Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

Bergeron, David; Obaid, Sami; Fournier‐Gosselin, Marie‐Pierre; Bouthillier, Alain; Nguyen, Dang Khoa

doi:10.3390/brainsci11050639

Cited by 28 publications

(24 citation statements)

References 136 publications

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“…pINS is considered the primary interoceptive cortex and plays a crucial role in integrating somatic processing and pain perception [85,[102][103][104]. Further, pINS has been shown to play a role in momentary self-referential processing [105].…”

Section: Discussionmentioning

confidence: 99%

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Cohen

Tsuchiyagaito

et al. 2022

Brain Sciences

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Mindfulness training (MT) reduces self-referential processing and promotes interoception, the perception of sensations from inside the body, by increasing one’s awareness of and regulating responses to them. The posterior cingulate cortex (PCC) and the insular cortex (INS) are considered hubs for self-referential processing and interoception, respectively. Although MT has been consistently found to decrease PCC, little is known about how MT relates to INS activity. Understanding links between mindfulness and interoception may be particularly important for informing mental health in adolescence, when neuroplasticity and emergence of psychopathology are heightened. We examined INS activity during real-time functional magnetic resonance imaging neurofeedback-augmented mindfulness training (NAMT) targeting the PCC. Healthy adolescents (N = 37; 16 female) completed the NAMT task, including Focus-on-Breath (MT), Describe (self-referential processing), and Rest conditions, across three neurofeedback runs and two non-neurofeedback runs (Observe, Transfer). Regression coefficients estimated from the generalized linear model were extracted from three INS subregions: anterior (aINS), mid (mINS), and posterior (pINS). Mixed model analyses revealed the main effect of run for Focus-on-Breath vs. Describe contrast in aINS [R2 = 0.39] and pINS [R2 = 0.33], but not mINS [R2 = 0.34]. Post hoc analyses revealed greater aINS activity and reduced pINS activity during neurofeedback runs, and such activities were related to lower self-reported life satisfaction and less pain behavior, respectively. These findings revealed the specific involvement of insula subregions in rtfMRI-nf MT.

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Section: Discussionmentioning

confidence: 99%

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Cohen

Tsuchiyagaito

et al. 2022

Brain Sciences

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“…Among them, the posterior insula is one of the regions most closely related to pain. Electrical stimulation of the posterior insula can cause acute pain, 9 and chronic injury in the posterior insula can lead to neuropathic pain 10 . Also, several VBM studies have shown that the GM of the insular lobe of patients with chronic neuropathic pain is significantly reduced, including trigeminal neuralgia, 11 chronic low back pain, 6 and migraines 12 .…”

Section: Discussionmentioning

confidence: 99%

Cerebral structural alterations in the patients undergoing postherpetic neuralgia: A VBM–MRI study

Niu

Yuan

et al. 2022

Ibrain

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This study aimed to investigate the changes in gray matter (GM) volume and density in patients with postherpetic neuralgia (PHN). Using voxel-based morphometry (VBM), the differences in cerebral GM volume and concentration between 25 PHN patients and 25 healthy controls with similar gender ratios, ages, and education were compared. Meanwhile, correlation analysis was performed between the value of GM volume/concentration in the brain areas with discrepancy and the visual analog scale (VAS) score/lesion duration. The global GM volume in PHN patients was lower than that of healthy controls, while the total volume of cerebrospinal fluid in PHN patients was higher than that of healthy controls. In PHN patients, the GM volume decreased in the striatum, cerebellum, precentral gyrus, middle frontal gyrus, parahippocampal gyrus, postcentral gyrus, and so forth; the GM concentration decreased in the striatum, insula, middle and posterior cingulate, and superior temporal gyrus. There was a negative correlation between GM concentration in the right parahippocampal gyrus and the VAS in patients with PHN. In PHN patients, GM volume and density in the brain regions involved in nociceptive sensation, pain perception, and integration decreased significantly. The interaction between chronic pain of PHN and alteration of the cerebral structure may contribute to the occurrence and development of PHN.

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“…Neuronal tracing studies in primates has identified the posterior insula as an important relay in the spinothalamic pathway via connections with the VPM ( 54 – 57 ). Furthermore, the posterior insula is considered an important cortical center for the integration of pain and interoception ( 54 , 58 – 63 ).…”

Section: Preclinical Modelsmentioning

confidence: 99%

“…In addition to its role as a relay in ascending pain pathways, the posterior insula is densely connected with the anterior insula, which projects to (i) brainstem nuclei involved in the descending pain modulation system (raphe, locus coeruleus, ventral tegmental area, and PAG), and (ii) limbic structures involved in the emotional valence to painful stimuli, such as the ACC and the amygdala ( 61 , 62 , 64 ). Intracranial recordings during painful stimuli have demonstrated the existence of nociceptive neurons in the posterior insula ( 54 , 65 ). In addition, most chronic pain syndromes are associated with abnormal functional connectivity of the posterior insula.…”

Section: Preclinical Modelsmentioning

confidence: 99%

Translational aspects of deep brain stimulation for chronic pain

et al. 2023

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The use of deep brain stimulation (DBS) for the treatment of chronic pain was one of the first applications of this technique in functional neurosurgery. Established brain targets in the clinic include the periaqueductal (PAG)/periventricular gray matter (PVG) and sensory thalamic nuclei. More recently, the anterior cingulum (ACC) and the ventral striatum/anterior limb of the internal capsule (VS/ALIC) have been investigated for the treatment of emotional components of pain. In the clinic, most studies showed a response in 20%–70% of patients. In various applications of DBS, animal models either provided the rationale for the development of clinical trials or were utilized as a tool to study potential mechanisms of stimulation responses. Despite the complex nature of pain and the fact that animal models cannot reliably reflect the subjective nature of this condition, multiple preparations have emerged over the years. Overall, DBS was shown to produce an antinociceptive effect in rodents when delivered to targets known to induce analgesic effects in humans, suggesting a good predictive validity. Compared to the relatively high number of clinical trials in the field, however, the number of animal studies has been somewhat limited. Additional investigation using modern neuroscience techniques could unravel the mechanisms and neurocircuitry involved in the analgesic effects of DBS and help to optimize this therapy.

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Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

Cited by 28 publications

References 136 publications

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Cerebral structural alterations in the patients undergoing postherpetic neuralgia: A VBM–MRI study

Translational aspects of deep brain stimulation for chronic pain

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