Pain affect encoded in human anterior cingulate but not somatosensory cortex

A neuronal morphologic type unique to humans and great apes

We report the existence and distribution of an unusual type of projection neuron, a large, spindle-shaped cell, in layer Vb of the anterior cingulate cortex of pongids and hominids. These spindle cells were not observed in any other primate species or any other mammalian taxa, and their volume was correlated with brain volume residuals, a measure of encephalization in higher primates. These observations are of particular interest when considering primate neocortical evolution, as they reveal possible adaptive changes and functional modifications over the last 15-20 million years in the anterior cingulate cortex, a region that plays a major role in the regulation of many aspects of autonomic function and of certain cognitive processes. That in humans these unique neurons have been shown previously to be severely affected in the degenerative process of Alzheimer's disease suggests that some of the differential neuronal susceptibility that occurs in the human brain in the course of age-related dementing illnesses may have appeared only recently during primate evolution.

Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia

Chronic pain often differs from acute pain. The correlation between tissue pathology and the perceived severity of the chronic pain experience is poor or even absent. Furthermore, the sharp spatial localization of acute pain is not a feature of chronic pain; chronic pain is more diffuse and often spreads to areas beyond the original site. Of importance, chronic pain seldom responds to the therapeutic measures that are successful in treating acute pain. Physicians who are unaware of these differences may label the patient with chronic pain as being neurotic or even a malingerer. During the past decade, an exponential growth has occurred in the scientific underpinnings of chronic pain states. In particular, the concept of nonnociceptive pain has been refined at a physiologic, structural, and molecular level. This review focuses on this new body of knowledge, with particular reference to the chronic pain state termed "fibromyalgia."

CNS pattern of metabolic activity during tonic pain: evidence for modulation by beta-endorphin

CNS correlates of acute prolonged pain, and the effects of partial blockade of the central beta-endorphin system, were investigated by the quantitative 2-deoxyglucose technique in unanaesthetized, freely moving rats. Experiments were performed during the second, tonic phase of the behavioural response to a prolonged chemical noxious stimulus (s.c. injection of dilute formalin into a forepaw), or after minor tissue injury (s.c. saline injection). During formalin-induced pain, local glucose utilization rates in the CNS were bilaterally increased in the grey matter of the cervical spinal cord, in spinal white matter tracts and in several supraspinal structures, including portions of the medullary reticular formation, locus coeruleus, lateral parabrachial region, anterior pretectal nucleus, the medial, lateral and posterior thalamic regions, basal ganglia, and the parietal, cingulate, frontal, insular and orbital cortical areas. Pretreatment with anti-beta-endorphin antibodies, injected i.c.v., led to increased metabolism in the tegmental nuclei, locus coeruleus, hypothalamic and thalamic structures, putamen, nucleus accumbens, diagonal band nuclei and dentate gyrus, and in portions of the parietal, cingulate, insular, frontal and orbital cortex. In formalin-injected rats, pretreated with anti-beta-endorphin, behavioural changes indicative of hyperalgesia (increased licking response) were found, which were paralleled by a significant enhancement of functional activity in the anterior pretectal nucleus and in thalamo-cortical systems. A positive correlation was found between the duration of the licking response and metabolic activity of several forebrain regions. These results provide a map of the CNS pattern of metabolic activity during tonic somatic pain, and demonstrate a modulatory role for beta-endorphin in central networks that process somatosensory inputs.

Anticipatory coping of pain expressed in the human anterior cingulate cortex: a positron emission tomography study

We used positron emission tomography (PET) to monitor the regional cerebral blood flow (rCBF) as an index of brain activity in regions proposed to participate in affective-motivational and cognitive-evaluative dimensions of pain during anticipation of a noxious stimulation. Specifically we were interested in the anterior cingulate cortex (ACC), the ventromedial prefrontal cortex (VMPFC) and the periaqueductal grey (PAG). Anticipating an unpredictable and unlearned pain stimulus activated the right ACC, the VMPFC and the PAG while anticipating a learned pain-stimulus resulted in a decreased activity in the ACC and the VMPFC. These patterns are compatible with two facets of affect-laden cognitive coping: alertness and attention-distraction. The right-preponderant expression of the changes in the ACC supports the hypothesis of a preferential role of the non-dominant hemisphere in negative emotional processing. The data demonstrate an anticipatory coping mechanism and illustrate a neurophysiological process underlying the modulation of attention to pain.

The contribution of functional imaging techniques to our understanding of rheumatic pain

The main cerebral components of the human pain matrix have been defined using functional imaging techniques. The experience of pain is likely to be elaborated as a result of parallel processing within this matrix. There is not, therefore, a single pain center. The determinants of pain are as likely to be determined by top-down as by bottom-up processes. The precise function of the different components of the matrix are just beginning to be defined. There appear to be important adaptive responses in the forebrain components of the matrix during arthritic pain. Endogenous opioid peptides are strong candidates for the modulation of some of these responses. More extensive and sequential behavioral and functional imaging studies are required to establish the contribution these adaptive responses make to the perception of pain.

Pain in fibromyalgia

Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.

Cortical event-related potentials show the structure of hypnotic suggestions is crucial

Electroencephalographic cortical event-related potentials (ERPs) are affected by information processing strategies and are particularly appropriate for the examination of hypnotic alterations in perception. The effects of positive obstructive and negative obliterating instructions on visual and auditory P300 ERPs were tested. Twenty participants, stringently selected for hypnotizability, were requested to perform identical tasks during waking and alert hypnotic conditions. High hypnotizables showed greater ERP amplitudes while experiencing negative hallucinations and lower ERP amplitudes while experiencing positive obstructive hallucinations, in contrast to low hypnotizables and their own waking imagination-only conditions. The data show that when participants are carefully selected for hypnotizability and responses are time locked to events, rather robust physiological markers of hypnosis emerge. These reflect alterations in consciousness that correspond to participants' subjective experiences of perceptual alteration. Accounting for suggestion type reveals remarkable consistency of findings among dozens of researchers.

The induction of pain: an integrative review

The highly disagreeable sensation of pain results from an extraordinarily complex and interactive series of mechanisms integrated at all levels of the neuroaxis, from the periphery, via the dorsal horn to higher cerebral structures. Pain is usually elicited by the activation of specific nociceptors ('nociceptive pain'). However, it may also result from injury to sensory fibres, or from damage to the CNS itself ('neuropathic pain'). Although acute and subchronic, nociceptive pain fulfils a warning role, chronic and/or severe nociceptive and neuropathic pain is maladaptive. Recent years have seen a progressive unravelling of the neuroanatomical circuits and cellular mechanisms underlying the induction of pain. In addition to familiar inflammatory mediators, such as prostaglandins and bradykinin, potentially-important, pronociceptive roles have been proposed for a variety of 'exotic' species, including protons, ATP, cytokines, neurotrophins (growth factors) and nitric oxide. Further, both in the periphery and in the CNS, non-neuronal glial and immunecompetent cells have been shown to play a modulatory role in the response to inflammation and injury, and in processes modifying nociception. In the dorsal horn of the spinal cord, wherein the primary processing of nociceptive information occurs, N-methyl-D-aspartate receptors are activated by glutamate released from nocisponsive afferent fibres. Their activation plays a key role in the induction of neuronal sensitization, a process underlying prolonged painful states. In addition, upon peripheral nerve injury, a reduction of inhibitory interneurone tone in the dorsal horn exacerbates sensitized states and further enhance nociception. As concerns the transfer of nociceptive information to the brain, several pathways other than the classical spinothalamic tract are of importance: for example, the postsynaptic dorsal column pathway. In discussing the roles of supraspinal structures in pain sensation, differences between its 'discriminative-sensory' and 'affective-cognitive' dimensions should be emphasized. The purpose of the present article is to provide a global account of mechanisms involved in the induction of pain. Particular attention is focused on cellular aspects and on the consequences of peripheral nerve injury. In the first part of the review, neuronal pathways for the transmission of nociceptive information from peripheral nerve terminals to the dorsal horn, and therefrom to higher centres, are outlined. This neuronal framework is then exploited for a consideration of peripheral, spinal and supraspinal mechanisms involved in the induction of pain by stimulation of peripheral nociceptors, by peripheral nerve injury and by damage to the CNS itself. Finally, a hypothesis is forwarded that neurotrophins may play an important role in central, adaptive mechanisms modulating nociception. An improved understanding of the origins of pain should facilitate the development of novel strategies for its more effective treatment.

Region-specific encoding of sensory and affective components of pain in the human brain: a positron emission tomography correlation analysis

Brain imaging with positron emission tomography has identified some of the principal cerebral structures of a central network activated by pain. To discover whether the different cortical and subcortical areas process different components of the multidimensional nature of pain, we performed a regression analysis between noxious heat-related regional blood flow increases and experimental pain parameters reflecting detection of pain, encoding of pain intensity, as well as pain unpleasantness. The results of our activation study indicate that different functions in pain processing can be attributed to different brain regions; ie, the gating function reflected by the pain threshold appeared to be related to anterior cingulate cortex, the frontal inferior cortex, and the thalamus, the coding of pain intensity to the periventricular gray as well as to the posterior cingulate cortex, and the encoding of pain unpleasantness to the posterior sector of the anterior cingulate cortex.

Temporal and intensity coding of pain in human cortex

Temporal and intensity coding of pain in human cortex. J. Neurophysiol. 80:3312-3320, 1998. We used a high-resolution functional magnetic resonance imaging (fMRI) technique in healthy right-handed volunteers to demonstrate cortical areas displaying changes of activity significantly related to the time profile of the perceived intensity of experimental somatic pain over the course of several minutes. Twenty-four subjects (ascorbic acid group) received a subcutaneous injection of a dilute ascorbic acid solution into the dorsum of one foot, inducing prolonged burning pain (peak pain intensity on a 0-100 scale: 48 +/- 3, mean +/- SE; duration: 11.9 +/- 0.8 min). fMRI data sets were continuously acquired for approximately 20 min, beginning 5 min before and lasting 15 min after the onset of stimulation, from two sagittal planes on the medial hemispheric wall contralateral to the stimulated site, including the cingulate cortex and the putative foot representation area of the primary somatosensory cortex (SI). Neural clusters whose fMRI signal time courses were positively or negatively correlated (P < 0.0005) with the individual pain intensity curve were identified by cross-correlation statistics in all 24 volunteers. The spatial extent of the identified clusters was linearly related (P < 0.0001) to peak pain intensity. Regional analyses showed that positively correlated clusters were present in the majority of subjects in SI, cingulate, motor, and premotor cortex. Negative correlations were found predominantly in medial parietal, perigenual cingulate, and medial prefrontal regions. To test whether these neural changes were due to aspecific arousal or emotional reactions, related either to anticipation or presence of pain, fMRI experiments were performed with the same protocol in two additional groups of volunteers, subjected either to subcutaneous saline injection (saline: n = 16), inducing mild short-lasting pain (peak pain intensity 23 +/- 4; duration 2.8 +/- 0.6 min) or to nonnoxious mechanical stimulation of the skin (controls: n = 16) at the same body site. Subjects did not know in advance which stimulus would occur. The spatial extent of neural clusters whose signal time courses were positively or negatively correlated with the mean pain intensity curve of subjects injected with ascorbic acid was significantly larger (P < 0.001) in the ascorbic acid group than both saline and controls, suggesting that the observed responses were specifically related to pain intensity and duration. These findings reveal distributed cortical systems, including parietal areas as well as cingulate and frontal regions, involved in dynamic encoding of pain intensity over time, a process of great biological and clinical relevance.

Response of anterior parietal cortex to different modes of same-site skin stimulation

Response of anterior parietal cortex to different modes of same-site skin stimulation. J. Neurophysiol. 80: 3272-3283, 1998. Intrinsic optical signal (IOS) imaging was used to study responses of the anterior parietal cortical hindlimb region (1 subject) and forelimb region (3 subjects) to repetitive skin stimulation. Subjects were four squirrel monkeys anesthetized with a halothane/nitrous oxide/oxygen gas mixtures. Cutaneous flutter of 25 Hz evoked a reflectance decrease in the sectors of cytoarchitectonic areas 3b and/or 1 that receive input from the stimulated skin site. The intrinsic signal evoked by 25-Hz flutter attained maximal intensity </=2.5-3.5 s after stimulus onset, remained well maintained as long as stimulation was continued, and disappeared rapidly (usually </=2-5 s) after stimulus termination. Repetitive skin heating stimuli were delivered via a probe/thermode in stationary contact with the skin (6 temperature ramps/trial; within-trial ramp frequency 0.42 Hz; intertrial interval 180 s; initial temperature 32-36 degreesC; maximal temperature 48-52 degreesC; rate of temperature change 19 degreesC/s). Skin heating led to a large-amplitude reflectance decrease within a zone of area 3a, which neighbored the region in areas 3b/1 that emitted an intrinsic signal in response to same-site 25-Hz flutter in the same subject. In three of four subjects a lower-amplitude decrease in reflectance also occurred in a region of area 4 continuous with the area 3a region that responded maximally to same-site skin heating. The reflectance decrease evoked in areas 3a/4 by skin heating consistently exceeded in both intensity and spatial extent the decrease in reflectance evoked in areas 3b/1 by same-site 25-Hz cutaneous flutter. These findings are viewed as consistent with the proposal that area 3a plays a leading role in the anterior parietal cortical processing of the afferent drive evoked by skin-heating stimuli perceived as painful. In all four subjects the reflectance decrease evoked in areas 3a/4 by skin heating was accompanied by a simultaneous but opposite change in reflectance (a reflectance increase) within a large territory located immediately posterior to the regions that responded with a decrease in reflectance-an observation that raised the possibility that skin heating evoked opposing influences on the activity of area 3a and 3b/1 regions that receive input from the stimulated skin site. This was evaluated with the method of correlation mapping. The observations obtained with correlation mapping appear consistent with demonstrations by others that skin-heating stimuli perceived as painful by conscious subjects suppress/inhibit the anterior parietal response to innocuous mechanical skin stimulation. The opposing (relative to the response of area 3a) optical response of area 1 and/or area 3b during skin heating stimulation is attributed to suppression/inhibition of area 1 and/or area 3b neuron activity.

Stimulation of human thalamus for pain relief: possible modulatory circuits revealed by positron emission tomography

Stimulation of human thalamus for pain relief: possible modulatory circuits revealed by positron emission tomography. J. Neurophysiol. 80: 3326-3330, 1998. Stimulation of the somatosensory thalamus was used for more than 2 decades to treat chronic pain in the human. However, despite clinical reports of successful results, little is known about the actual mechanisms mediating this form of stimulation-produced analgesia. To reveal possible neuronal pathways evoked by thalamic stimulation, we measured regional changes in cerebral blood flow (rCBF) in five patients who received successful long-term relief of chronic pain with somatosensory thalamic stimulation. Positron emission tomography during thalamic stimulation revealed significant activation of the thalamus in the region of the stimulating electrodes as well as activation of the insular cortex ipsilateral to the thalamic electrodes (contralateral to the patients' clinical pain). For these patients, thalamic stimulation also evoked paresthesiae that included thermal sensations in addition to tingling sensations. Results of this study indicate that in some cases somatosensory thalamic stimulation may activate a thalamocortical pain modulation circuit that involves thermal pathways. These results are consistent with other recent reports suggesting that activation of thermal pathways may contribute to modulation of nociceptive information.

Attention, self-regulation and consciousness

Consciousness has many aspects. These include awareness of the world, feelings of control over one's behaviour and mental state (volition), and the notion of continuing self. Focal (executive) attention is used to control details of our awareness and is thus closely related to volition. Experiments suggest an integrated network of neural areas involved in executive attention. This network is associated with our voluntary ability to select among competing items, to correct error and to regulate our emotions. Recent neuroimaging studies suggest that these various functions involve separate areas of the anterior cingulate. We have adopted a strategy of using marker tasks, shown to activate the brain area by imaging studies, as a means of tracing the development of attentional networks. Executive attention appears to develop first to regulate distress during the first year of life. During later childhood the ability to regulate conflict among competing stimuli builds upon the earlier cingulate anatomy to provide a means of cognitive control. During childhood the activation of cingulate structures relates both to the child's success on laboratory tasks involving conflict and to parental reports of self-regulation and emotional control. These studies indicate a start in understanding the anatomy, circuitry and development of executive attention networks that serve to regulate both cognition and emotion.

Septocingulate and septohippocampal cholinergic pathways: involvement in working/episodic memory

The contribution of the septohippocampal cholinergic pathway to performance of a working/episodic memory task was compared to that of the septocingulate cholinergic path. The septocingulate and septohippocampal cholinergic pathways were selectively destroyed in male Sprague-Dawley rats using site-specific injections of the anti-neuronal immunotoxin 192-IgG saporin into either the hippocampus or the cingulate cortex. 192-IgG-saporin selectively destroys cholinergic neurons and terminals that express the p75 neurotrophin receptor. Following extensive pre-operative training, working memory was assessed using a delayed nonmatch to sample eight arm radial maze task, with delays of 1, 4 and 8 h. The group with lesions of the septohippocampal cholinergic pathway displayed performance deficits on this task which were not related to length of delay. In contrast, the group with lesions of the septocingulate cholinergic pathway did display delay-dependent deficits which were observed at the 4- and 8-h delays, but not at the 1-h delay. These data suggest that the septocingulate cholinergic pathway is critically involved in working/episodic memory but that the septohippocampal cholinergic pathway is either not contributing to working/episodic memory per se or it is involved only at shorter delays.

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

Neurophysiological evaluation of pain

Neurophysiological techniques for the evaluation of pain in humans have made important advances in the last decade. A number of features of neuroanatomy and physiology of nociception qualifies pain as a multidimensional phenomenon which is rather unique among the sensory systems and which poses a number of technical and procedural requirements for its appropriate diagnostic assessment. Various stimulation techniques to induce defined pain in humans and used in combination with the methodology of evoked electrical brain potentials and magnetic fields are presented. Most recent knowledge gathered from scalp topography and dipole source analysis of pain-relevant evoked potentials and fields is discussed. Particular emphasis is put upon laser-evoked potentials and their application for diagnosis, pathophysiological description and monitoring of patients with neurological disorders and abnormal pain states. Future perspectives in this growing field of research are discussed briefly.

Characterizing stimulus-response functions using nonlinear regressors in parametric fMRI experiments

Parametric study designs proved very useful in characterizing the relationship between experimental parameters (e.g., word presentation rate) and regional cerebral blood flow in positron emission tomography studies. In a previous paper we presented a method that fits nonlinear functions of stimulus or task parameters to hemodynamic responses, using second-order polynomial expansions. Here we expand this approach to model nonlinear relationships between BOLD responses and experimental parameters, using fMRI. We present a framework that allows this technique to be implemented in the context of the general linear model employed by statistical parametric mapping (SPM). Statistical inferences, in this instance, are based on F statistics and in this respect we emphasize the use of corrected P values for F fields (i.e., SPM¿F¿). The approach is illustrated with a fMRI study that looked at the effect of increasing auditory word-presentation rate. Our parametric design allowed us to characterize different forms of rate-dependent responses in three critical regions: (i) bilateral frontal regions showed a categorical response to the presence of words irrespective of rate, suggesting a role for this region in establishing cognitive (e.g., attentional) set; (ii) in bilateral occipitotemporal regions activations increased linearly with increasing word rate; and (iii) posterior auditory association cortex exhibited a nonlinear (inverted U) relationship to word rate.

Neural correlates of levels of emotional awareness. Evidence of an interaction between emotion and attention in the anterior cingulate cortex

Recent functional imaging studies have begun to identify the neural correlates of emotion in healthy volunteers. However, studies to date have not differentially addressed the brain areas associated with the perception, experience, or expression of emotion during emotional arousal. To explore the neural correlates of emotional experience, we used positron emission tomography (PET) and 15-water to measure cerebral blood flow (CBF) in 12 healthy women during film- and recall-induced emotion and correlated CBF changes attributable to emotion with subjects' scores on the Levels of Emotional Awareness Scale (LEAS), a measure of individual differences in the capacity to experience emotion in a differentiated and complex way. A conjunction analysis revealed that the correlations between LEAS and CBF during film- and recall-induced emotion overlapped significantly (z = 3.74, p < 0. 001) in Brodmann's area 24 of the anterior cingulate cortex (ACC). This finding suggests that individual differences in the ability to accurately detect emotional signals interoceptively or exteroceptively may at least in part be a function of the degree to which the ACC participates in the experiential processing and response to emotion cues. To the extent that this finding is consistent with the functions of the ACC involving attention and response selection, it suggests that this neural correlate of conscious emotional experience is not exclusive to emotion.

Abnormal functional activity of the central nervous system in fibromyalgia syndrome

The evaluation of pain is one of the major problems facing general practitioners and specialists in medicine. Although the source of pain can be usually be traced to specific abnormalities in a given organ system, some patients present with generalized pain syndromes, such as fibromyalgia, for which no specific source can be found. Some researchers have begun to consider that although there may be a somatic source of such pain at its initiation, over time the pain may be maintained or exacerbated by functional alterations in critical regions of the brain and spinal cord that are involved in pain processing or pain inhibition. This article describes the techniques currently used to measure regional cerebral blood flow (rCBF) in the brain by single photon emission computed tomography (SPECT) imaging, and reviews the SPECT and positron emission tomography literature concerning alterations in functional brain activity associated with pain in healthy individuals and in patients with chronic pain, including those with fibromyalgia. The article concludes by describing the implications of current knowledge about pain and abnormal functional brain activity in the understanding of the pathophysiology of fibromyalgia and in the development of therapeutic strategies to manage patients with this disorder.

Cerebral responses to a continual tonic pain stimulus measured using positron emission tomography

We have previously demonstrated the localised positron emission tomographic cerebral correlates of the experience of painful phasic heat in the normal human brain. In this study we examine whether these responses are different using a continuous, tonic heat stimulus. The regional cerebral responses to non-painful and painful thermal stimuli in 12 male subjects were studied by monitoring serial measurements of regional cerebral blood flow (rCBF) with positron emission tomography (PET) using H2(15)O. Significantly increased rCBF responses to tonic noxious stimulation compared with non-noxious stimulation were observed bilaterally in the anterior cingulate (Brodmann's area (BA) 24) cortex. Contralateral responses were observed in the lentiform nucleus and posterior insula cortex and ipsilateral responses were observed in the thalamus, cerebellum, prefrontal (BA 10) cortex and anterior insula cortex. These findings demonstrate general agreement between the main areas of cerebral activation during both phasic and tonic pain.

Outward current produced by somatostatin (SRIF) in rat anterior cingulate pyramidal cells in vitro

1. A high density of receptors for somatostatin (SRIF) exists in the anterior cingulate cortex but their function is unknown. Whole-cell patch clamp recordings were made from visualized deep layer pyramidal cells of the rat anterior cingulate cortex contained in isolated brain slices to investigate the putative effects of SRIF and to identify the receptor subtype(s) involved. 2. SRIF (1-1000 nM) produced a concentration-dependent outward current which was associated with an increased membrane conductance, was sensitive to Ba2+ (300 microM - 1 mM), and was absent in the presence of a maximal concentration of the GABA(B) receptor agonist, baclofen (100 microM). These observations suggest the outward current was carried by K+ ions. 3. SRIF analogues also elicited outward currents with a rank potency order of (EC50, nM): octreotide (1.8)>BIM-23027 (3.7)>SRIF (20)=L-362,855 (20). BIM-23056 was without agonist or antagonist activity. Responses to L-362,855 were unlike those to the other agonists since they were sustained for the duration of the application. 4. The sst2 receptor antagonist, L-Tyr8Cyanamid 154806 (1 microM), had no effect alone but partially reversed responses to submaximal concentrations of SRIF (100 nM, 44+/-6% reversal) and L-362,855 (100 nM, 70+/-6% reversal) and fully reversed the response to BIM-23027 (10 nM). In contrast, L-Tyr8Cyanamid 154806 did not antagonize the response to baclofen (10 microM). 5. We conclude that SRIF activates a K+ conductance in anterior cingulate pyramidal neurones via an action predominantly at sst2 receptors.

Brain systems mediating aversive conditioning: an event-related fMRI study

We have used event-related functional magnetic resonance imaging (fMRI) to characterize neural responses associated with emotional learning. Employing a classical conditioning paradigm in which faces were conditioned by pairing with an aversive tone (US), we compared responses evoked by conditioned (CS+) and nonconditioned (CS-) stimuli. Pairing 50% of the CS+ with the US enabled us to constrain our analysis to responses evoked by a CS+ not followed by a US. Differential evoked responses, related to conditioning, were found in the anterior cingulate and the anterior insula, regions with known involvement in emotional processing. Differential responses of the amygdalae were best characterized by a time by stimulus interaction indicating a rapid adaptation of CS+-specific responses in this region.

Painful stimuli evoke potentials recorded over the human anterior cingulate gyrus

Clinical studies of cingulotomy patients and imaging studies predict that the human cingulate gyrus might display pain-related activity. We now report potentials evoked by painful cutaneous stimulation with a CO2 laser (LEP) and recorded from subdural electrodes over the medial wall of the hemisphere. In response to facial laser stimulation on both sides, a negative (latency 211-242 ms) and then a positive wave (325-352 ms) were recorded from the cortex of right medial wall and from the falcine dura overlying the left medial wall. Medial wall LEPs were similar to scalp LEPs and were largest over the anterior cingulate and superior frontal gyri just anterior to motor cortex contralateral to the side of stimulation. These results demonstrate that there is significant direct nociceptive input to the human anterior cingulate gyrus (Brodmann's area 24).