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The Journal of Neurophysiology Vol. 82 No. 4 October 1999, pp. 1934-1943
Copyright ©1999 by the American Physiological Society
1Pain and Neurosensory Mechanisms Branch,
Coghill, Robert C.,
Christine N. Sang,
Jose Ma. Maisog, and
Michael J. Iadarola.
Pain Intensity Processing Within the Human Brain: A Bilateral,
Distributed Mechanism. J. Neurophysiol. 82: 1934-1943, 1999. Functional imaging studies of human
subjects have identified a diverse assortment of brain areas that are
engaged in the processing of pain. Although many of these brain areas
are highly interconnected and are engaged in multiple processing roles,
each area has been typically considered in isolation. Accordingly,
little attention has been given to the global functional organization
of brain mechanisms mediating pain processing. In the present
investigation, we have combined positron emission tomography with
psychophysical assessment of graded painful stimuli to better
characterize the multiregional organization of supraspinal pain
processing mechanisms and to identify a brain mechanism subserving the
processing of pain intensity. Multiple regression analysis revealed
statistically reliable relationships between perceived pain intensity
and activation of a functionally diverse group of brain regions,
including those important in sensation, motor control, affect, and
attention. Pain intensity-related activation occurred bilaterally in
the cerebellum, putamen, thalamus, insula, anterior cingulate cortex, and secondary somatosensory cortex, contralaterally in the primary somatosensory cortex and supplementary motor area, and ipsilaterally in
the ventral premotor area. These results confirm the existence of a
highly distributed, bilateral supraspinal mechanism engaged in the
processing of pain intensity. The conservation of pain intensity
information across multiple, functionally distinct brain areas
contrasts sharply with traditional views that sensory-discriminative processing of pain is confined within the somatosensory cortex and can
account for the preservation of conscious awareness of pain intensity
after extensive cerebral cortical lesions.
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