Anterior Insula Integrates Information about Salience into Perceptual Decisions about Pain

Abstract

The decision as to whether a sensation is perceived as painful does not only depend on sensory input but also on the significance of the stimulus. Here, we show that the degree to which an impending stimulus is interpreted as threatening biases perceptual decisions about pain and that this bias toward pain manifests before stimulus encounter. Using functional magnetic resonance imaging we investigated the neural mechanisms underlying the influence of an experimental manipulation of threat on the perception of laser stimuli as painful. In a near-threshold pain detection paradigm, physically identical stimuli were applied under the participants' assumption that the stimulation is entirely safe (low threat) or potentially harmful (high threat). As hypothesized, significantly more stimuli were rated as painful in the high threat condition. This context-dependent classification of a stimulus as painful was predicted by the prestimulus signal level in the anterior insula, suggesting that this structure integrates information about the significance of a stimulus into the decision about pain. The anticipation of pain increased the prestimulus functional connectivity between the anterior insula and the midcingulate cortex (MCC), a region that was significantly more active during stimulation the more a participant was biased to rate the stimulation as painful under high threat. These findings provide evidence that the anterior insula and MCC as a "salience network" integrate information about the significance of an impending stimulation into perceptual decision-making in the context of pain.

Trying to trust: Brain activity during interpersonal social attitude change

“…This finding is consistent with several studies associating insula activity with the processing of negative social and emotional information, such as pain and anxiety (Simmons, Matthews, Stein, & Paulus, 2004;Wiech et al, 2010). The insula is broadly involved in the subjective experience of emotions (Craig, 2011;Gu, Hof, Friston, & Fan, 2013) and has often been shown to be active during the processing of negative emotions (Duerden, Arsalidou, Lee, & Taylor, 2013).…”

Neural correlates coding stimulus level and perception of capsaicin-evoked urge-to-cough in humans

“…However, the anterior insula may also play a role in contributing the significance of a stimulus into decisions about pain (Wiech et al, 2010). By contrast, our data are consistent with the notion that sensory evoked responses in the prefrontal and posterior parietal cortices may contribute to spatial discrimination of the sensory input (Oshiro et al, 2007).…”

New Developments in the Psychological Management of Chronic Pain

“…It alerts us to the role of the researcher or clinician as observer, and to his or her moral and cultural biases (for example, see Encandela 85 ). It is entirely consistent with the rapidly expanding field of neuroscience, in which excitatory pain pathways become active, and inhibitory pathways are quiet, in the presence of anxiety, 86 depression, 87 threat, 88 and catastrophic thoughts about pain, 89 and the opposite happens as people with pain learn to regain control by various methods, such as CBT or mindfulness. 90 This opens up the possibility that, in future, rather than aiming to use psychological methods only to rehabilitate people despite ongoing pain, we will start to target their pain as well.…”