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Central Modulation of Pain
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The somatosensory cortex is important for the localization and sensation of pain. Functional magnetic resonance imaging studies have showed that a large brain network is activated during acute pain. These include the primary somatosensory cortex and secondary somatosensory cortex with the adjacent insula region, anterior cingulate cortex, ventromedial prefrontal cortex and thalamus. These regions of the brain form the ‘pain matrix’. The functions of these cortical areas are summarized in Table 70.2. The anterior cingulate cortex and the prefrontal cortex directly feedback to the PAG, which activates the descending anti-nociceptive pathways. Damage to the prefrontal cortex reduces the ability to evaluate the severity of pain. Cingulotomy decreases the emotional aspects of pain.
The nervous system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Each section of this region of cortex receives sensory input from a specific area of the body in a highly organized and sequential manner. It is organized in a “foot-to-tongue” pattern along the medial-to-lateral axis (top-to-bottom of the gyrus). Interestingly, the size of the region of the cortex devoted to different areas of the body is quite disproportionate. For example, the trunk of the body and the legs are not densely innervated with sensory neurons. As a result, the axonal terminations of the pathways originating in these body parts are limited in number and take up only a small portion of the somatosensory cortex. Conversely, the face, the tongue and the hands are very densely innervated with sensory neurons. Therefore, the terminations of pathways originating in these body parts are numerous and are represented in a much larger portion of the somatosensory cortex. The proportion of cortex devoted to a given body part is determined by the degree of sensory perception associated with that body part as well as the importance of the sensory input from that part of the body. The somatosensory cortex not only localizes the source of sensory input, it also perceives the intensity of the stimulus.
Wilder Graves Penfield (1891–1976)
Published in Andrew P. Wickens, Key Thinkers in Neuroscience, 2018
Another brain region to be examined was the postcentral gyrus in the parietal lobes. Otherwise known as the somatosensory cortex, this area receives sensory, tactile and proprioceptive feedback from the skin and muscles of the body. Penfield and Boldrey mapped this region after patients reported a tingling or tactile sensation from a body region following stimulation. Again, it was found that this strip-like region was topographically organised with a map of the body resembling, although not identical, with the one in the motor cortex. For example, the somatosensory cortex had a greater proportion of tissue dedicated to input from the hands, lips and tongue that are capable of finer tactile discriminations. The topography of the motor and somatosensory cortices was famously illustrated in two drawings by Penfield and Rasmussen in 1950.
Exploring the effectiveness of immersive Virtual Reality interventions in the management of musculoskeletal pain: a state-of-the-art review
Published in Physical Therapy Reviews, 2021
Niamh Brady, Joseph G. McVeigh, Karen McCreesh, Ebonie Rio, Thomas Dekkers, Jeremy S. Lewis
Currently there is uncertainty around the mechanisms underlying the effect that VR has on pain and range of movement. Persistent pain is associated with sensory changes and functional reorganization of the somatosensory cortex. Melzack [38] proposed that the neurosignature for pain experience is determined by the synaptic architecture of the neuromatrix, which is produced by genetic and sensory influences. The neurosignature projects to various areas of the brain to create a sense of awareness of self, feelings, emotions, and activation of behavior. Riva et al. [5] describe a brain mechanism called ‘embodied simulations’, which contribute to the body neuromatrix. VR technology shares this basic mechanism [5]. Like the brain, VR technology maintains a simulation of the body and the space around it so that it can accurately predict the consequences of an individual’s actions within the virtual world. By doing this, VR may be able to trick the predictive coding mechanisms used by the brain [5], generating the feeling of presence in the virtual body and altering the experience of the body, including the pain experience. Riva et al. [5] suggest that VR as an embodied medicine may offer a new platform for augmenting the experience of the body for clinical goals and may explain the mechanisms behind clinical improvements demonstrated in VR literature to date. In addition, using VR to demonstrate the change in experience of neck pain reported by Harvie et al. [23] or other types of pain may offer a valuable education tool for explaining pain.
Cognitive and Symbolic Aspects of Art Therapy and Similarities With Large Scale Brain Networks
Published in Art Therapy, 2020
Vija B. Lusebrink, Lisa D. Hinz
Lusebrink (2004, 2010) described possible brain structures and functions involved in visual information processing and proposed that art expressions on the Kinesthetic/Sensory level predominantly reflect brain activity in the primary sensory motor cortices dealing with kinesthetic and sensory input. This information is presumed to be initially processed through the basal ganglia, primary motor cortex, and somatosensory cortex before it is forwarded to or incorporated into other brain areas for further processing. Visual information processing on the Perceptual/Affective level appears to represent functioning of the ventral visual stream, with the influence of the Affective component of the Perceptual/Affective level representing activity of the anterior insula (AI) and the amygdala in the limbic cortex (Lusebrink, 2010).
Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review
Published in Physiotherapy Theory and Practice, 2019
Felipe Reis, Fernanda Guimarães, Leandro Calazans Nogueira, Ney Meziat-Filho, Tiago A. Sanchez, Timothy Wideman
This systematic review shows that there are few (heterogeneous) studies that have investigated the relationship of psychological factors to PD, which indicates the need for further research. Although not highly consistent, the results from the included studies point to a very weak positive correlation between symptoms of depression and the PD. We recommend further studies using other instruments developed specifically to identify depression (e.g. Beck Depression Inventory, Center for Epidemiologic Studies Depression Scale, and Inventory for Depression) and more accurate (computer-based) methods of PD assessment to verify this relation. It is also important to recognize that several studies have demonstrated that chronic pain changes the somatosensory cortex leading to altered perceptions of their painful body regions. Two-point discrimination test is a clinical marker for evaluating alterations of S1 cortical reorganization. To the best of our knowledge, there is no study that investigates the relation between pain extent and two-point discrimination test. Thus, we strongly recommend new studies considering the relation between pain extent to other somatosensory, psychological, emotional, cognitive and behavioral factors.