Fast left prefrontal rTMS acutely suppresses analgesic effects of perceived controllability on the emotional component of pain experience.
The prefrontal cortex may be a promising target for transcranial magnetic stimulation (TMS) in the management of pain. It is not clear how prefrontal TMS affects pain perception, but previous findings suggest that ventral lateral and medial prefrontal circuits may comprise an important part of a circuit of perceived controllability regarding pain, stress, and learned helplessness. Although the left dorsolateral prefrontal cortex is a common TMS target for treating clinical depression as well as modulating pain, little is known about whether TMS over this area may affect perceived controllability. The present study explored the immediate effects of fast TMS over the left dorsolateral prefrontal cortex on the analgesic effects of perceived pain controllability. Twenty-four healthy volunteers underwent a laboratory pain task designed to manipulate perception of pain controllability. Real TMS, compared with sham, suppressed the analgesic benefits of perceived control on the emotional dimension of pain, but not the sensory/discriminatory dimension. Findings suggest that, at least acutely, fast TMS over the left dorsolateral prefrontal cortex may interrupt the perceived-controllability effect on the emotional dimension of pain experience. Although it is not clear whether this cortical area is directly involved with modulating perceived controllability or whether downstream effects are responsible for the present findings, it appears possible that left dorsolateral prefrontal TMS may produce analgesic effects by acting through a cortical perceived-control circuit regulating limbic and brainstem areas of the pain circuit. Despite evidence that prefrontal TMS can have analgesic effects, fast left prefrontal TMS appears to acutely suppress analgesia associated with perceived-control. This effect may be limited to the emotional dimension of pain experience.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA Department of Anesthesiology and Perioperative Medicine, MUSC, Charleston, SC, USA Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Neurology, MUSC, Charleston, SC, USA Department of Radiology, MUSC, Charleston, SC, USA Center for Neurosensory Disorders, Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, SC, USA Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
Jeffrey J
JJ
Borckardt
Scott T
ST
Reeves
Heather
H
Frohman
Alok
A
Madan
Mark P
MP
Jensen
David
D
Patterson
Kelly
K
Barth
Richard A
RA
Smith
Richard
R
Gracely
Mark S
MS
George
D000328:Adult; D000698:Analgesia / Q000379:methods*; D016009:Chi-Square Distribution; D004644:Emotions; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D008297:Male; D010147:Pain Measurement / Q000379:methods; D058748:Pain Perception / Q000502:physiology*; D017397:Prefrontal Cortex / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*