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Pain serves as a critical warning signal that alerts the body to potential or actual harm. When mechanical pressure on the skin is intense, such as from a sharp pinch, the sensation transitions from touch to pain. Similarly, extreme temperatures, like a hot pot handle, convert the sensation of heat into pain. Pain can also result from overstimulation of other senses, such as blinding light, loud noise, or the intense heat from habañero peppers. This ability to sense pain is essential for...
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Different Brain Circuitries Mediating Controllable and Uncontrollable Pain.

Anne-Kathrin Bräscher1, Susanne Becker2, Marie-Eve Hoeppli3

  • 1Alan Edwards Centre for Research on Pain, Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz 55122, Germany, abraesch@uni-mainz.de.

The Journal of Neuroscience : the Official Journal of the Society for Neuroscience
|May 6, 2016
PubMed
Summary

Controlling pain reduces its intensity by engaging the dorsolateral prefrontal cortex (dlPFC). Uncontrollable pain, however, increases pain perception and brain activation via the medial prefrontal cortex (mPFC) and insula.

Keywords:
controllabilitydorsolateral prefrontal cortex (dlPFC)insulamedial prefrontal cortex (mPFC)painpain modulation

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Area of Science:

  • Neuroscience
  • Pain Research
  • Cognitive Neuroscience

Background:

  • Pain perception is modulated by stimulus controllability.
  • The neural mechanisms underlying how controllability influences pain processing remain incompletely understood.
  • The prefrontal cortex (PFC) is implicated in pain modulation, but specific roles of its subregions are debated.

Purpose of the Study:

  • To investigate the distinct neural mechanisms by which controllable versus uncontrollable pain affects pain perception and brain activation.
  • To identify specific brain regions and their connectivity patterns mediating pain facilitation and inhibition based on stimulus control.
  • To elucidate the role of the prefrontal cortex in endogenous pain modulation.

Main Methods:

  • Functional magnetic resonance imaging (fMRI) was used in healthy volunteers.
  • Participants underwent tasks involving self-adjusted (controllable) and yoked (uncontrollable) painful thermal stimulation.
  • Brain activation and functional connectivity were analyzed during different pain conditions.

Main Results:

  • Uncontrollable pain led to increased pain intensity ratings and heightened activation in pain-processing areas (insula, ACC, thalamus).
  • Controllable pain was associated with reduced activation in pain-processing regions, mediated by the dorsolateral prefrontal cortex (dlPFC).
  • Uncontrollable pain showed increased connectivity between the medial prefrontal cortex (mPFC) and insula, suggesting pain facilitation.
  • Controllable pain demonstrated negative connectivity between dlPFC and insula, indicating pain inhibition.

Conclusions:

  • The dlPFC exerts an inhibitory effect on pain processing during controllable pain via the anterior insula.
  • The mPFC facilitates pain processing during uncontrollable pain, also through connections with the anterior insula.
  • These findings reveal context-dependent neural mechanisms of pain modulation and their link to subjective pain experience.