brodmann areas in repeated studies of GERD patients. Cortical activity associated with perceived and unperceived esophageal acid exposure in GERD patients and healthy controls, respectively, involves multiple brain regions but occurs more rapidly and with greater intensity in GERD patients than the activity in response to subliminal acid exposure in healthy controls. The cortical pain-processing pathway seems to be involved in perception of esophageal acid exposure and could explain the variations encountered in clinical practice defining this sensation.
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Affiliation(s)
- Mark Kern
- Medical College of Wisconsin Dysphagia Institute, Division of Gastroenterology and Hepatology, Digestive Disease Center, Biophysics Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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104
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Carlsson K, Petersson KM, Lundqvist D, Karlsson A, Ingvar M, Ohman A. Fear and the Amygdala: Manipulation of Awareness Generates Differential Cerebral Responses to Phobic and Fear-Relevant (but Nonfeared) Stimuli. Emotion 2004; 4:340-53. [PMID: 15571433 DOI: 10.1037/1528-3542.4.4.340] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rapid response to danger holds an evolutionary advantage. In this positron emission tomography study, phobics were exposed to masked visual stimuli with timings that either allowed awareness or not of either phobic, fear-relevant (e.g., spiders to snake phobics), or neutral images. When the timing did not permit awareness, the amygdala responded to both phobic and fear-relevant stimuli. With time for more elaborate processing, phobic stimuli resulted in an addition of an affective processing network to the amygdala activity, whereas no activity was found in response to fear-relevant stimuli. Also, right prefrontal areas appeared deactivated, comparing aware phobic and fear-relevant conditions. Thus, a shift from top-down control to an affectively driven system optimized for speed was observed in phobic relative to fear-relevant aware processing.
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Affiliation(s)
- Katrina Carlsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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105
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De Wachter S, Wyndaele JJ. Frequency-volume charts: A tool to evaluate bladder sensation. Neurourol Urodyn 2003; 22:638-42. [PMID: 14595606 DOI: 10.1002/nau.10160] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Bladder sensation is routinely evaluated by cystometric bladder filling and electrical stimulation. These methods require catheterization and stimulate the bladder artificially. In this study, we evaluated whether frequency-volume charts can be used as a non-invasive tool to study bladder sensation during normal daily life. Furthermore the agreement between sensory data obtained from frequency-volume charts and conventional cystometric bladder filling is studied. MATERIALS AND METHODS Fifteen healthy female students filled out frequency-volume charts at home and scored the grade of perception of bladder fullness at each micturition. They also measured the volume of three voidings after postponing micturition as long as possible. Sensation of bladder filling was finally evaluated during cystometry. RESULTS On frequency-volume charts, 65% of all voidings was made without desire to void, only 9.5% was with strong desire. Urgent desire to void was not reported except after voluntarily postponing micturition. Higher grades of perception of fullness were associated with significantly higher voided volumes. Mean volumes for the different sensations of fullness on the charts were not significantly different from volumes at different sensations reported during cystometry. CONCLUSIONS In conclusion, bladder sensation during daily life can be evaluated by scoring the grade of perception of fullness on frequency-volume charts. During life voiding usually occurs without desire to void. The voided volumes at different sensations of fullness are comparable to the volumes at different sensations of filling during cystometry. Therefore, frequency-volume charts with evaluation of perception of fullness may provide an initial non-invasive tool to study bladder sensation.
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106
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Critchley HD, Mathias CJ, Josephs O, O'Doherty J, Zanini S, Dewar BK, Cipolotti L, Shallice T, Dolan RJ. Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain 2003; 126:2139-52. [PMID: 12821513 DOI: 10.1093/brain/awg216] [Citation(s) in RCA: 822] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human anterior cingulate function has been explained primarily within a cognitive framework. We used functional MRI experiments with simultaneous electrocardiography to examine regional brain activity associated with autonomic cardiovascular control during performance of cognitive and motor tasks. Using indices of heart rate variability, and high- and low-frequency power in the cardiac rhythm, we observed activity in the dorsal anterior cingulate cortex (ACC) related to sympathetic modulation of heart rate that was dissociable from cognitive and motor-related activity. The findings predict that during effortful cognitive and motor behaviour the dorsal ACC supports the generation of associated autonomic states of cardiovascular arousal. We subsequently tested this prediction by studying three patients with focal damage involving the ACC while they performed effortful cognitive and motor tests. Each showed abnormalities in autonomic cardiovascular responses with blunted autonomic arousal to mental stress when compared with 147 normal subjects tested in identical fashion. Thus, converging neuroimaging and clinical findings suggest that ACC function mediates context-driven modulation of bodily arousal states.
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Affiliation(s)
- Hugo D Critchley
- Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, London WC1N 3BG, UK.
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107
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Abstract
Penfield's sensory homunculus included visceral organs at its lateral extreme, and vagal input was recently identified lateral to the intraoral representation in primary somatosensory cortex (S1) of rats. We tested whether vagal input is similarly located in cats where area 3b (equivalent to S1) is clearly distinguishable from adjacent regions. Field potentials were recorded from the intact dura over the left hemisphere using electrical stimulation of the left or right cervical vagus nerve in seven cats. A surface positive-negative potential was evoked from either side in the lateral part of the sigmoid gyrus. Finer mapping made at the pial surface with a microelectrode identified a focal site anteromedial to the anterior tip of the coronal sulcus. Depth recordings demonstrated polarity reversals and multi-unit vagal responses, indicating that the potentials were generated by an afferent activation focus in the middle layers of the cortex. The S1 mechanoreceptive representation was localized by mapping multi-unit somatosensory receptive fields in the middle cortical layers near the coronal sulcus. The vagal-evoked potential site was distinctly anterior to the intraoral S1 representation and adjacent to the masseteric-nerve-evoked potential focus. Lesions made at the focal site revealed that this site is cytoarchitectonically located in area 3a not area 3b. Thus vagal input to the sensorimotor cortex in cats resembles deep rather than cutaneous somatic input, similar to the localization of nociceptive-specific input to area 3a in monkeys. The possibilities are considered that this vagal input is involved in motor control and in the sensory experience of visceral afferent activity.
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Affiliation(s)
- Shin-Ichi Ito
- Atkinson Pain Research Laboratory, Barrow Neurological Institute, Phoenix, Arizona 85013, USA
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108
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Harris ML, Aziz Q. Brain-gut interaction in irritable bowel syndrome. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2003; 64:264-9. [PMID: 12789734 DOI: 10.12968/hosp.2003.64.5.1757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abdominal pain occurs commonly in irritable bowel syndrome. The mechanism of pain is likely to be either peripheral or central sensitization of gut nerves or aberrant brain processing. Functional brain techniques are now allowing the study of brain-gut interactions.
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Affiliation(s)
- M L Harris
- Department of Gastrointestinal Science, University of Manchester, Salford M6 8HD
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109
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Maihöfner C, Kaltenhäuser M, Neundörfer B, Lang E. Temporo-spatial analysis of cortical activation by phasic innocuous and noxious cold stimuli--a magnetoencephalographic study. Pain 2002; 100:281-290. [PMID: 12467999 DOI: 10.1016/s0304-3959(02)00276-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical findings and recent non-invasive functional imaging studies pinpoint the insular cortex as the crucial brain area involved in cold sensation. By contrast, the role of primary (SI) and secondary (SII) somatosensory cortices in central processing of cold is controversial. So far, temporal activation patterns of cortical areas involved in cold processing have not been examined. Using magnetoencephalography, we studied, in seven healthy subjects, the temporo-spatial dynamics of brain processes evoked by innocuous and noxious cold stimulation as compared to tactile stimuli. For this purpose, a newly designed and magnetically silent cold-stimulator was employed. In separate runs, cold and painful cold stimuli were delivered to the dorsum of the right hand. Tactile afferents were stimulated by pneumatic tactile stimulation.Following innocuous cold stimulation (DeltaT=5+/-0.3 degrees C in 50+/-2ms), magnetic source imaging revealed an exclusive activation of the contra- and ipsilateral posterior insular cortex. The mean peak latencies were 194.3+/-38.1 and 241.0+/-31.7ms for the response in the ipsi- and contralateral insular cortex, respectively. Based on the measurement of onset latencies, the estimated conduction velocity of peripheral nerve fibres mediating cold fell in the range of Adelta-fibres (7.4+/-0.8 m/s). Noxious cold stimulation (DeltaT=35+/-5 degrees C in 70+/-12ms) initially activated the contra- and ipsilateral insular cortices in the same latency ranges as innocuous cold stimuli. Additionally, we found an activation of the contra- and ipsilateral SII areas (peak latencies 304+/-22.7 and 310.1+/-19.4ms, respectively) and a variable activation of the cingulate cortex. Notably, neither cold- nor painful cold stimulation produced an activation of SI. By contrast, the evoked cortical responses following tactile stimulation could be located to the contralateral SI cortex and bilateral SII. In conclusion, this study strongly corroborates the posterior insular cortex as the primary somatosensory area for cortical processing of cold sensation. Furthermore, it supports the role of SII and the cingulate cortex in mediating freeze-pain. Therefore, these results suggest different processing of cold, freeze-pain and touch in the human brain.
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Affiliation(s)
- Christian Maihöfner
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, Universitatsstrasse, D-91054 Erlangen, Germany
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110
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Lotze M, Wietek B, Birbaumer N, Ehrhardt J, Grodd W, Enck P. Cerebral activation during anal and rectal stimulation. Neuroimage 2001; 14:1027-34. [PMID: 11697934 DOI: 10.1006/nimg.2001.0901] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
While the rectum is innervated by visceral afferents, the anal canal is innervated by the somatosensory pudendal nerve. The representation of these two central domains of intestinal sensations in the human brain is largely unknown. Nonpainful pneumatic stimulation of the anal canal and the distal rectum using event-related functional magnetic resonance imaging (fMRI) was performed in eight healthy subjects. Subjective scaling of sensations revealed no differences in unpleasantness and pain during both stimuli. Both types of stimuli revealed fMRI activation in secondary somatosensory, insula, cingular gyrus, left inferior parietal, and right orbitofrontal cortex. Anal stimulation resulted in additional activation of primary sensory and motor cortex, supplementary motor area, and left cerebellum. We concluded that viscerorectal and somatosensory anal stimulation predominantly differ in their primary sensory activation and additional activation in motor areas. This motor response following aversive somatosensory stimuli may be caused by a reflexive avoidance reaction which is not observed after the more diffuse experienced visceral stimulation.
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Affiliation(s)
- M Lotze
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, D-72074, Germany
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