Supraspinal Pain Processing: Distinct Roles of Emotion and Attention

Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
The Neuroscientist (Impact Factor: 6.84). 04/2010; 16(3):276-84. DOI: 10.1177/1073858409359200
Source: PubMed


Attentional and emotional states alter the way we perceive pain. Recent findings suggest that the mechanisms underlying these two forms of pain modulation are at least partially separable. This concept is supported by the observation that attention and emotions differentially alter the sensory and affective dimensions of pain perception and apparently implicate different brain circuits. In this review, we will examine those recent findings within the broader cognitive neuroscience conceptualization of human attention and emotion and the corresponding functional neuroanatomy.

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    • "[54], [55] In the study reported herein, the superior temporal/inferior parietal region for which there was a negative correlation with pain thresholds in controls but a lack of such correlation in migraineurs is estimated to be located within the ventral frontoparietal attention network. [56], [57] This network is activated when relevant stimuli are detected and is involved in orienting and re-orienting in response to the relevant stimulus. [55], [58] Although the ventral frontoparietal attention network is typically right hemisphere dominant, with attention-demanding tasks this lateralization is lost. "
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    ABSTRACT: Background/Objective Migraineurs have atypical pain processing, increased expectations for pain, and hypervigilance for pain. Recent studies identified correlations between brain structure and pain sensation in healthy adults. The objective of this study was to compare cortical thickness-to-pain threshold correlations in migraineurs to healthy controls. We hypothesized that migraineurs would have aberrant relationships between the anatomical neurocorrelates of pain processing and pain thresholds. Methods Pain thresholds to cutaneously applied heat were determined for 31 adult migraineurs and 32 healthy controls. Cortical thickness was determined from magnetic resonance imaging T1-weighted sequences. Regional cortical thickness-to-pain threshold correlations were determined for migraineurs and controls separately using a general linear model whole brain vertex-wise analysis. A pain threshold-by-group interaction analysis was then conducted to estimate regions where migraineurs show alterations in the pain threshold-to-cortical thickness correlations relative to healthy controls. Results Controls had negative correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left posterior cingulate/precuneus, right superior temporal, right inferior parietal, and left inferior temporal regions, and a negative correlation (p<0.01 Monte Carlo corrected) with a left superior temporal/inferior parietal region. Migraineurs had positive correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left superior temporal/inferior parietal, right precuneus, right superior temporal/inferior parietal, and left inferior parietal regions. Cortical thickness-to-pain threshold correlations differed between migraine and control groups (p<0.01 uncorrected) for right superior temporal/inferior parietal, right precentral, left posterior cingulate/precuneus, and right inferior parietal regions and (p<0.01 Monte Carlo corrected) for a left superior temporal/inferior parietal region. Conclusions Unlike healthy control subjects who have a significant negative correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds, migraineurs have a non-significant positive correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds. Since this region participates in orienting and attention to painful stimuli, absence of the normal correlation might represent a migraineurs inability to inhibit pain sensation via shifting attention away from the painful stimulus.
    Full-text · Article · Jun 2014 · PLoS ONE
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    ABSTRACT: Aversive learning seems to be mediated by the neural systems responsive to pain, while the subjective perception of pain was found to be implemented by the same cerebral network involved in orienting attention to novel, unexpected stimuli, and also in errors detection. This “attentional network” managing automatic shifting of attention to unexpected, relevant stimuli – “orienting reflex” – is superimposed over the danger detection mechamisms, and is known to be involved in triggering anxiety in humans. Biochemically, phasic dopaminergic and noradrenergic components are responsible for processing novelty and triggering attention shiftings in response to environmental changes, phasic dopamine component being involved also in adaptation to pain – or analgesic response – making a “chemical connection” between pain processing and the mechanisms which trigger behavioral adaptation to change. In addition, the same brain network which gestionates novelty detection and physical pain subjective perception are involved in processing of negative feedback and social rejection, these processes being associated with a proinflammatory immune response, suggesting that immune response is modulated by social relationships and the success in activity or our ability to adapt to change.
    Full-text · Article · Jan 2010
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    ABSTRACT: Since modern brain imaging of pain began 20 years ago, networks in the brain related to pain processing and those related to different types of pain modulation, including placebo, have been identified. Functional and anatomical connectivity of these circuits has begun to be analyzed. Imaging in patients suggests that chronic pain is associated with altered function and structural abnormalities in pain modulatory circuits. Moreover, biochemical alterations associated with chronic pain are being identified that provide information on cellular correlates as well as potential mechanisms of structural changes. Data from these brain imaging studies reinforce the idea that chronic pain leads to brain changes that could have functional significance.
    Full-text · Article · Nov 2010 · The Journal of clinical investigation
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