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Imaging how attention modulates pain in human using functional MRI

Oxford University Department of Clinical Neurology, Centre for Functional Magnetic Resonance Imaging of the Brain, John Radcliffe Hospital, Headington, Oxford, UK.
Brain (Impact Factor: 10.23). 03/2002; 125(Pt 2):310-9.
Source: PubMed

ABSTRACT Current clinical and experimental literature strongly supports the phenomenon of reduced pain perception whilst attention is distracted away from noxious stimuli. This study used functional MRI to elucidate the underlying neural systems and mechanisms involved. An analogue of the Stroop task, the counting Stroop, was used as a cognitive distraction task whilst subjects received intermittent painful thermal stimuli. Pain intensity scores were significantly reduced when subjects took part in the more cognitively demanding interference task of the counting Stroop than in the less demanding neutral task. When subjects were distracted during painful stimulation, brain areas associated with the affective division of the anterior cingulate cortex (ACC) and orbitofrontal regions showed increased activation. In contrast, many areas of the pain matrix (i.e. thalamus, insula, cognitive division of the ACC) displayed reduced activation, supporting the behavioural results of reduced pain perception.

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    • "Attentional focus is then directed away from the pain sensations and towards mental tasks. By using a pain-inducing activity (e.g., solving mental tasks), certain benefits would be expected (e.g., reduced pain perception while attention is distracted away from noxious stimuli) (Banestick et al., 2002; Johnson, 2005). Some ancillary evidence suggests that distraction should be used with caution; for instance, findings show that distraction from chronic pain (during a pain-inducing activity) is associated with greater post-activity pain (Goubert, Crombez, Eccleston, & Devulder, 2004). "
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    ABSTRACT: Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a person's health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patient's perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23-78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: "A reactive process on symptoms," "A reactive process on emotional triggers," "An active process of taking an inventory of abilities," and "A shifting from BA to the outside world." In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patient's general health.
    International Journal of Qualitative Studies on Health and Well-Being 10/2014; 9:24670. DOI:10.3402/qhw.v9.24670 · 0.93 Impact Factor
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    • "Incongruent Stroop was found to reduce heat pain sensitivity and increase activation of the cingulo-frontal cortex including the orbitofrontal and perigenual anterior cingulate cortex (ACC) as well as the periaqueductal gray (PAG) and the posterior thalamus in healthy controls [15]. Bantick et al. (2002) found that pain intensity scores for heat stimuli were significantly reduced when subjects took part in the cognitively more demanding task (incongruent stimuli) compared to the less demanding neutral task and this was accompanied by reduced activation in pain relevant brain areas such as insula, mid cingulate and thalamus. They also found that the peringual cingulate cortex and orbitofrontal cortex were more activated when painful stimuli and cognitive stimuli were presented together than what would be expected by a simple additive effect of the two [16]. "
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    ABSTRACT: The mechanisms causing cognitive problems in chronic pain patients are not well understood. We used the Stroop color word task (SCWT) to investigate distraction-induced analgesia, cognitive performance, and cerebral activation patterns in 29 fibromyalgia (FM) patients (mean age 49.8 years, range 25-64 years) and 31 healthy controls (HC) (mean age 46.3 years, range 20-63 years). In the first study, SCWT was used to investigate distraction-induced analgesia in FM patients. Two versions of the task were applied, one with only congruent color-word images and one with incongruent images. Pressure pain thresholds were assessed using a pressure algometer before, during, and following SCWT. In the second study, reaction times (RTs) were assessed and functional magnetic resonance imaging (fMRI) was used to investigate cerebral activation patterns in FM patients and HC during the SCWT. An event-related task mixing incongruent and congruent images was used. In study one, we found reduced pressure pain sensitivity during SCWT in both groups alike and no statistically significant differences were seen between the incongruent and congruent conditions. The study two revealed longer RTs during the incongruent compared to the congruent condition in both groups. FM patients had longer RTs than HC in both conditions. Furthermore, we found a significant interaction between group and congruency; that is, the group differences in RTs were more pronounced during the incongruent condition. This was reflected in a reduced activation of the caudate nucleus, lingual gyrus, temporal areas, and the hippocampus in FM patients compared to HC. In conclusion, we found normal pain inhibition during SWTC in FM patients. The cognitive difficulties seen in FM patients, reflected in longer RTs, were related to reduced activation of the caudate nucleus and hippocampus during incongruent SCWT, which most likely affected the mechanisms of cognitive learning in FM patients.
    PLoS ONE 10/2014; 9(10):e108637. DOI:10.1371/journal.pone.0108637 · 3.23 Impact Factor
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    • "It has been shown that VR is highly effective since it can provide an alternative reality, fully immersive and interactive. Indeed, distraction per se has been recognized as a powerful factor in lowering pain ratings outside VR (Bantick et al., 2002). Nonetheless, not all the analgesic effects due to psychological factors rely upon sheer attentional modulation. "
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    ABSTRACT: Appropriate sensorimotor correlations can result in the illusion of ownership of exogenous body parts. Nevertheless, whether and how the illusion of owning a new body part affects human perception, and in particular pain detection, is still poorly investigated. Recent findings have shown that seeing one's own body is analgesic, but it is not known whether this effect is transferable to newly embodied, but exogenous, body parts. In recent years, results from our laboratory have demonstrated that a virtual body can be felt as one's own, provided realistic multisensory correlations. The current work aimed at investigating the impact of virtual body ownership on pain threshold. An immersive virtual environment allowed a first-person perspective of a virtual body that replaced the own. Passive movement of the index finger congruent with the movement of the virtual index finger was used in the 'synchronous' condition to induce ownership of the virtual arm. The pain threshold was tested by thermal stimulation under four conditions: (1) synchronous movements of the real and virtual fingers; (2) asynchronous movements; (3) seeing a virtual object instead of an arm; and (4) not seeing any limb in real world. Our results show that, independently of attentional and stimulus adaptation processes, the ownership of a virtual arm per se can significantly increase the thermal pain threshold. This finding may be relevant for the development and improvement of digital solutions for rehabilitation and pain treatment.
    European journal of pain (London, England) 08/2014; 18(7). DOI:10.1002/j.1532-2149.2014.00451.x · 3.22 Impact Factor
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