Somatosensory & motor research
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The medial prefrontal cortex has been implicated in pain perception by recent anatomical, physiological, and functional imaging data demonstrating that frontal and anterior cingulate cortices receive inputs related to nociception; neurosurgical case reports suggest that lesions involving these areas may specifically reduce the affective or emotional component of chronic intractable pain. We examined this hypothesis more closely by assessing psychophysical ratings of (1) warmth, pain intensity, and unpleasantness evoked by phasic thermal stimuli, (2) tolerance to tonic cold stimuli, and (3) perceived intensity of visual stimuli, both before and after neurosurgical lesions of the fiber tracts connecting the frontal lobes to subcortical structures. A 22-year-old male, with no history of chronic pain, underwent psychophysical testing 3 days before, 5 days after, and 6 months after receiving bilateral lesions of the anterior internal capsule (aIC), performed as treatment for obsessive-compulsive disorder. ⋯ Magnetic resonance imaging 5 days following surgery revealed bilateral lesions and edema centered in the aIC, with some edema in the left frontal lobe. Those 6 months later showed substantially smaller lesions involving less than half of the aIC and no edema; pain ratings and cold-water tolerance measured at that time indicated a substantial return toward the patient's presurgical values. These data suggest that blocking subcortical input to the anterior cingulate and frontal cortices reduces both the perceived intensity and the unpleasantness of noxious stimuli; reduced cold tolerance times--in the face of decreased pain perception--may reflect a disinhibition of cortical control on spinal reflexes.(ABSTRACT TRUNCATED AT 400 WORDS)
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The properties of a newly developed tonic heat pain model (THPM), which makes use of pulsating contact heat, were investigated in 18 young men. The most important feature of this model is that repetitive heat pulses with an intensity of 1 degree C above the individual pain threshold are employed. This approach was used to tailor the tonic pain stimulation to the individual pain sensitivity. ⋯ Moreover, there was absolutely no indication of a dichotomy between "pain-sensitive" and "pain-tolerant" individuals in the THPM, although such a dichotomy was evident in the CPT. This implies that the distinction between pain-sensitive and pain-tolerant individuals can be made only with the CPT, and that this distinction represents individual differences in peripheral vascular reactions to cold rather than in pain perception. In conclusion, the THPM appears to produce a stable and predictable temporal pattern of tonic pain with a predominant affective component, and to be suitable for application in the majority of individuals without causing undue discomfort.