The localised PET cerebral correlates of the painful experience in the normal human brain have previously been demonstrated. This study examined whether these responses are different in patients with chronic atypical facial pain. The regional cerebral responses to nonpainfil and painful thermal stimuli in six female patients with atypical facial pain and six matched female controls were studied by taking serial measurements of regional blood flow by PET. Both groups displayed highly significant differences in responses to painful heat compared with non-painful heat in the thalamus, anterior cingulate cortex (area 24), lentiform nucleus, insula, and prefrontal cortex. These structures are closely related to the "medial pain system". The atypical facial pain group had increased blood flow in the anterior cingulate cortex and decreased blood flow in the prefrontal cortex. These findings show the importance of the anterior cingulate cortex and the reciprocal (possibly inhibitory) connections with the prefrontal cortex in the processing of pain in patients with this disorder. A hypothesis is proposed to explain the mechanisms of cognitive and pharmacological manipulation of these pain processes.

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-This article presents the findings of a focused literature review and consensus meetings on the definition and clinical significance of painful symptoms in patients with depression. About 50% of depressed patients report pain, and many types of pain occur more frequently in people with depression than in those without. There is some evidence that pain in depressed patients is associated with a poor response to treatment. Pain and depression may share common pathways and may both respond to treatment with certain antidepressants. Doctors need to be alert to pain in depressed patients and be prepared to treat it.