Insular Cortex Activity Is Associated with Effects of Negative Expectation on Nociceptive Long-Term Habituation

Abstract

It is generally accepted that acute painful experience is influenced by context information shaping expectation and modulating attention, arousal, stress, and mood. However, little is known about the nature, duration, and extent of this effect, particularly regarding the negative expectation. We used a standardized longitudinal pain paradigm and painful heat test stimuli in healthy participants over a time course of 8 consecutive days, inducing nociceptive habituation over time. Thirty-eight healthy volunteers were randomly assigned to two different groups. One group received the information that the investigators expected the pain intensity to increase over time (context group). The other group was not given any information (control group). All participants rated the pain intensity of the daily standardized pain paradigm on a visual analog scale. In agreement with previous studies the pain ratings in the control group habituated over time. However, the context group reported no change of pain ratings over time. Functional imaging data showed a difference between the two groups in the right parietal operculum. These data suggest that a negative context not only has an effect on immediate pain but can modulate perception of pain in the future even without experience/conditioning. Neuronally, this process is mediated by the right opercular region.

Enhanced Short-Term Sensitization of Facial Compared With Limb Heat Pain

“…Previous behavioral and neuroimaging studies have shown that these responses to repetitive noxious stimulation involve central nervous system mechanisms, such as activity in the descending pain modulatory system, 4,42 are modulated by both bottomup and top-down factors, such as expectation, 28 and might be associated with the individual's susceptibility to clinical pain disorders. 11,24,35,40 However, in most of these studies on habituation and sensitization, painful heat stimuli were applied to the extremities.…”

“…11,24,35,40 However, in most of these studies on habituation and sensitization, painful heat stimuli were applied to the extremities. 4,6,21,28,39 Only a few studies have investigated habituation to repetitive pain stimuli in the trigeminal system, 1,36,37 and they did not directly compare habituation and sensitization processes between the trigeminal and spinal systems (limb).…”

Treatment Outcomes with Biosimilars: Be Aware of the Nocebo Effect

“…The role of negative perceptions and attitudes were previously described and are known to have the potential to negatively impact adherence and treatment outcomes [8][9][10]. Different publications have described this as the nocebo effect, which is the negative equivalent to a placebo effect, and have looked into its impact on adherence to medications [11][12][13].…”

Personality, Anxiety, and Individual Variation in Psychophysiological Habituation and Sensitization to Painful Stimuli

“…For example, recent research suggests that higher cognitive processes influence the extent of habituation to noxious stimulations. Habituation in healthy adults can be attenuated when they are informed that noxious stimulus levels may intensify over time [17], whereas expectation of attenuated stimulus levels over time seems to potentiate habituation [18].…”