Human ventromedial prefrontal cortex lesions enhance the effect of expectations on pain perception

Towards a Real-Life Understanding of the Altered Functional Behaviour of the Default Mode and Salience Network in Chronic Pain: Are People with Chronic Pain Overthinking the Meaning of Their Pain?

“…However, despite the established role of the dorsal vmPFC in emotional and affective regulation, its complete functional spectrum is highly multidimensional and also includes domains such as valence and reward processing [ 13 , 15 , 16 , 65 , 70 , 71 ], decision-making [ 65 , 72 , 73 , 74 , 75 ], memory retrieval and prospection [ 65 , 73 ], and self-referential processing [ 76 , 77 , 78 ]. Accordingly, in addition to emotional dysregulation, individuals with vmPFC lesions also exhibit behavioural changes characterized by increased impulsivity and irresponsibility [ 67 ], as well as an impaired or blunted ability to adapt their behaviour to previous experiences and environmental cues [ 67 , 79 ], including in contexts of pain [ 80 ]. Hence, increased emotional processing of pain may serve as a partial explanation for the altered behaviour of the dorsal vmPFC, but does it provide the complete explanation?…”

“…Critically, the pgACC also resembles one of the areas most frequently reported to exhibit altered activity and/or functional connectivity in people with chronic pain [ 44 , 45 , 47 , 51 , 53 , 54 , 55 , 56 , 61 , 117 ]. Activity in the pgACC (among other regions) has been found to predict the experience of experimental pain independent of stimulus intensity [ 118 ], and data from patients with lesions to the vmPFC, including the pgACC, showed no difference in neither thermal pain threshold nor tolerance compared to healthy controls [ 80 ]. Thus, although nociceptive transmission is often facilitated in people with chronic pain via sensitization of peripheral and/or central nociceptive neurons [ 119 , 120 , 121 ], such afferent nociceptive mechanisms may not explain the altered functional behaviour of the pgACC in people with chronic pain.…”