Distinct Brain Systems Mediate the Effects of Nociceptive Input and Self-Regulation on Pain

Summary

Cognitive self-regulation can strongly modulate pain and emotion. However, it is unclear whether self-regulation primarily influences primary nociceptive and affective processes or evaluative ones. In this study, participants engaged in self-regulation to increase or decrease pain while experiencing multiple levels of painful heat during functional magnetic resonance imaging (fMRI) imaging. Both heat intensity and self-regulation strongly influenced reported pain, but they did so via two distinct brain pathways. The effects of stimulus intensity were mediated by the neurologic pain signature (NPS), an a priori distributed brain network shown to predict physical pain with over 90% sensitivity and specificity across four studies. Self-regulation did not influence NPS responses; instead, its effects were mediated through functional connections between the nucleus accumbens and ventromedial prefrontal cortex. This pathway was unresponsive to noxious input, and has been broadly implicated in valuation, emotional appraisal, and functional outcomes in pain and other types of affective processes. These findings provide evidence that pain reports are associated with two dissociable functional systems: nociceptive/affective aspects mediated by the NPS, and evaluative/functional aspects mediated by a fronto-striatal system.

Key Points

• 1Cognitive self-regulation can influence pain perception and experience
• 2Pain is processed through two distinct brain systems: nociceptive and evaluative
• 3The neurologic pain signature tracks pain primarily associated with nociceptive input
• 4Self-regulation effects are mediated via a pathway involving the nucleus accumbens and ventromedial prefrontal cortex
• 5The study underscores the complexity of pain as a multi-faceted experience beyond simple nociceptive responses.

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