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Neuronal activation patterns during self-referential pain imagination

DOI: 10.1016/j.ynpai.2024.100158
Vetterlein, A., Plieger, T., Monzel, M., Hogeterp, S. A., Wagner, L., Grünhage, T., Felten, A., Trautner, P., Karneboge, J., & Reuter, M. (2024). Neuronal activation patterns during self-referential pain imagination. Neurobiology of Pain, 16, 100158. doi:10.1016/j.ynpai.2024.100158

Abstract

In clinical assessments and pain therapy, patients are asked to imagine themselves in pain. However, the underlying neuronal processes remain poorly understood. Prior research has focused on empathy for pain or reported small sample sizes. Thus, the present study aimed to promote the neurobiological understanding of self-referential pain imagination. We hypothesised to find activation contrast (pain vs. no pain) across pain-related areas and expected two of the most prominent predictors of chronic pain, pain sensitivity (PS) and locus of control (LoC), to be moderators. In an fMRI study, N = 82 participants completed a pain imagination task, in which they were asked to imagine themselves in painful and non-painful situations presented in the form of pictures and texts. After each trial, they were instructed to give painfulness ratings. As a laboratory measure of PS, electrical pain thresholds were assessed. A questionnaire was completed to measure LoC. Across presentation modes we found activity contrasts in previously pain-related regions, such as the prefrontal, supplementary motor, primary motor, somatosensory and posterior parietal cortices, and the cerebellum. We found positive associations of PS and external LoC with painfulness ratings, and a negative correlation between PS and internal LoC. Despite our hypotheses, neither PS nor internal LoC were significant predictors of the BOLD-signal contrast. Though future studies are needed to draw further conclusions, our results provide preliminary evidence of a potential neuronal imagination-perception overlap in pain.

Authors

  • Annabel Vetterlein4
  • Thomas Plieger1
  • Merlin Monzel23
  • Svea A. Hogeterp2
  • Lilli Wagner1
  • Thomas Grünhage1
  • Andrea Felten1
  • Peter Trautner1
  • Jana Karneboge4
  • Martin Reuter15

Understanding How Our Brain Imagines Pain

Overview/Introduction

When we think about pain, our brains might react similarly to when we actually experience it. This study explores the brain's activity when people imagine themselves in painful situations. By understanding these processes, we can improve pain therapy and clinical assessments. The research focuses on how pain sensitivity and a person's sense of control over their life (locus of control) influence these brain activities.

Methodology

  • Participants: 82 healthy adults aged 20-50, screened for MRI compatibility.
  • Tasks: Participants imagined themselves in painful and non-painful scenarios presented as pictures and texts while undergoing an fMRI scan.
  • Pain Sensitivity: Measured using electrical pain thresholds.
  • Locus of Control: Assessed through a questionnaire.
  • Data Collection: Brain activity was recorded using a 3T MRI scanner, and participants rated the painfulness of each scenario on a scale from 0 to 10.

Key Findings

  • Brain Activity: Imagining pain activated several brain regions associated with actual pain processing, such as the prefrontal cortex, motor areas, and somatosensory regions.
  • Pain Sensitivity and Locus of Control: Higher pain sensitivity and an external locus of control were linked to higher painfulness ratings. However, these factors did not predict brain activity differences between pain and no-pain scenarios.
  • Presentation Mode: Text descriptions of painful situations were rated as more painful than pictures, suggesting that reading might evoke a stronger emotional response.

Implications

  • Pain Therapy: Understanding how the brain imagines pain can help develop better therapeutic strategies for chronic pain sufferers by targeting specific brain regions.
  • Clinical Assessments: The findings suggest that personal factors like pain sensitivity and locus of control influence how we perceive imagined pain, which could be considered in clinical settings.
  • Future Research: Further studies could explore the transition from imagined to chronic pain and how these brain patterns change over time.

Limitations

  • Sample Diversity: The study's generalizability is limited due to the relatively young and homogenous sample.
  • Predictive Factors: Pain sensitivity and locus of control did not predict brain activity, suggesting that other factors might be at play.
  • Task Design: The difference in painfulness ratings between text and picture scenarios indicates that the mode of presentation affects emotional engagement, which should be considered in future research.
In conclusion, this study sheds light on the brain's response to imagined pain, highlighting the complex interplay between personal traits and brain activity. While further research is needed, these insights could pave the way for more effective pain management strategies.