Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain

By Marwan N. Baliki, Dante R. Chialvo, Paul Geha, R. Levy, R. Harden, Todd B. Parrish, Apkar Vania Apkarian. Journal of Neuroscience, 2006

752 citations recorded by the source corpus.

Living with unrelenting pain (chronic pain) is maladaptive and is thought to be associated with physiological and psychological modifications, yet there is a lack of knowledge regarding brain elements involved in such conditions. Here, we identify brain regions involved in spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n = 13 and n = 11), and contrast brain activity between spontaneous pain and thermal pain (CBP and healthy subjects, n = 11 each). Continuous ratings of fluctuations of spontaneous pain during functional magnetic resonance imaging were separated into two components: high sustained pain and increasing pain. Sustained high pain of CBP resulted in increased activity in the medial prefrontal cortex (mPFC; including rostral anterior cingulate). This mPFC activity was strongly related to intensity of CBP, and the region is known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. In contrast, the increasing phase of CBP transiently activated brain regions commonly observed for acute pain, best exemplified by the insula, which tightly reflected duration of CBP. When spontaneous pain of CBP was contrasted to thermal stimulation, we observe a double-dissociation between mPFC and insula with the former correlating only to intensity of spontaneous pain and the latter correlating only to pain intensity for thermal stimulation. These findings suggest that subjective spontaneous pain of CBP involves specific spatiotemporal neuronal mechanisms, distinct from those observed for acute experimental pain, implicating a salient role for emotional brain concerning the self.

Subfields: Cognitive Neuroscience, Pharmacology, Physiology

View Paper: https://www.semanticscholar.org/paper/136bcfca148ff5c9e54f86ab1459d49683afcf4c

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Citations in the corpus

Physiology and neurobiology of stress and adaptation: central role of the brain. (2007, background): “In IBS, as also in other chronic pain conditions, there are alterations in activation of brain regions associated with central arousal, pain, and strong emotions, including brain stem, the insula, amygdala, hippocampus, and cingulate cortex among other brain regions (19, 172, 207, 243, 388).”
Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics (2008, methodology): “Functional MR data were acquired with a 3T Siemens (Munich, Germany) Trio whole-body scanner with echo planar imaging capability using the standard radio-frequency head coil [scanning parameters were as in Baliki et al. (2006); see supplemental material, available at www.jneurosci.org].”
Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. (2013, methodology): “In the first study examining brain activity for rating spontaneous perception of back pain, we predominantly identified medial prefrontal cortex activity as a unique marker for CBP (Baliki et al., 2006).”
Intrinsic Brain Connectivity in Fibromyalgia is Associated with Chronic Pain Intensity (2010, positive): “Finally, continuous on-line patient report of spontaneous pain fluctuation was used to guide fMRI statistical analysis and found that fMRI signal in the medial-prefrontal cortex (MPFC) correlates with spontaneous pain intensity (1).”
Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain (2010, methodology): “We have used this technique to identify brain activity for spontaneous pain in chronic back pain patients [8].”
The cerebral signature for pain perception and its modulation. (2007, background): “Furthermore, the medial PFC activity was strongly related to the intensity of chronic back pain (Baliki et al., 2006).”
Towards a theory of chronic pain (2008, neutral): “These brain parameters account for over 70–80% of the variance for intensity and duration of CBP.”