Asymbolia for pain: A sensory‐limbic disconnection syndrome

M, Berthier; Starkstein, Sergio E.; Leiguarda, R

doi:10.1002/ana.410240109

Cited by 378 publications

(189 citation statements)

References 29 publications

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“…Patients with insular cortical lesions have been reported to identify a noxious stimulus as painful but are unable to properly appreciate the meaning of their pain (48). Similarly, terminal cancer patients who have had prefrontal lobotomies appear to fully appreciate novel pain but exhibit diminished appreciation of the implications of their cancerrelated pain (49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

The subjective experience of pain: Where expectations become reality

Koyama

McHaffie

Laurienti

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

620

408

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Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information. However, the neural mechanisms supporting these interactions remain poorly understood. By using combined psychophysical and functional MRI techniques, brain activation related to the intensity of expected pain and experienced pain was characterized. As the magnitude of expected pain increased, activation increased in the thalamus, insula, prefrontal cortex, anterior cingulate cortex (ACC) and other brain regions. Pain-intensityrelated brain activation was identified in a widely distributed set of brain regions but overlapped partially with expectation-related activation in regions, including the anterior insula and ACC. When expected pain was manipulated, expectations of decreased pain powerfully reduced both the subjective experience of pain and activation of pain-related brain regions, such as the primary somatosensory cortex, insular cortex, and ACC. These results confirm that a mental representation of an impending sensory event can significantly shape neural processes that underlie the formulation of the actual sensory experience and provide insight as to how positive expectations diminish the severity of chronic disease states.functional MRI ͉ mental imagery ͉ placebo ͉ psychophysical T he experience of a sensory event is highly subjective and can vary substantially from one individual to the next (1). Much of this individual variation may result from the manner in which past experience and future predictions about a stimulus are used to interpret afferent information. Consistent pairing of environmental cues with sensory events provides a learned historical context that is critically important for the prediction and processing of future sensations (2, 3). However, expectations that are inconsistent with sensory information can dramatically alter the sensory experience. In the case of pain, positive expectations can powerfully reduce the subjective experience of pain evoked by a consistently noxious stimulus, whereas negative expectations may result in the amplification of pain (4-7). Furthermore, expectations in which there is a high degree of certainty as to the outcome may activate descending control systems to diminish pain, whereas expectations associated with uncertain outcomes may amplify pain (8).The prefrontal cortex (PFC), anterior insula, and anterior cingulate cortex (ACC) are activated during the anticipation of pain, but their exact role in pain expectation remains poorly delineated (9-12). Moreover, the neural mechanisms by which conscious predictions about the magnitude of pain influence the experience of pain remain poorly understood and largely unexploited in the treatment of pain. At the most fundamental level, expectation-induced modulation of pain must necessarily engage three neural processes. First, an active mental representation of an impending event must be formulated by incorporating past information with the present context and future implica...

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Section: Discussionmentioning

confidence: 99%

The subjective experience of pain: Where expectations become reality

Koyama

McHaffie

Laurienti

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

620

408

View full text Add to dashboard Cite

show abstract

“…Thus, lesions to the dorsal portion of the ACC (dACC) (4) or insula (5) result in patients reporting that they are no longer bothered by painful stimulation even though they can still perceive it. Similarly, neuroimaging studies have shown that the dACC tracks the affective component of pain (6) and is closely correlated with perceived pain unpleasantness (7)(8)(9).…”

mentioning

confidence: 99%

Variation in the μ-opioid receptor gene (OPRM1) is associated with dispositional and neural sensitivity to social rejection

Way

Taylor

Eisenberger

2009

Proc. Natl. Acad. Sci. U.S.A.

241

195

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Scientific understanding of social pain-the hurt feelings resulting from social rejection, separation, or loss-has been facilitated by the hypothesis that such feelings arise, in part, from some of the same neural and neurochemical systems that generate the unpleasant feelings resulting from physical pain. Accordingly, in animals, the painkiller morphine not only alleviates the distress of physical pain, but also the distress of social separation. Because morphine acts on the -opioid receptor, we examined whether variation in the -opioid receptor gene (OPRM1), as measured by the functional A118G polymorphism, was associated with individual differences in rejection sensitivity. Participants (n ‫؍‬ 122) completed a self-report inventory of dispositional sensitivity to social rejection and a subsample (n ‫؍‬ 31) completed a functional MRI session in which they were rejected from an online ball-tossing game played with two supposed others. The A118G polymorphism was associated with dispositional sensitivity to rejection in the entire sample and in the fMRI subsample. Consistent with these results, G allele carriers showed greater reactivity to social rejection in neural regions previously shown to be involved in processing social pain as well as the unpleasantness of physical pain, particularly the dorsal anterior cingulate cortex (dACC) and anterior insula. Furthermore, dACC activity mediated the relationship between the A118G polymorphism and dispositional sensitivity to rejection, suggesting that this is a critical site for -opioid-related influence on social pain. Taken together, these data suggest that the A118G polymorphism specifically, and the -opioid receptor more generally, are involved in social pain in addition to physical pain.anterior cingulate ͉ brain ͉ exclusion ͉ genetic ͉ social pain

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“…Finally, and perhaps of the utmost signifi cance, the re representation of this pathway in the anterior insular cortex is crucial for subjective feelings of pain (or any other feeling) in humans [15][16][17][18][19] , and neither rodents nor monkeys seem to have a homologous structure. The inescapable truth is that pain in humans is indeed a subjective experience.…”

mentioning

confidence: 99%

A rat is not a monkey is not a human: comment on Mogil (Nature Rev. Neurosci. 10, 283–294 (2009))

2009

Nat Rev Neurosci

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Asymbolia for pain: A sensory‐limbic disconnection syndrome

Cited by 378 publications

References 29 publications

The subjective experience of pain: Where expectations become reality

The subjective experience of pain: Where expectations become reality

Variation in the μ-opioid receptor gene (OPRM1) is associated with dispositional and neural sensitivity to social rejection

A rat is not a monkey is not a human: comment on Mogil (Nature Rev. Neurosci. 10, 283–294 (2009))

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