title: A magnetoencephalography study of multi-modal processing of pain anticipation in primary sensory cortices.
abstract: Pain anticipation plays a critical role in pain chronification and results in disability due to pain avoidance. It is important to understand how different sensory modalities (auditory, visual or tactile) may influence pain anticipation as different strategies could be applied to mitigate anticipatory phenomena and chronification. In this study, using a countdown paradigm, we evaluated with magnetoencephalography the neural networks associated with pain anticipation elicited by different sensory modalities in normal volunteers. When encountered with well-established cues that signaled pain, visual and somatosensory cortices engaged the pain neuromatrix areas early during the countdown process, whereas the auditory cortex displayed delayed processing. In addition, during pain anticipation, the visual cortex displayed independent processing capabilities after learning the contextual meaning of cues from associative and limbic areas. Interestingly, cross-modal activation was also evident and strong when visual and tactile cues signaled upcoming pain. Dorsolateral prefrontal cortex and mid-cingulate cortex showed significant activity during pain anticipation regardless of modality. Our results show pain anticipation is processed with great time efficiency by a highly specialized and hierarchical network. The highest degree of higher-order processing is modulated by context (pain) rather than content (modality) and rests within the associative limbic regions, corroborating their intrinsic role in chronification.
authors.affiliation: Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. Electronic address: gopalar@ccf.org.
authors.forename: R
authors.initials: R
authors.lastname: Gopalakrishnan
authors.affiliation: Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Burgess
authors.affiliation: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Plow
authors.affiliation: Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Floden
authors.affiliation: Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Machado
mesh_terms: D000328:Adult; D000368:Aged; D059031:Anticipation, Psychological / Q000502:physiology*; D001307:Auditory Perception / Q000502:physiology; D001611:Beta Rhythm; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000502:physiology*; D003213:Conditioning, Psychological / Q000502:physiology; D003463:Cues; D005071:Evoked Potentials; D005260:Female; D065818:Gamma Rhythm; D006358:Hot Temperature; D006801:Humans; D015225:Magnetoencephalography; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D058748:Pain Perception / Q000502:physiology*; D010812:Physical Stimulation; D014796:Visual Perception / Q000502:physiology
keywords: anticipatory processing; auditory; multimodal; tactile; visual