Musical Hallucinations in Chronic Pain: The Anterior Cingulate Cortex Regulates Internally Generated Percepts

Abstract

The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.

Complex auditory musical hallucinations with ambivalent feelings

“…during active MH also showed that the posterior aspect of the temporal lobes, right basal ganglia, inferior frontal cortices, thalamus, brainstem, pons, cerebellum and auditory radiations were active while the primary auditory cortex was not. 12 26 The frontal speech areas, 28 anterior cingulate 29 left anterior superior temporal gyrus, the motor cortex and posteromedial cortex also might have a role in the generation of MH. 2 11 27 30 Vascular brain lesions can have heterogeneous clinical presentations.…”

The phenomenon of musical hallucinations: An updated review

“…One case report identified an uncommon but increasingly recognized anti-IgLON5 disease accompanied by MHs [13], which demonstrates the diverse and ever-changing clinical phenotypes observed in autoimmune central nervous system diseases. Chronic pain, electrical stimulation of the anterior cingulate cortex for refractory chronic pain, anaplastic pleomorphic xanthoastrocytoma, hybrid cochlear implantation, insular glioma resection, left temporal lobectomy, abdominal pain, and electroconvulsive therapy were the other causes of MHs in the NOC group [14,24,28,36,58,61,65,67].…”

The Benefits of Music Listening for Induced State Anxiety: Behavioral and Physiological Evidence

“…The superior temporal gyrus is known to be involved in auditory processing, where the characteristic response is mainly focused on the gamma band [26]. Indeed, a simple steady-state auditory click stimulation paradigm at gamma frequency (~40 Hz) has been reproducibly shown to reduce entrainment as measured by electroencephalography (EEG) in patients [27,28] and listening to music generating perceptual phenomenon was associated with different changes in gamma power (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) [29]. Acoustic tomography allows us to transform acoustic information into visual representations [30], and gamma is linked to the transformation of sensory signals along feedforward pathways [31].…”