Donna M. Lloyd

Vicarious responses to pain in anterior cingulate cortex: is empathy a multisensory issue?

Results obtained with functional magnetic resonance imaging show that both feeling a moderately painful pinprick stimulus to the fingertips and witnessing another person’s hand undergo similar stimulation are associated with common activity in a pain-related area in the right dorsal anterior cingulate cortex (ACC). Common activity in response to noxious tactile and visual stimulation was restricted to the right inferior Brodmann’s area 24b. These results suggest a shared neural substrate for felt and seen pain for aversive ecological events happening to strangers and in the absence of overt symbolic cues. In contrast to ACC 24b, the primary somatosensory cortex showed significant activations in response to both noxious and innocuous tactile, but not visual, stimuli. The different response patterns in the two areas are consistent with the ACC’s role in coding the motivational-affective dimension of pain, which is associated with the preparation of behavioral responses to aversive events.

Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery.

Using functional MRI (fMRI) we investigated 13 upper limb amputees with phantom limb pain (PLP) during hand and lip movement, before and after intensive 6-week training in mental imagery. Prior to training, activation elicited during lip purse showed evidence of cortical reorganization of motor (M1) and somatosensory (S1) cortices, expanding from lip area to hand area, which correlated with pain scores. In addition, during imagined movement of the phantom hand, and executed movement of the intact hand, group maps demonstrated activation not only in bilateral M1 and S1 hand area, but also lip area, showing a two-way process of reorganization. In healthy participants, activation during lip purse and imagined and executed movement of the non-dominant hand was confined to the respective cortical representation areas only. Following training, patients reported a significant reduction in intensity and unpleasantness of constant pain and exacerbations, with a corresponding elimination of cortical reorganization. Post hoc analyses showed that intensity of constant pain, but not exacerbations, correlated with reduction in cortical reorganization. The results of this study add to our current understanding of the pathophysiology of PLP, underlining the reversibility of neuroplastic changes in this patient population while offering a novel, simple method of pain relief.

Spatial limits on referred touch to an alien limb may reflect boundaries of visuo-tactile peripersonal space surrounding the hand

In this study, the spatial limits of referred touch to a rubber hand were investigated. Participants rated the strength of the perceived illusion when the rubber hand was placed in one of six different spatial positions (at a distance of 17.5-67.5cm horizontal from the participants own hand). The results revealed a significant nonlinear relationship in the strength of the illusion, with the strongest ratings given when the two hands were closest; decaying significantly after a distance of 30cm. The time taken to elicit the illusion followed a similar trend. These results may reflect the response properties of bimodal visuo-tactile cells encoding peripersonal space around the hand.

Multisensory representation of limb position in human premotor cortex

Using functional magnetic resonance imaging (fMRI) in humans, we identified regions of cortex involved in the encoding of limb position. Tactile stimulation of the right hand, across the body midline, activated the right parietal cortex when the eyes were closed; activation shifted to a left parietofrontal network when the eyes were open. These data reveal important similarities between human and non-human primates in the network of brain areas involved in the multisensory representation of limb position.

Audiotactile interactions in roughness perception

The sounds produced when we touch textured surfaces frequently provide information regarding the structure of those surfaces. It has recently been demonstrated that the perception of the texture of the hands can be modified simply by manipulating the frequency content of such touch-related sounds. We investigated whether similar auditory manipulations change people’s perception of the roughness of abrasive surfaces (experiment 1). Participants were required to make speeded, forced-choice discrimination responses regarding the roughness of a series of abrasive samples which they touched briefly. Analysis of discrimination errors verified that tactile roughness perception was modulated by the frequency content of the auditory feedback. Specifically, attenuating high frequencies led to a bias towards an increased perception of tactile smoothness. In experiment 2, we replicated the rubbing-hands manipulation of previous experimenters while participants rated either the perceived roughness or wetness of their hands. The wetness scale data replicated the results in the literature, while the roughness scale data replicated the result from experiment 1. A final experiment showed that delaying the auditory feedback from the hand-rubbing reduced the magnitude of this parchment-skin illusion. These experiments demonstrate the dramatic effect that auditory frequency manipulations can have on the perceived tactile roughness and moistness of surfaces, and are consistent with the proposal that different auditory perceptual dimensions may have varying salience for different surfaces.

Vision influences tactile perception without proprioceptive orienting

THE perception of tactile stimuli is facilitated when subjects look towards the stimulated body site: this facilitation even takes place when visual information is unavailable, as when orienting in the dark. It is not known whether the facilitation is due entirely to such proprioceptive orienting of eye and head, or whether visual information of the body site can also facilitate touch. An experiment is reported which dissociates vision and proprioception, and demonstrates for the first time that vision of a body part, independent of proprioceptive orienting, can indeed effect somatosensation.

Placebo conditioning and placebo analgesia modulate a common brain network during pain anticipation and perception

ABSTRACT The neural mechanisms whereby placebo conditioning leads to placebo analgesia remain unclear. In this study we aimed to identify the brain structures activated during placebo conditioning and subsequent placebo analgesia. We induced placebo analgesia by associating a sham treatment with pain reduction and used fMRI to measure brain activity associated with three stages of the placebo response: before, during and after the sham treatment, while participants anticipated and experienced brief laser pain. In the control session participants were explicitly told that the treatment was inactive. The sham treatment group reported a significant reduction in pain rating (p = 0.012). Anticipatory brain activity was modulated during placebo conditioning in a fronto‐cingulate network involving the left dorsolateral prefrontal cortex (DLPFC), medial frontal cortex and the anterior mid‐cingulate cortex (aMCC). Identical areas were modulated during anticipation in the placebo analgesia phase with the addition of the orbitofrontal cortex (OFC). However, during altered pain experience only aMCC, post‐central gyrus and posterior cingulate demonstrated altered activity. The common frontal cortical areas modulated during anticipation in both the placebo conditioning and placebo analgesia phases have previously been implicated in placebo analgesia. Our results suggest that the main effect of placebo arises from the reduction of anticipation of pain during placebo conditioning that is subsequently maintained during placebo analgesia.

Counter-stimulatory effects on pain perception and processing are significantly altered by attention: an fMRI study.

Counter-stimulation reduces pain perception; however, the role of attention during this process is rarely discussed despite attention itself being a well known modulator of pain perception. This study investigated the effect of attentional modulation on pain perception during counter-stimulation using fMRI. Subjects received a noxious thermal stimulus together with an innocuous vibratory counter-stimulus. Subjects directed their attention towards either pain, vibration, or a neutral visual stimulus. During painful and counter-stimulation all subjects reported a reduction in pain perception when attending to counter-stimulation compared with attending to pain. Imaging data supported this behavioural finding showing reduced activity in pain processing areas (anterior cingulate, insula, thalamus). These results suggest attention plays an important part in the pain relief experienced from counter-stimulation.

In touch with the future: The sense of touch from cognitive neuroscience to virtual reality

TOUCH IN THE LABORATORY 1: INTRODUCING THE SENSE OF TOUCH 1. Introduction 2. The fundamentals of touch: The organization of the somatosensory system 3. Tactile perceptual organization TOUCH IN THE LABORATORY 2: THE HIGHER ORDER FACTORS THAT AFFECT TACTILE PERCEPTION 4. The awareness of touch 5. A memory for touch 6. Tactile attention 7. Caressing the skin: The social side of touch 8. Outside the boundaries of our bodies: The relationship between touch and the representation of the body in our mind TOUCH IN THE REAL WORLD 1: OVERCOMING THE LIMITATIONS IN TACTILE INFORMATION PROCESSING 9. Technologies of touch 10. Tactile and multisensory warning signals TOUCH IN THE REAL WORLD 2: ENHANCING THE AFFECTIVE DESIGN OF TOUCH 11. Touch in the marketplace: Selling by means of touch 12. Touch in the museum: Sculpture, art, aesthetics, and visual impairment 13. Touch in the bedroom: The role of touch in sexual behavior 14. Touch in the restaurant: A touch of gastronomy CONCLUSIONS 15. Touching the future References

Differences in low back pain behavior are reflected in the cerebral response to tactile stimulation of the lower back.

Study Design. Two groups of patients with chronic low back pain (cLBP) were scanned with functional magnetic resonance imaging during stimulation of the lower back; those showing 4 or 5 positive Waddell signs (WS-H) and those showing 1 or none (WS-L) as an index of pain-related illness behavior. Objective. We hypothesized that patients showing good versus poor adjustment to cLBP mobilize cortical affective-cognitive functions differently in response to sensory stimulation and show increased reorganization of somatosensory cortex corresponding to the back. Summary of Background Data. Some patients with cLBP go on to develop significant disability while the majority do not, and physical disease or psychosocial factors alone do not account for the difference. Neuroimaging studies have suggested abnormalities in cortical pain modulation systems can lead to variable pain and behavioral responses, which may account for these differences. Methods. Fifteen WS-L and 13 WS-H patients were scanned with functional magnetic resonance imaging while receiving intense tactile stimulation to the lower back. Questionnaire measures of psychosocial function were also collected. Results. There were no significant differences in cLBP duration or lumbar stimulation tolerance threshold between the 2 groups. Significantly more activation was seen in the WS-L versus WS-H group in regions previously associated with normal affective-cognitive processing of sensory input including posterior cingulate and parietal cortices; the magnitude of this activation negatively correlated with catastrophizing scores. WS-H patients showed a modest medial shift in primary somatosensory cortex activation relative to the WS-L group. Conclusion. Successful adjustment to cLBP is associated with a patients ability to effectively engage a sensory modulation system. In patients in whom such activation does not occur, subjective lack of control maypredispose to altered affective and behavioral responses with poor adjustment to pain. Pain experience may be furthermodified by reorganization of somatosensory cortex, contributing to maintenance of the chronic pain state.