1
|
Pavy F, Zaman J, Van den Noortgate W, Scarpa A, von Leupoldt A, Torta DM. The effect of unpredictability on the perception of pain: a systematic review and meta-analysis. Pain 2024; 165:1702-1718. [PMID: 38422488 DOI: 10.1097/j.pain.0000000000003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
ABSTRACT Despite being widely assumed, the worsening impact of unpredictability on pain perception remains unclear because of conflicting empirical evidence, and a lack of systematic integration of past research findings. To fill this gap, we conducted a systematic review and meta-analysis focusing on the effect of unpredictability on pain perception. We also conducted meta-regression analyses to examine the moderating effect of several moderators associated with pain and unpredictability: stimulus duration, calibrated stimulus pain intensity, pain intensity expectation, controllability, anticipation delay, state and trait negative affectivity, sex/gender and age of the participants, type of unpredictability (intensity, onset, duration, location), and method of pain induction (thermal, electrical, mechanical pressure, mechanical distention). We included 73 experimental studies with adult volunteers manipulating the (un)predictability of painful stimuli and measuring perceived pain intensity and pain unpleasantness in predictable and unpredictable contexts. Because there are insufficient studies with patients, we focused on healthy volunteers. Our results did not reveal any effect of unpredictability on pain perception. However, several significant moderators were found, ie, targeted stimulus pain intensity, expected pain intensity, and state negative affectivity. Trait negative affectivity and uncontrollability showed no significant effect, presumably because of the low number of included studies. Thus, further investigation is necessary to clearly determine their role in unpredictable pain perception.
Collapse
Affiliation(s)
- Fabien Pavy
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Jonas Zaman
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- School of Social Sciences, Hasselt University, Hasselt, Belgium
| | - Wim Van den Noortgate
- Methodology of Educational Sciences, Faculty of Psychology and Educational Sciences, & Itec, an Imec Research Group, KU Leuven, Belgium
| | - Aurelia Scarpa
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Andreas von Leupoldt
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Diana M Torta
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| |
Collapse
|
2
|
Abstract
Deep, dreamless sleep is considered the only “normal” state under which consciousness is lost. The main reason for the voluntary, external induction of an unconscious state, via general anesthesia, is to silence the brain circuitry of nociception. In this article, I describe the perception of pain as a neural and behavioral correlate of consciousness. I briefly mention the brain areas and parameters that are connected to the presence of consciousness, mainly by virtue of their absence under deep anesthesia, and parallel those to brain areas responsible for the perception of pain. Activity in certain parts of the cortex and thalamus, and the interaction between them, will be the main focus of discussion as they represent a common ground that connects our general conscious state and our ability to sense the environment around us, including the painful stimuli. A plethora of correlative and causal evidence has been described thus far to explain the brain’s involvement in consciousness and nociception. Despite the great advancement in our current knowledge, the manifestation and true nature of the perception of pain, or any conscious experience, are far from being fully understood.
Collapse
|
3
|
Manzler CA, Radoman M, Khorrami KJ, Gorka SM. Association between startle reactivity to uncertain threats and structural brain volume. Psychophysiology 2022; 59:e14074. [PMID: 35579909 PMCID: PMC10080733 DOI: 10.1111/psyp.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Sensitivity to uncertain threat (U-threat) is a clinically important individual difference factor in multiple psychopathologies. Recent studies have implicated a specific frontolimbic circuit as a key network involved in the anticipation of aversive stimuli. In particular, the insula, thalamus, and dorsal anterior cingulate cortex (dACC) have recently been found to be robustly activated by anticipation of U-threat. However, no study to date has examined the association between U-threat reactivity and structural brain volume. In the present study, we utilized a pooled sample of 186 young adult volunteers who completed a structural MRI scan and the well-validated No-Predictable-Unpredictable (NPU) threat of electric shock task. Startle eyeblink potentiation was collected during the NPU task as an objective index of aversive reactivity. ROI-based analyses revealed that increased startle reactivity to U-threat was associated with reduced gray matter volume in the right insula and bilateral thalamus, but not the dACC. These results add to a growing literature implicating the insula and thalamus as core nodes involved in individual differences in U-threat reactivity.
Collapse
Affiliation(s)
- Charles A Manzler
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kia J Khorrami
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
4
|
Martin SL, Jones AKP, Brown CA, Kobylecki C, Whitaker GA, El-Deredy W, Silverdale MA. Altered Pain Processing Associated with Administration of Dopamine Agonist and Antagonist in Healthy Volunteers. Brain Sci 2022; 12:brainsci12030351. [PMID: 35326306 PMCID: PMC8946836 DOI: 10.3390/brainsci12030351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Striatal dopamine dysfunction is associated with the altered top-down modulation of pain processing. The dopamine D2-like receptor family is a potential substrate for such effects due to its primary expression in the striatum, but evidence for this is currently lacking. Here, we investigated the effect of pharmacologically manipulating striatal dopamine D2 receptor activity on the anticipation and perception of acute pain stimuli in humans. Participants received visual cues that induced either certain or uncertain anticipation of two pain intensity levels delivered via a CO2 laser. Rating of the pain intensity and unpleasantness was recorded. Brain activity was recorded with EEG and analysed via source localisation to investigate neural activity during the anticipation and receipt of pain. Participants completed the experiment under three conditions, control (Sodium Chloride), D2 receptor agonist (Cabergoline), and D2 receptor antagonist (Amisulpride), in a repeated-measures, triple-crossover, double-blind study. The antagonist reduced an individuals’ ability to distinguish between low and high pain following uncertain anticipation. The EEG source localisation showed that the agonist and antagonist reduced neural activations in specific brain regions associated with the sensory integration of salient stimuli during the anticipation and receipt of pain. During anticipation, the agonist reduced activity in the right mid-temporal region and the right angular gyrus, whilst the antagonist reduced activity within the right postcentral, right mid-temporal, and right inferior parietal regions. In comparison to control, the antagonist reduced activity within the insula during the receipt of pain, a key structure involved in the integration of the sensory and affective aspects of pain. Pain sensitivity and unpleasantness were not changed by D2R modulation. Our results support the notion that D2 receptor neurotransmission has a role in the top-down modulation of pain.
Collapse
Affiliation(s)
- Sarah L. Martin
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6GX, UK
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK; (A.K.P.J.); (C.A.B.)
- Correspondence:
| | - Anthony K. P. Jones
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK; (A.K.P.J.); (C.A.B.)
| | - Christopher A. Brown
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK; (A.K.P.J.); (C.A.B.)
- Department of Psychological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Christopher Kobylecki
- Salford Royal NHS Foundation Trust, Department of Neurology, Manchester Academic Health Science Centre, Salford M6 8HD, UK; (C.K.); (M.A.S.)
| | - Grace A. Whitaker
- Advanced Center for Electrical and Electronics Engineering, Federico Santa María Technical University, Valparaíso 1680, Chile;
| | - Wael El-Deredy
- Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaiso 1680, Chile;
| | - Monty A. Silverdale
- Salford Royal NHS Foundation Trust, Department of Neurology, Manchester Academic Health Science Centre, Salford M6 8HD, UK; (C.K.); (M.A.S.)
| |
Collapse
|
5
|
Is it a painful error? The effect of unpredictability and intensity of punishment on the error-related negativity, and somatosensory evoked potentials. Biol Psychol 2021; 165:108177. [PMID: 34478779 DOI: 10.1016/j.biopsycho.2021.108177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022]
Abstract
We examined how predictable and unpredictable punishment intensity contingent on error commission modulated ERN amplitudes. We recorded the ERN in 35 healthy volunteers performing the Eriksen flanker task. Errors were punished with predictable nonpainful, painful or unpredictable electrical stimulation. Furthermore, we investigated trait anxiety. We observed that ERN amplitudes did not differ across conditions, nor were there significant effects of anxiety. In contrast, we found that predictable painful punishments led to smaller Error Positivity (Pe). The effects of predictability and intensity were present in Somatosensory Evoked Potentials elicited by the punishments. N1 amplitudes were increased for painful compared to nonpainful stimulation, and P2/P3 amplitudes for painful compared to nonpainful, and for unpredictable compared to predictable stimulation. We suggest that unpredictability and increased painfulness of punishments enhance the potential motivational significance of the errors, but do not potentiate ERN amplitudes beyond the ones elicited by errors punished with predictable nonpainful stimulation.
Collapse
|
6
|
Hewitt D, Byrne A, Henderson J, Newton-Fenner A, Tyson-Carr J, Fallon N, Brown C, Stancak A. Inhibition of cortical somatosensory processing during and after low frequency peripheral nerve stimulation in humans. Clin Neurophysiol 2021; 132:1481-1495. [PMID: 34023628 DOI: 10.1016/j.clinph.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Transcutaneous low-frequency stimulation (LFS) elicits long-term depression-like effects on human pain perception. However, the neural mechanisms underlying LFS are poorly understood. We investigated cortical activation changes occurring during LFS and if changes were associated with reduced nociceptive processing and increased amplitude of spontaneous cortical oscillations post-treatment. METHODS LFS was applied to the radial nerve of 25 healthy volunteers over two sessions using active (1 Hz) or sham (0.02 Hz) frequencies. Changes in resting electroencephalography (EEG) and laser-evoked potentials (LEPs) were investigated before and after LFS. Somatosensory-evoked potentials were recorded during LFS and source analysis was carried out. RESULTS Ipsilateral midcingulate and operculo-insular cortex source activity declined linearly during LFS. Active LFS was associated with attenuated long-latency LEP amplitude in ipsilateral frontocentral electrodes and increased resting alpha (8-12 Hz) and beta (16-24 Hz) band power in electrodes overlying operculo-insular, sensorimotor and frontal cortical regions. Reduced ipsilateral operculo-insular cortex source activity during LFS correlated with a smaller post-treatment alpha-band power increase. CONCLUSIONS LFS attenuated somatosensory processing both during and after stimulation. SIGNIFICANCE Results further our understanding of the attenuation of somatosensory processing both during and after LFS.
Collapse
Affiliation(s)
- Danielle Hewitt
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Adam Byrne
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| | - Jessica Henderson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Alice Newton-Fenner
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| | - John Tyson-Carr
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Christopher Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrej Stancak
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| |
Collapse
|
7
|
Uncertainty in a context of pain: disliked but also more painful? Pain 2021; 162:995-998. [PMID: 33027219 DOI: 10.1097/j.pain.0000000000002106] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
|
8
|
Neige C, Brun C, Gagné M, Bouyer LJ, Mercier C. Do nociceptive stimulation intensity and temporal predictability influence pain-induced corticospinal excitability modulation? Neuroimage 2020; 216:116883. [DOI: 10.1016/j.neuroimage.2020.116883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/31/2020] [Accepted: 04/23/2020] [Indexed: 01/12/2023] Open
|
9
|
Martin SL, Jones AKP, Brown CA, Kobylecki C, Silverdale MA. A neurophysiological investigation of anticipation to pain in Parkinson's disease. Eur J Neurosci 2019; 51:611-627. [DOI: 10.1111/ejn.14559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Sarah L. Martin
- The Human Pain Research Group Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - Anthony K. P. Jones
- The Human Pain Research Group Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | | | - Christopher Kobylecki
- Institution is Department of Neurology Salford Royal NHS Foundation Trust Manchester Academic Health Science Centre The University of Manchester Manchester UK
| | - Monty A. Silverdale
- Institution is Department of Neurology Salford Royal NHS Foundation Trust Manchester Academic Health Science Centre The University of Manchester Manchester UK
| |
Collapse
|
10
|
Abstract
OBJECTIVE The extent to which pain-related expectations, known to affect pain perception, also affect perception of nonpainful sensations remains unclear, as well as the potential role of unpredictability in this context. METHODS In a proprioceptive fear conditioning paradigm, various arm extension movements were associated with predictable and unpredictable electrocutaneous pain or its absence. During a subsequent test phase, nonpainful electrocutaneous stimuli with a high or low intensity were presented during movement execution. We used hierarchical drift diffusion modeling to examine the influence of expecting pain on the perceptual decision-making process underlying intensity perception of nonpainful sensations. In the first experiment (n = 36), the pain stimulus was never presented during the test phase after conditioning. In the second experiment (n = 39), partial reinforcement was adopted to prevent extinction of pain expectations. RESULTS In both experiments, movements that were associated with (un)predictable pain led to higher pain expectancy, self-reported fear, unpleasantness, and arousal as compared with movements that were never paired with pain (effect sizes η2 ranging from 0.119 to 0.557; all p values < .05). Only in the second experiment-when the threat of pain remained present-we found that the expectation of pain affected decision making. Compared with the no pain condition, an a priori decision-making bias toward the high-intensity decision threshold was found with the strongest bias during unpredictable pain (effect sizes η2 ranging from 0.469 to 0.504; all p-values < .001). CONCLUSIONS Thus, the expectation of pain affects inferential processes not only for subsequent painful but also for nonpainful bodily stimuli, with unpredictability moderating these effects, and only when the threat of pain remains present due to partial reinforcement.
Collapse
|
11
|
Liang M, Su Q, Mouraux A, Iannetti GD. Spatial Patterns of Brain Activity Preferentially Reflecting Transient Pain and Stimulus Intensity. Cereb Cortex 2019; 29:2211-2227. [PMID: 30844052 PMCID: PMC6458907 DOI: 10.1093/cercor/bhz026] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/29/2019] [Indexed: 01/19/2023] Open
Abstract
How pain emerges in the human brain remains an unresolved question. Neuroimaging studies have suggested that several brain areas subserve pain perception because their activation correlates with perceived pain intensity. However, painful stimuli are often intense and highly salient; therefore, using both intensity- and saliency-matched control stimuli is crucial to isolate pain-selective brain responses. Here, we used these intensity/saliency-matched painful and non-painful stimuli to test whether pain-selective information can be isolated in the functional magnetic resonance imaging responses elicited by painful stimuli. Using two independent datasets, multivariate pattern analysis was able to isolate features distinguishing the responses triggered by (1) intensity/saliency-matched painful versus non-painful stimuli, and (2) high versus low-intensity/saliency stimuli regardless of whether they elicit pain. This indicates that neural activity in the so-called "pain matrix" is functionally heterogeneous, and part of it carries information related to both painfulness and intensity/saliency. The response features distinguishing these aspects are spatially distributed and cannot be ascribed to specific brain structures.
Collapse
Affiliation(s)
- M Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Q Su
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - A Mouraux
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | - G D Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
- Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome, Italy
| |
Collapse
|
12
|
Hoskin R, Berzuini C, Acosta-Kane D, El-Deredy W, Guo H, Talmi D. Sensitivity to pain expectations: A Bayesian model of individual differences. Cognition 2019; 182:127-139. [DOI: 10.1016/j.cognition.2018.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/08/2023]
|
13
|
Uncertain is worse: modulation of anxiety on pain anticipation by intensity uncertainty: evidence from the ERP study. Neuroreport 2018; 29:1023-1029. [PMID: 29846299 DOI: 10.1097/wnr.0000000000001061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the effect of uncertain information in the anticipation phase, this study used four cues to inform participants that they would face four kinds of subsequent electrical shocks: low-intensity shock, high-intensity shock, 50-50% chance of low-intensity or high-intensity shock, and no shock. Subjective evaluation on the anxiety elicited by different cues showed that uncertain cues aroused higher anxiety than certain cues, but the effect was observed only at low-intensity shock. The electroencephalogram data revealed that uncertain-shock cue elicited significantly larger stimulus-preceding negativity than certain-high-shock cue at the frontal site. The uncertain-shock cue and certain-high-shock cue both elicited significantly larger stimulus-preceding negativity than the cues of certain-low-shock and nonshock, respectively. Uncertain cues elicited significantly larger pain-evoked P2 than certain cues. The results implied that uncertainty of information regarding shock intensity captured more motivational engagement, aroused higher anxiety on anticipating for the electrical shock, and elicited higher perceived pain of shock stimulation.
Collapse
|
14
|
Liberati G, Algoet M, Klöcker A, Ferrao Santos S, Ribeiro-Vaz JG, Raftopoulos C, Mouraux A. Habituation of phase-locked local field potentials and gamma-band oscillations recorded from the human insula. Sci Rep 2018; 8:8265. [PMID: 29844373 PMCID: PMC5974133 DOI: 10.1038/s41598-018-26604-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/15/2018] [Indexed: 01/18/2023] Open
Abstract
Salient nociceptive and non-nociceptive stimuli elicit low-frequency local field potentials (LFPs) in the human insula. Nociceptive stimuli also elicit insular gamma-band oscillations (GBOs), possibly preferential for thermonociception, which have been suggested to reflect the intensity of perceived pain. To shed light on the functional significance of these two responses, we investigated whether they would be modulated by stimulation intensity and temporal expectation - two factors contributing to stimulus saliency. Insular activity was recorded from 8 depth electrodes (41 contacts) implanted in the left insula of 6 patients investigated for epilepsy. Thermonociceptive, vibrotactile, and auditory stimuli were delivered using two intensities. To investigate the effects of temporal expectation, the stimuli were delivered in trains of three identical stimuli (S1-S2-S3) separated by a constant 1-s interval. Stimulation intensity affected intensity of perception, the magnitude of low-frequency LFPs, and the magnitude of nociceptive GBOs. Stimulus repetition did not affect perception. In contrast, both low-frequency LFPs and nociceptive GBOs showed a marked habituation of the responses to S2 and S3 as compared to S1 and, hence, a dissociation with intensity of perception. Most importantly, although insular nociceptive GBOs appear to be preferential for thermonociception, they cannot be considered as a correlate of perceived pain.
Collapse
Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium.
| | - Maxime Algoet
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| | - Anne Klöcker
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| | | | | | | | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| |
Collapse
|
15
|
Zaman J, Vanpaemel W, Aelbrecht C, Tuerlinckx F, Vlaeyen J. Biased pain reports through vicarious information: A computational approach to investigate the role of uncertainty. Cognition 2017; 169:54-60. [DOI: 10.1016/j.cognition.2017.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023]
|
16
|
Ecsy K, Brown CA, Jones AKP. Cortical nociceptive processes are reduced by visual alpha-band entrainment in the human brain. Eur J Pain 2017; 22:538-550. [PMID: 29139226 DOI: 10.1002/ejp.1136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute noxious stimuli induce a suppression of cortical alpha activity, yet little is known about whether increasing alpha activity affects the processing of noxious stimuli. We have previously shown that visual alpha stimulation reduces experimental pain. Here, we demonstrate that increasing alpha power causes a reciprocal suppression of acute nociceptive processing. METHODS We attempted to increase cortical alpha activity through visual entrainment at 8 Hz, 10 Hz and 12 Hz to investigate the influence on the electrophysiological pain response. Moderately painful laser-heat stimuli were delivered following 10 minutes of visual entrainment across the alpha range. RESULTS Alpha power increased significantly relative to the 1 Hz control condition following 8 Hz and 10 Hz visual stimulation. Significant reductions in the P2 peak amplitude of the laser-evoked potential were found following visual entrainment at 10 Hz; the frequency stimulation resulting in the largest reduction in pain perception. Source analysis revealed that, following the 10 Hz stimulation, sources of increased alpha power and decreased nociceptive processing overlapped in precuneus and posterior cingulate cortex, with further reductions in nociceptive processing in insula cortex. CONCLUSIONS As far as we are aware, this is the first study to provide direct evidence that experimental induction of increased alpha power suppresses the cortical processing of acute pain. SIGNIFICANCE While it is known that visual stimulation can increase the brain's oscillatory alpha rhythms, here, we show that this increase in alpha power occurs alongside reduced cortical processing of nociception, as measured with EEG. This establishes an objective marker of alpha entrainment-based analgesia that may be useful in the development of neuromodulatory treatments for clinical pain.
Collapse
Affiliation(s)
- K Ecsy
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
| | - C A Brown
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - A K P Jones
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
| |
Collapse
|
17
|
Davis KD, Flor H, Greely HT, Iannetti GD, Mackey S, Ploner M, Pustilnik A, Tracey I, Treede RD, Wager TD. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations. Nat Rev Neurol 2017; 13:624-638. [PMID: 28884750 DOI: 10.1038/nrneurol.2017.122] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way. The task force emphasizes that the use of brain imaging in this context is in a discovery phase, but has the potential to increase our understanding of the neural underpinnings of chronic pain, inform the development of therapeutic agents, and predict treatment outcomes for use in personalized pain management. The task force proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes. The admissibility of such evidence in legal cases also strongly depends on laws that vary between jurisdictions. For these reasons, the task force concludes that the use of brain imaging findings to support or dispute a claim of chronic pain - effectively as a pain lie detector - is not warranted, but that imaging should be used to further our understanding of the mechanisms underlying pain.
Collapse
Affiliation(s)
- Karen D Davis
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room MP12-306, Toronto, Ontario M5T 2S8, Canada.,Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, J5, D-86169 Mannheim, Germany
| | - Henry T Greely
- Stanford Program in Neuroscience and Society, Center for Law and the Biosciences, Stanford Law School, Stanford University, Stanford, California 94305-8610, USA
| | - Gian Domenico Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero, Suite 200, Palo Alto, California 94304, USA
| | - Markus Ploner
- Department of Neurology and TUM-Neuroimaging Center, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Amanda Pustilnik
- Center for Law, Brain &Behavior, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA.,University of Maryland School of Law, 500 W. Baltimore Street, Baltimore, Maryland 21201, USA
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rolf-Detlef Treede
- Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
| | - Tor D Wager
- Department of Psychology and Neuroscience, Muezinger D244, 345 UCB, Boulder, Colorado 80309-0345, USA.,Institute of Cognitive Science, University of Colorado, 344 UCB, Boulder, Colorado 80309-0344, USA
| |
Collapse
|
18
|
Świder K, Wronka E, Oosterman JM, van Rijn CM, Jongsma MLA. Influence of transient spatial attention on the P3 component and perception of painful and non-painful electric stimuli in crossed and uncrossed hands positions. PLoS One 2017; 12:e0182616. [PMID: 28873414 PMCID: PMC5584947 DOI: 10.1371/journal.pone.0182616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 07/22/2017] [Indexed: 11/19/2022] Open
Abstract
Recent reports show that focusing attention on the location where pain is expected can enhance its perception. Moreover, crossing the hands over the body’s midline is known to impair the ability to localise stimuli and decrease tactile and pain sensations in healthy participants. The present study investigated the role of transient spatial attention on the perception of painful and non-painful electrical stimuli in conditions in which a match or a mismatch was induced between skin-based and external frames of reference (uncrossed and crossed hands positions, respectively). We measured the subjective experience (Numerical Rating Scale scores) and the electrophysiological response elicited by brief electric stimuli by analysing the P3 component of Event-Related Potentials (ERPs). Twenty-two participants underwent eight painful and eight non-painful stimulus blocks. The electrical stimuli were applied to either the left or the right hand, held in either a crossed or uncrossed position. Each stimulus was preceded by a direction cue (leftward or rightward arrow). In 80% of the trials, the arrow correctly pointed to the spatial regions where the stimulus would appear (congruent cueing). Our results indicated that congruent cues resulted in increased pain NRS scores compared to incongruent ones. For non-painful stimuli such an effect was observed only in the uncrossed hands position. For both non-painful and painful stimuli the P3 peak amplitudes were higher and occurred later for incongruently cued stimuli compared to congruent ones. However, we found that crossing the hands substantially reduced the cueing effect of the P3 peak amplitudes elicited by painful stimuli. Taken together, our results showed a strong influence of transient attention manipulations on the NRS ratings and on the brain activity. Our results also suggest that hand position may modulate the strength of the cueing effect, although differences between painful and non-painful stimuli exist.
Collapse
Affiliation(s)
- Karolina Świder
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- * E-mail:
| | - Eligiusz Wronka
- Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Clementina M. van Rijn
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Marijtje L. A. Jongsma
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Almarzouki AF, Brown CA, Brown RJ, Leung MHK, Jones AKP. Negative expectations interfere with the analgesic effect of safety cues on pain perception by priming the cortical representation of pain in the midcingulate cortex. PLoS One 2017; 12:e0180006. [PMID: 28665973 PMCID: PMC5493341 DOI: 10.1371/journal.pone.0180006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/08/2017] [Indexed: 12/23/2022] Open
Abstract
It is well known that the efficacy of treatment effects, including those of placebos, is heavily dependent on positive expectations regarding treatment outcomes. For example, positive expectations about pain treatments are essential for pain reduction. Such positive expectations not only depend on the properties of the treatment itself, but also on the context in which the treatment is presented. However, it is not clear how the preceding threat of pain will bias positive expectancy effects. One hypothesis is that threatening contexts trigger fearful and catastrophic thinking, reducing the pain-relieving effects of positive expectancy. In this study, we investigated the disruptive influence of threatening contexts on positive expectancy effects while 41 healthy volunteers experienced laser-induced heat pain. A threatening context was induced using pain-threatening cues that preceded the induction of positive expectancies via subsequent pain-safety cues. We also utilised electroencephalography (EEG) to investigate potential neural mechanisms underlying these effects. Lastly, we used the Fear of Pain Questionnaire to address whether the disruptive effect of negative contexts on cued pain relief was related to the degree of fear of pain. As predicted, participants responded less to pain-safety cues (i.e., experienced more pain) when these were preceded by pain-threatening cues. In this threatening context, an enhancement of the N2 component of the laser-evoked potential was detected, which was more pronounced in fearful individuals. This effect was localised to the midcingulate cortex, an area thought to integrate negative affect with pain experience to enable adaptive behaviour in aversive situations. These results suggest that threatening contexts disrupt the effect of pain relief cues via an aversive priming mechanism that enhances neural responses in the early stages of sensory processing.
Collapse
Affiliation(s)
- Abeer F. Almarzouki
- Physiology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail:
| | - Christopher A. Brown
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Richard J. Brown
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Anthony K. P. Jones
- Human Pain Research Group, Division of Neuroscience and Cognitive Psychology, University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| |
Collapse
|
20
|
Munn RG, Hardcastle K, Porter B, Bilkey D. Circadian-scale periodic bursts in theta and gamma-band coherence between hippocampus, cingulate and insular cortices. Neurobiol Sleep Circadian Rhythms 2017; 3:26-37. [PMID: 31236501 PMCID: PMC6575562 DOI: 10.1016/j.nbscr.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/10/2017] [Accepted: 04/01/2017] [Indexed: 11/21/2022] Open
Abstract
Previous studies have demonstrated that mean activity levels in the hippocampus oscillate on a circadian timescale, both at the single neuron and EEG level. This oscillation is also entrained by the availability of food, suggesting that the circadian modulation of hippocampal activity might comprise part of the recently discovered food-entrainable circadian oscillator (FEO). In order to determine whether the circadian oscillation in hippocampal activity is linked to activity in other brain regions, we recorded field-potential EEG from hippocampus and two cortical regions known to connect to hippocampus; the anterior cingulate cortex and the agranular insular cortex. These latter regions are involved in executive control (cingulate) and gustatory feedback (insula) and so are in a position where they could usefully contribute to, or benefit from, hippocampal memorial information in order to undertake task-related processing. We recorded EEG from these three regions for 20 m every hour for 58 consecutive hours in one continuous exposure to the recording environment. We found that there are regular and distinct increases in magnitude coherence between hippocampus and both cortical regions for EEG in both theta (6-12 Hz) and gamma (30-48 Hz) bands. These periods of increased coherence are spaced approximately one solar day apart, appear not to be specifically light-entrained, and are most apparent for gamma frequency activity. The gamma association between the two cortical regions shows the same temporal pattern of coherence peaks as the hippocampal-cortical coherences. We propose that these peaks in coherence represent the transient synchronization of temporally tagged memorial information between the hippocampus and other brain regions for which this information may be relevant. These findings suggest that the FEO involves coordinated activity across a number of brain regions and may underlie a mechanism via which an organism can store and recall salient gustatory events on a circadian timescale.
Collapse
Affiliation(s)
- Robert G.K. Munn
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Department of Neurobiology, Stanford University, USA
| | | | - Blake Porter
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - David Bilkey
- Department of Psychology, University of Otago, Dunedin, New Zealand
| |
Collapse
|
21
|
Benromano T, Pick CG, Granovsky Y, Defrin R. Increased Evoked Potentials and Behavioral Indices in Response to Pain Among Individuals with Intellectual Disability. PAIN MEDICINE 2017; 18:1715-1730. [DOI: 10.1093/pm/pnw349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Gopalakrishnan R, Burgess RC, Lempka SF, Gale JT, Floden DP, Machado AG. Pain anticipatory phenomena in patients with central poststroke pain: a magnetoencephalography study. J Neurophysiol 2016; 116:1387-95. [PMID: 27358316 DOI: 10.1152/jn.00215.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
Central poststroke pain (CPSP) is characterized by hemianesthesia associated with unrelenting chronic pain. The final pain experience stems from interactions between sensory, affective, and cognitive components of chronic pain. Hence, managing CPSP will require integrated approaches aimed not only at the sensory but also the affective-cognitive spheres. A better understanding of the brain's processing of pain anticipation is critical for the development of novel therapeutic approaches that target affective-cognitive networks and alleviate pain-related disability. We used magnetoencephalography (MEG) to characterize the neural substrates of pain anticipation in patients suffering from intractable CPSP. Simple visual cues evoked anticipation while patients awaited impending painful (PS), nonpainful (NPS), or no stimulus (NOS) to their nonaffected and affected extremities. MEG responses were studied at gradiometer level using event-related fields analysis and time-frequency oscillatory analysis upon source localization. On the nonaffected side, significantly greater responses were recorded during PS. PS (vs. NPS and NOS) exhibited significant parietal and frontal cortical activations in the beta and gamma bands, respectively, whereas NPS (vs. NOS) displayed greater activation in the orbitofrontal cortex. On the affected extremity, PS (vs. NPS) did not show significantly greater responses. These data suggest that anticipatory phenomena can modulate neural activity when painful stimuli are applied to the nonaffected extremity but not the affected extremity in CPSP patients. This dichotomy may stem from the chronic effects of pain on neural networks leading to habituation or saturation. Future clinically effective therapies will likely be associated with partial normalization of the neurophysiological correlates of pain anticipation.
Collapse
Affiliation(s)
- Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott F Lempka
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and
| | - John T Gale
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
23
|
Kuttikat A, Noreika V, Shenker N, Chennu S, Bekinschtein T, Brown CA. Neurocognitive and Neuroplastic Mechanisms of Novel Clinical Signs in CRPS. Front Hum Neurosci 2016; 10:16. [PMID: 26858626 PMCID: PMC4728301 DOI: 10.3389/fnhum.2016.00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/12/2016] [Indexed: 12/16/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a chronic, debilitating pain condition that usually arises after trauma to a limb, but its precise etiology remains elusive. Novel clinical signs based on body perceptual disturbances have been reported, but their pathophysiological mechanisms remain poorly understood. Investigators have used functional neuroimaging techniques (including MEG, EEG, fMRI, and PET) to study changes mainly within the somatosensory and motor cortices. Here, we provide a focused review of the neuroimaging research findings that have generated insights into the potential neurocognitive and neuroplastic mechanisms underlying perceptual disturbances in CRPS. Neuroimaging findings, particularly with regard to somatosensory processing, have been promising but limited by a number of technique-specific factors (such as the complexity of neuroimaging investigations, poor spatial resolution of EEG/MEG, and use of modeling procedures that do not draw causal inferences) and more general factors including small samples sizes and poorly characterized patients. These factors have led to an underappreciation of the potential heterogeneity of pathophysiology that may underlie variable clinical presentation in CRPS. Also, until now, neurological deficits have been predominantly investigated separately from perceptual and cognitive disturbances. Here, we highlight the need to identify neurocognitive phenotypes of patients with CRPS that are underpinned by causal explanations for perceptual disturbances. We suggest that a combination of larger cohorts, patient phenotyping, the use of both high temporal, and spatial resolution neuroimaging methods, and the identification of simplified biomarkers is likely to be the most fruitful approach to identifying neurocognitive phenotypes in CRPS. Based on our review, we explain how such phenotypes could be characterized in terms of hierarchical models of perception and corresponding disturbances in recurrent processing involving the somatosensory, salience and executive brain networks. We also draw attention to complementary neurological factors that may explain some CRPS symptoms, including the possibility of central neuroinflammation and neuronal atrophy, and how these phenomena may overlap but be partially separable from neurocognitive deficits.
Collapse
Affiliation(s)
- Anoop Kuttikat
- Department of Rheumatology, Addenbrooke's Hospital , Cambridge , UK
| | - Valdas Noreika
- Cognition and Brain Sciences Unit, Medical Research Council , Cambridge , UK
| | - Nicholas Shenker
- Department of Rheumatology, Addenbrooke's Hospital , Cambridge , UK
| | - Srivas Chennu
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, UK; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tristan Bekinschtein
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, UK; Department of Psychology, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
24
|
Gopalakrishnan R, Burgess RC, Plow EB, Floden DP, Machado AG. Early event related fields during visually evoked pain anticipation. Clin Neurophysiol 2015; 127:1855-63. [PMID: 26733321 DOI: 10.1016/j.clinph.2015.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/02/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pain experience is not only a function of somatosensory inputs. Rather, it is strongly influenced by cognitive and affective pathways. Pain anticipatory phenomena, an important limitation to rehabilitative efforts in the chronic state, are processed by associative and limbic networks, along with primary sensory cortices. Characterization of neurophysiological correlates of pain anticipation, particularly during very early stages of neural processing is critical for development of therapeutic interventions. METHODS Here, we utilized magnetoencephalography to study early event-related fields (ERFs) in healthy subjects exposed to a 3 s visual countdown task that preceded a painful stimulus, a non-painful stimulus or no stimulus. RESULTS We found that the first countdown cue, but not the last cue, evoked critical ERFs signaling anticipation, attention and alertness to the noxious stimuli. Further, we found that P2 and N2 components were significantly different in response to first-cues that signaled incoming painful stimuli when compared to non-painful or no stimuli. CONCLUSIONS The findings indicate that early ERFs are relevant neural substrates of pain anticipatory phenomena and could be potentially serve as biomarkers. SIGNIFICANCE These measures could assist in the development of neurostimulation approaches aimed at curbing the negative effects of pain anticipation during rehabilitation.
Collapse
Affiliation(s)
- Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ela B Plow
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|
25
|
Seidel EM, Pfabigan DM, Hahn A, Sladky R, Grahl A, Paul K, Kraus C, Küblböck M, Kranz GS, Hummer A, Lanzenberger R, Windischberger C, Lamm C. Uncertainty during pain anticipation: the adaptive value of preparatory processes. Hum Brain Mapp 2014; 36:744-55. [PMID: 25324216 DOI: 10.1002/hbm.22661] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/07/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Anticipatory processes prepare the organism for upcoming experiences. The aim of this study was to investigate neural responses related to anticipation and processing of painful stimuli occurring with different levels of uncertainty. EXPERIMENTAL DESIGN Twenty-five participants (13 females) took part in an electroencephalography and functional magnetic resonance imaging (fMRI) experiment at separate times. A visual cue announced the occurrence of an electrical painful or nonpainful stimulus, delivered with certainty or uncertainty (50% chance), at some point during the following 15 s. PRINCIPAL OBSERVATIONS During the first 2 s of the anticipation phase, a strong effect of uncertainty was reflected in a pronounced frontal stimulus-preceding negativity (SPN) and increased fMRI activation in higher visual processing areas. In the last 2 s before stimulus delivery, we observed stimulus-specific preparatory processes indicated by a centroparietal SPN and posterior insula activation that was most pronounced for the certain pain condition. Uncertain anticipation was associated with attentional control processes. During stimulation, the results revealed that unexpected painful stimuli produced the strongest activation in the affective pain processing network and a more pronounced offset-P2. CONCLUSIONS Our results reflect that during early anticipation uncertainty is strongly associated with affective mechanisms and seems to be a more salient event compared to certain anticipation. During the last 2 s before stimulation, attentional control mechanisms are initiated related to the increased salience of uncertainty. Furthermore, stimulus-specific preparatory mechanisms during certain anticipation also shaped the response to stimulation, underlining the adaptive value of stimulus-targeted preparatory activity which is less likely when facing an uncertain event.
Collapse
Affiliation(s)
- Eva-Maria Seidel
- Social, Cognitive and Affective Neuroscience Unit, Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Machado AG, Gopalakrishnan R, Plow EB, Burgess RC, Mosher JC. A magnetoencephalography study of visual processing of pain anticipation. J Neurophysiol 2014; 112:276-86. [PMID: 24790165 DOI: 10.1152/jn.00193.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anticipating pain is important for avoiding injury; however, in chronic pain patients, anticipatory behavior can become maladaptive, leading to sensitization and limiting function. Knowledge of networks involved in pain anticipation and conditioning over time could help devise novel, better-targeted therapies. With the use of magnetoencephalography, we evaluated in 10 healthy subjects the neural processing of pain anticipation. Anticipatory cortical activity elicited by consecutive visual cues that signified imminent painful stimulus was compared with cues signifying nonpainful and no stimulus. We found that the neural processing of visually evoked pain anticipation involves the primary visual cortex along with cingulate and frontal regions. Visual cortex could quickly and independently encode and discriminate between visual cues associated with pain anticipation and no pain during preconscious phases following object presentation. When evaluating the effect of task repetition on participating cortical areas, we found that activity of prefrontal and cingulate regions was mostly prominent early on when subjects were still naive to a cue's contextual meaning. Visual cortical activity was significant throughout later phases. Although visual cortex may precisely and time efficiently decode cues anticipating pain or no pain, prefrontal areas establish the context associated with each cue. These findings have important implications toward processes involved in pain anticipation and maladaptive pain conditioning.
Collapse
Affiliation(s)
- Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - John C Mosher
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
27
|
The visual size of one׳s own hand modulates pain anticipation and perception. Neuropsychologia 2014; 57:93-100. [PMID: 24657712 DOI: 10.1016/j.neuropsychologia.2014.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 12/29/2022]
Abstract
How to reduce pain is a fundamental clinical and experimental question. Acute pain is a complex experience which seems to emerge from the co-activation of two main processes, namely the nociceptive/discriminative analysis and the affective/cognitive evaluation of the painful stimulus. Recently it has been found that pain threshold increases following the visual magnification of the body part targeted by the painful stimulation. This finding is compatible with the well-known notion that body representation and perceptual experience relay on complex, multisensory factors. However, the level of cognitive processing and the physiological mechanisms underlying this analgesic effect are still to be investigated. In the present work we found that following the visual magnification of a body part, the Skin Conductance Responses (SCR), to an approaching painful stimulus increases before contact and decreases following the real stimulation, compared to the non-distorted view of the hand. By contrast, an unspecific SCR increase is found when the hand is visually shrunk. Moreover a reduction of subjective pain experience was found specifically for the magnified hand in explicit pain ratings. These findings suggest that the visual increase of body size enhances the cognitive, anticipatory component of pain processing; such an anticipatory reaction reduces the response to the following contact with the noxious stimulus. The present results support the idea that cognitive aspects of pain experience relay on the multisensory representation of the body, and that could be usefully exploited for inducing a significant reduction of subjective pain experience.
Collapse
|
28
|
Illusory self-identification with an avatar reduces arousal responses to painful stimuli. Behav Brain Res 2014; 261:275-81. [DOI: 10.1016/j.bbr.2013.12.049] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/11/2013] [Accepted: 12/21/2013] [Indexed: 11/18/2022]
|
29
|
Romano D, Gandola M, Bottini G, Maravita A. Arousal responses to noxious stimuli in somatoparaphrenia and anosognosia: clues to body awareness. ACTA ACUST UNITED AC 2014; 137:1213-23. [PMID: 24531623 DOI: 10.1093/brain/awu009] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A complex brain representation of our body allows us to monitor incoming sensory stimuli and plan actions towards the external world. A critical element of such a complex representation is the sense of ownership towards our own body parts. Brain damage may disrupt this representation, leading to the striking neuropsychological condition called somatoparaphrenia, that is, the delusion that one's own limbs belong to someone else. The clinical features characterizing somatoparaphrenia are well known, however, physiological clues of the level at which this condition may disrupt sensory functions are unknown. In the present study we investigated this issue by measuring the anticipatory skin conductance response to noxious stimuli approaching either the affected or the intact body side in a group of patients with somatoparaphrenia (n=5; three females, age range=66-84), and in a group of patients with anosognosia for sensory deficits, i.e. preserved ownership but decreased awareness of somatosensory deficit, (n=5; one female, age range=62-81 years) and in a group of purely hemiplegic patients (n=5; two females, age range=63-74 years) with no deficits of ownership or sensory awareness. Results show that anticipatory skin conductance responses to noxious stimuli directed to the contralesional hand are significantly reduced as compared to noxious stimuli directed to the ipsilesional hand in patients with somatoparaphrenia. By contrast a non-reduced anticipatory skin conductance response was observed in control participants as well as in patients affected by anosognosia for the somatosensory deficit and in patients affected by pure motor deficits. Furthermore, a pain anticipation response was always measured when the stimuli were directed towards the ipsilesional, unaffected hand in all groups. Our results show for the first time that the delusions shown by somatoparaphrenic patients are associated with an altered physiological index of perceptual analysis. The reduced response to sensory threats approaching the body suggests a deep detachment of the affected body part from the patient's body representation. Conversely, normal reactions to incoming threats are found in the presence of impaired sensory awareness but intact body ownership, supporting the notion that representation of the body may be affected at different levels following brain damage.
Collapse
Affiliation(s)
- Daniele Romano
- 1 Department of Psychology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | | | | |
Collapse
|
30
|
Perceptual bias in pain: A switch looks closer when it will relieve pain than when it won’t. Pain 2013; 154:1961-1965. [DOI: 10.1016/j.pain.2013.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/22/2022]
|
31
|
|
32
|
Hypnotic modulation of pain perception and of brain activity triggered by nociceptive laser stimuli. Cortex 2013; 49:446-62. [DOI: 10.1016/j.cortex.2012.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/09/2012] [Accepted: 02/15/2012] [Indexed: 11/18/2022]
|
33
|
Lev R, Granovsky Y, Yarnitsky D. Enhanced pain expectation in migraine: EEG-based evidence for impaired prefrontal function. Headache 2012; 53:1054-70. [PMID: 23216259 DOI: 10.1111/j.1526-4610.2012.02297.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dysexcitability characterizes the interictal migraineous brain. The main central expressions of this dysexcitability are decreased habituation and enhanced anticipation and attention to pain and other external sensory stimuli. OBJECTIVE This study evaluates the effects of anticipation on pain modulation and their neural correlates in migraine. METHODS In 39 migraineurs (20 migraine with aura [MWA] and 19 migraine without aura [MOA]) and 22 healthy controls, cortical responses to 2 successive trains of noxious contact-heat stimuli, presented in either predicted or unpredicted manner, were analyzed using standardized low-resolution electromagnetic tomography key. RESULTS A lack of habituation to repeated predicted pain was associated with significantly increased pain-evoked potential amplitudes in MWAs (increase of 3.9 μV) and unchanged ones in MOAs (1.1 μV) but not in controls (decrease of 5 μV). Repeated unpredicted pain resulted in enhanced pain-evoked potential amplitudes in both MWA and MOA groups (increase of 5.5 μV and 4.4 μV, respectively) compared with controls (decrease of 0.2 μV). Source localization revealed reduced activations in the anterior-medial prefrontal cortices and subsequent increased somatosensory activity in migraineurs (P < .05). The prefrontal-somatosensory dysfunction positively correlated with lifetime headache duration (P < .05) and concern of upcoming migraine attacks (P < .05) in MWAs, and with frequency of migraine attacks in MOAs (P < .05). CONCLUSIONS Our findings of impaired modulation of anticipated pain in migraine suggest a heightened state of anticipatory readiness combined with ineffective recruitment of prefrontal inhibitory pathways during experience of pain; the latter might account for the former, at least partially. In line, less efficient inhibitory capability is a plausible mechanistic explanation for patients' high concern about their upcoming migraine attacks.
Collapse
Affiliation(s)
- Rina Lev
- Department of Clinical Neurophysiology, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | | |
Collapse
|
34
|
Women, but not men, report increasingly more pain during repeated (un)predictable painful electrocutaneous stimulation: Evidence for mediation by fear of pain. Pain 2012; 153:1030-1041. [DOI: 10.1016/j.pain.2012.02.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/31/2012] [Accepted: 02/06/2012] [Indexed: 11/22/2022]
|
35
|
Van Ryckeghem DM, Crombez G, Eccleston C, Liefooghe B, Van Damme S. The Interruptive Effect of Pain in a Multitask Environment: An Experimental Investigation. THE JOURNAL OF PAIN 2012; 13:131-8. [DOI: 10.1016/j.jpain.2011.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/22/2011] [Accepted: 09/15/2011] [Indexed: 11/15/2022]
|
36
|
Valentini E, Torta DME, Mouraux A, Iannetti GD. Dishabituation of Laser-evoked EEG Responses: Dissecting the Effect of Certain and Uncertain Changes in Stimulus Modality. J Cogn Neurosci 2011; 23:2822-37. [DOI: 10.1162/jocn.2011.21609] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
The repetition of nociceptive stimuli of identical modality, intensity, and location at short and constant interstimulus intervals (ISIs) determines a strong habituation of the corresponding EEG responses, without affecting the subjective perception of pain. To understand what determines this response habituation, we (i) examined the effect of introducing a change in the modality of the repeated stimulus, and (ii) dissected the relative contribution of bottom–up, stimulus-driven changes in modality and top–down, cognitive expectations of such a change, on both laser-evoked and auditory-evoked EEG responses. Multichannel EEG was recorded while participants received trains of three stimuli (S1–S2–S3, a triplet) delivered to the hand dorsum at 1-sec ISI. S3 belonged either to the same modality as S1 and S2 or to the other modality. In addition, participants were either explicitly informed or not informed of the modality of S3. We found that introducing a change in stimulus modality produced a significant dishabituation of the laser-evoked N1, N2, and P2 waves; the auditory N1 and P2 waves; and the laser- and auditory-induced event-related synchronization and desynchronization. In contrast, the lack of explicit knowledge of a possible change in the sensory modality of the stimulus (i.e., uncertainty) only increased the ascending portion of the laser-evoked and auditory-evoked P2 wave. Altogether, these results indicate that bottom–up novelty resulting from the change of stimulus modality, and not top–down cognitive expectations, plays a major role in determining the habituation of these brain responses.
Collapse
Affiliation(s)
| | | | - André Mouraux
- 3Universitè Catholique de Louvain, Brussels, Belgium
| | | |
Collapse
|
37
|
Worthen SF, Hobson AR, Hall SD, Aziz Q, Furlong PL. Primary and secondary somatosensory cortex responses to anticipation and pain: a magnetoencephalography study. Eur J Neurosci 2011; 33:946-59. [DOI: 10.1111/j.1460-9568.2010.07575.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Legrain V, Iannetti GD, Plaghki L, Mouraux A. The pain matrix reloaded: a salience detection system for the body. Prog Neurobiol 2010; 93:111-24. [PMID: 21040755 DOI: 10.1016/j.pneurobio.2010.10.005] [Citation(s) in RCA: 587] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 10/08/2010] [Accepted: 10/20/2010] [Indexed: 01/18/2023]
Abstract
Neuroimaging and neurophysiological studies have shown that nociceptive stimuli elicit responses in an extensive cortical network including somatosensory, insular and cingulate areas, as well as frontal and parietal areas. This network, often referred to as the "pain matrix", is viewed as representing the activity by which the intensity and unpleasantness of the perception elicited by a nociceptive stimulus are represented. However, recent experiments have reported (i) that pain intensity can be dissociated from the magnitude of responses in the "pain matrix", (ii) that the responses in the "pain matrix" are strongly influenced by the context within which the nociceptive stimuli appear, and (iii) that non-nociceptive stimuli can elicit cortical responses with a spatial configuration similar to that of the "pain matrix". For these reasons, we propose an alternative view of the functional significance of this cortical network, in which it reflects a system involved in detecting, orienting attention towards, and reacting to the occurrence of salient sensory events. This cortical network might represent a basic mechanism through which significant events for the body's integrity are detected, regardless of the sensory channel through which these events are conveyed. This function would involve the construction of a multimodal cortical representation of the body and nearby space. Under the assumption that this network acts as a defensive system signaling potentially damaging threats for the body, emphasis is no longer on the quality of the sensation elicited by noxious stimuli but on the action prompted by the occurrence of potential threats.
Collapse
Affiliation(s)
- Valéry Legrain
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium.
| | | | | | | |
Collapse
|
39
|
Wang AL, Mouraux A, Liang M, Iannetti GD. Stimulus Novelty, and Not Neural Refractoriness, Explains the Repetition Suppression of Laser-Evoked Potentials. J Neurophysiol 2010; 104:2116-24. [DOI: 10.1152/jn.01088.2009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Brief radiant laser pulses selectively activate skin nociceptors and elicit transient brain responses (laser-evoked potentials [LEPs]). When LEPs are elicited by pairs of stimuli (S1–S2) delivered at different interstimulus intervals (ISIs), the S2-LEP is strongly reduced at short ISIs (250 ms) and progressively recovers at longer ISIs (2,000 ms). This finding has been interpreted in terms of order of arrival of nociceptive volleys and refractoriness of neural generators of LEPs. However, an alternative explanation is the modulation of another experimental factor: the novelty of the eliciting stimulus. To test this alternative hypothesis, we recorded LEPs elicited by pairs of nociceptive stimuli delivered at four ISIs (250, 500, 1,000, 2,000 ms), using two different conditions. In the constant condition, the ISI was identical across the trials of each block, whereas in the variable condition, the ISI was varied randomly across trials and single-stimulus trials were intermixed with paired trials. Therefore the time of occurrence of S2 was both less novel and more predictable in the constant than in the variable condition. In the constant condition, we observed a significant ISI-dependent suppression of the biphasic negative–positive wave (N2–P2) complex of the S2-LEP. In contrast, in the variable condition, the S2-LEP was completely unaffected by stimulus repetition. The pain ratings elicited by S2 were not different in the two conditions. These results indicate that the repetition-suppression of the S2-LEP is not due to refractoriness in nociceptive afferent pathways, but to a modulation of novelty and/or temporal predictability of the eliciting stimulus. This provides further support to the notion that stimulus saliency constitutes a crucial determinant of LEP magnitude and that a significant fraction of the brain activity time-locked to a brief and transient sensory stimulus is not directly related to the quality and the intensity of the corresponding sensation, but to bottom-up attentional processes.
Collapse
Affiliation(s)
- A. L. Wang
- Department of Neuroscience, Physiology and Pharmacology, University College London, London
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom; and
| | - A. Mouraux
- Institute of Neurosciences, Université Catholique de Louvain, Louvan, Belgium
| | - M. Liang
- Department of Neuroscience, Physiology and Pharmacology, University College London, London
| | - G. D. Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom; and
| |
Collapse
|
40
|
Iannetti GD, Mouraux A. From the neuromatrix to the pain matrix (and back). Exp Brain Res 2010; 205:1-12. [PMID: 20607220 DOI: 10.1007/s00221-010-2340-1] [Citation(s) in RCA: 388] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 06/14/2010] [Indexed: 12/29/2022]
Abstract
Pain is a conscious experience, crucial for survival. To investigate the neural basis of pain perception in humans, a large number of investigators apply noxious stimuli to the body of volunteers while sampling brain activity using different functional neuroimaging techniques. These responses have been shown to originate from an extensive network of brain regions, which has been christened the Pain Matrix and is often considered to represent a unique cerebral signature for pain perception. As a consequence, the Pain Matrix is often used to understand the neural mechanisms of pain in health and disease. Because the interpretation of a great number of experimental studies relies on the assumption that the brain responses elicited by nociceptive stimuli reflect the activity of a cortical network that is at least partially specific for pain, it appears crucial to ascertain whether this notion is supported by unequivocal experimental evidence. Here, we will review the original concept of the "Neuromatrix" as it was initially proposed by Melzack and its subsequent transformation into a pain-specific matrix. Through a critical discussion of the evidence in favor and against this concept of pain specificity, we show that the fraction of the neuronal activity measured using currently available macroscopic functional neuroimaging techniques (e.g., EEG, MEG, fMRI, PET) in response to transient nociceptive stimulation is likely to be largely unspecific for nociception.
Collapse
Affiliation(s)
- G D Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, Medical Sciences Building, Gower Street, London, WC1E 6BT, UK.
| | | |
Collapse
|
41
|
Brown CA, Jones AKP. Meditation experience predicts less negative appraisal of pain: electrophysiological evidence for the involvement of anticipatory neural responses. Pain 2010; 150:428-438. [PMID: 20494517 DOI: 10.1016/j.pain.2010.04.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 03/31/2010] [Accepted: 04/13/2010] [Indexed: 12/01/2022]
Abstract
The aim of mindfulness meditation is to develop present-focused, non-judgmental, attention. Therefore, experience in meditation should be associated with less anticipation and negative appraisal of pain. In this study we compared a group of individuals with meditation experience to a control group to test whether any differences in the affective appraisal of pain could be explained by lower anticipatory neural processing. Anticipatory and pain-evoked ERPs and reported pain unpleasantness were recorded in response to laser stimuli of matched subjective intensity between the two groups. ERP data were analysed after source estimation with LORETA. No group effects were found on the laser energies used to induce pain. More experienced meditators perceived the pain as less unpleasant relative to controls, with meditation experience correlating inversely with unpleasantness ratings. ERP source data for anticipation showed that in meditators, lower activity in midcingulate cortex relative to controls was related to the lower unpleasantness ratings, and was predicted by lifetime meditation experience. Meditators also reversed the normal positive correlation between medial prefrontal cortical activity and pain unpleasantness during anticipation. Meditation was also associated with lower activity in S2 and insula during the pain-evoked response, although the experiment could not disambiguate this activity from the preceding anticipation response. Our data is consistent with the hypothesis that meditation reduces the anticipation and negative appraisal of pain, but effects on pain-evoked activity are less clear and may originate from preceding anticipatory activity. Further work is required to directly test the causal relationship between meditation, pain anticipation, and pain experience.
Collapse
Affiliation(s)
- Christopher A Brown
- Human Pain Research Group, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | | |
Collapse
|