It is widely agreed that the right posterior parietal cortex has a preeminent role in visuospatial and orienting attention. A number of lines of evidence suggest that although orienting and the preparation of oculomotor responses are dissociable from each other, the two are intimately related. If this is true, then it should be possible to identify other attentional mechanisms tied to other response modalities. We used repetitive transcranial magnetic stimulation (rTMS) to demonstrate the existence of a distinct anterior parietal mechanism of motor attention. The critical area for motor attention is anterior to the one concerned with orienting, and it is lateralized to the left hemisphere in humans.

This study sought to investigate the recent claim by H.-O. Karnath and his colleagues that the crucial locus of neurological damage in neglect patients lies in the right superior temporal gyrus (STG), and not in the right posterior parietal cortex (PPC) as conventionally thought. Using transcranial magnetic stimulation (TMS), we first tested the involvement of the right STG in a task commonly used in the diagnosis of neglect, the landmark task. No evidence was found for a critical involvement of the right STG in the processing of this task, though evidence was found for the involvement of the right PPC. In contrast, however, when we examined the effects of TMS on exploratory search, a double dissociation between right STG and right PPC was found. When the processing of conjunction items was required, involvement of the right PPC (and not STG) was found in accordance with our previous research. When a difficult exploratory search through feature items was required, however, the right STG (not PPC) was found to be involved. A hitherto unknown role for right STG in visual search tasks was thus uncovered. These data suggest that conclusions about the area of brain damage resulting in neglect-like symptoms are highly dependent on the task used to diagnose them, with lesions in right PPC leading to deficits on the landmark task and conjunction visual search, and lesions in right STG resulting in deficits in feature based serial exploratory search tasks.

Transcranial magnetic stimulation (TMS) can be used to simulate the e¡ects of highly circumscribed brain damage permanently present in some neuropsychological patients, by reversibly disrupting the normal functioning of the cortical area to which it is applied. By using TMS we attempted to recreate de¢cits similar to those reported in a motion-blind patient and to assess the speci¢city of de¢cits when TMS is applied over human area V5. We used six visual search tasks and showed that subjects were impaired in a motion but not a form`pop-out' task when TMS was applied over V5. When motion was present, but irrelevant, or when attention to colour and form were required, TMS applied to V5 enhanced performance. When attention to motion was required in a motion^form conjunction search task, irrespective of whether the target was moving or stationary, TMS disrupted performance. These data suggest that attention to di¡erent visual attributes involves mutual inhibition between di¡erent extrastriate visual areas.

HighlightsWe discuss ‘inner speech’ theories of auditory verbal hallucinations.Atypical self-monitoring may lead to the experience of inner speech as external.We summarize research into the use of neurostimulation to treat hallucinations.Effects of neurostimulation may be due to modulation of self-monitoring networks.

ObjectivesOur central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders.DesignCross-sectional study design using data from the Health Survey for England 2011.SettingEngland.Primary and secondary outcome measuresChronic pain prevalence, pain intensity and opioid utilisation.ParticipantsParticipant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis.MethodsRegional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables.ResultsThere were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions—with evidence of a ‘pain divide’ between the North and the South, whereby people in the North of England more likely to have ‘severely limiting’ or ‘moderately limiting’ chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics.ConclusionsThere are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England—with evidence of a ‘pain divide’. Given the public health concerns associated with the long-term use of opioid analgesics—and their questionable activity in the management of chronic pain—more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.

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