What Part of the Brain Does Pain Come From?

Researchers are making progress in determining the areas of the brain that pain is modulated. They are figuring out the neural mechanisms underlying modulation of cognitive acute pain and have demonstrated the involvement of the dorsal anterior cingulate cortex (dACC), which could have important implications for future research targets. The studies have been looking for the area specifically involved in cognitive modulation of pain.

In studies being conducted, the involvement of the ACC in cognitive modulation of pain is not surprising, because it is a region that shows up often in relation to pain, cognitive control, and self-regulation. The new aspect of this research was that a different area of the ACC was associated with pain perception during pain modulation.

One study conducted included 15 healthy men and women, who were able to modulate acute heat pain by at least 30%. The process included delivering moderate heat pain stimulus to the participant’s left inside forearm. They were then asked to use whatever cognitive strategies they wanted to increase and decrease pain, such as visualization strategies. During this process, the participants underwent fMRI that consisted of an initial 30-second stimulation block followed by 5 30-second increase and decreased modulation blocks. Each modulation block was followed by 10-second rating period and a 40-second rest period.

The conclusion showed that pain modulation was associated with activation in areas related to body awareness and cognitive regulation and deactivation in areas related to sensation and emotion. Activation differences were found in areas related to pain processing, self-regulation, and cognitive function. Midline frontal areas and rostral anterior cingulate showed greater deactivation during increase of pain; dorsal ACC and presupplementary motor areas showed greater activation during decrease pain; and signal increases in prefrontal cortex,  dACC, and thalamus predicted decreased pain ratings. Results showed that successful cognitive modulation of pain involves brain areas associated with pain processing and cognitive control. It was also shown that the dACC may be a key component in modifying pain perception. It was correlated with pain ratings and showed a difference in activation between conditions.  

Researchers now want to study the dACC in neuromodulation by using real-time fMRI to train participants to modify pain experience by directly controlling neural processes related to pain. This information could be used to develop new medications that act on specific parts of the brain that modulate pain and ideally be able to control pain more effectively.

Source: American Academy of Pain Medicine (AAPM) 29th Annual Meeting. Poster 227. Presented April 12, 2013.

  

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