Real time fMRI feedback of the anterior cingulate and posterior insular cortex in the processing of pain

Rance, Mariela; Ruttorf, Michaela; Nees, Frauke; Schad, Lothar R.; Flor, Herta

doi:10.1002/hbm.22585

Cited by 41 publications

(64 citation statements)

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“…ACC is linked to the affective processing of pain, and also likely serves as an important relay station in descending inhibitory control of pain (Bingel et al, 2006; Lieberman and Eisenberger, 2015; Qu et al, 2011; Rainville et al, 1997; Rance et al, 2014; Russo and Sheth, 2015). PF has been proposed as a modulatory area for pain (Hardy and Haigler, 1985; Jahn et al, 2016; Lorenz et al, 2003; Nardone et al, 2017; Wiech et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain

Wang

Yang

et al. 2017

NeuroImage

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Numerous functional imaging and electrophysiological studies in humans and animals indicate that the two contiguous areas of secondary somatosensory cortex (S2) and posterior insula (pIns) are core regions in nociceptive processing and pain perception. In this study, we tested the hypothesis that the S2-pIns connection serves as a hub for connecting distinct sensory and affective nociceptive processing networks in the squirrel monkey brain. At 9.4T, we first mapped the brain regions that respond to nociceptive heat stimuli with high-resolution fMRI, and then used seed-based resting-state fMRI (rsfMRI) analysis to delineate and refine the global intrinsic functional connectivity circuits of the proximal S2 and pIns regions. In each subject, nociceptive (47.5 °C) heat-evoked fMRI activations were detected in many brain regions, including primary somatosensory (S1), S2, pIns, area 7b, anterior cingulate cortex (ACC), primary motor cortex (M1), prefrontal cortex (PF), supplementary motor area (SMA), thalamus, and caudate. Using the heat-evoked fMRI activation foci in S2 and pIns as the seeds, voxel-wise whole-brain resting-state functional connectivity (rsFC) analysis revealed strong functional connections between contralateral S2 and pIns, as well as their corresponding regions in the ipsilateral hemisphere. Spatial similarity and overlap analysis identified each region as part of two distinct intrinsic functional networks with 7% overlap: sensory S2-S1-area 7b and affective pIns-ACC-PCC networks. Moreover, a high degree of overlap was observed between the combined rsFC maps of nociceptive S2 and pIns regions and the nociceptive heat-evoked activation map. In summary, our study provides evidence for the existence of two distinct intrinsic functional networks for S2 and pIns nociceptive regions, and these two networks are joined via the S2-pIns connection. Brain regions that are involved in processing nociceptive inputs are also highly interconnected at rest. The presence of robust and distinct S1-S2-area 7b and pIns-ACC-PCC rsFC networks under anesthesia underscores their fundamental roles in processing nociceptive information.

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Section: Discussionmentioning

confidence: 99%

High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain

Wang

Yang

et al. 2017

NeuroImage

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“…As a control comparison, we will then correlate observed neuronal effects as a result of regulating the amygdala as compared with regulating prefrontal emotion regulatory regions in order to be able to conclude that the observed effects are site specific [Rance et al, 2014]. Additionally, warranting a larger sample, the dissociative subtype of PTSD should be examined separately.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

The neurobiology of emotion regulation in posttraumatic stress disorder: Amygdala downregulation via real‐time fMRI neurofeedback

Nicholson

Rabellino

Densmore

et al. 2016

Human Brain Mapping

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210

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Amygdala dysregulation has been shown to be central to the pathophysiology of posttraumatic stress disorder (PTSD) representing a critical treatment target. Here, amygdala downregulation was targeted using real-time fMRI neurofeedback (rt-fMRI-nf) in patients with PTSD, allowing us to examine further the regulation of emotional states during symptom provocation. Patients (n = 10) completed three sessions of rt-fMRI-nf with the instruction to downregulate activation in the amygdala, while viewing personalized trauma words. Amygdala downregulation was assessed by contrasting (a) regulate trials, with (b) viewing trauma words and not attempting to regulate. Training was followed by one transfer run not involving neurofeedback. Generalized psychophysiological interaction (gPPI) and dynamic causal modeling (DCM) analyses were also computed to explore task-based functional connectivity and causal structure, respectively. It was found that PTSD patients were able to successfully downregulate both right and left amygdala activation, showing sustained effects within the transfer run. Increased activation in the dorsolateral and ventrolateral prefrontal cortex (PFC), regions related to emotion regulation, was observed during regulate as compared with view conditions. Importantly, activation in the PFC, rostral anterior cingulate cortex, and the insula, were negatively correlated to PTSD dissociative symptoms in the transfer run. Increased functional connectivity between the amygdala- and both the dorsolateral and dorsomedial PFC was found during regulate, as compared with view conditions during neurofeedback training. Finally, our DCM analysis exploring directional structure suggested that amygdala downregulation involves both top-down and bottom-up information flow with regard to observed PFC-amygdala connectivity. This is the first demonstration of successful downregulation of the amygdala using rt-fMRI-nf in PTSD, which was critically sustained in a subsequent transfer run without neurofeedback, and corresponded to increased connectivity with prefrontal regions involved in emotion regulation during the intervention. Hum Brain Mapp 38:541-560, 2017. © 2016 Wiley Periodicals, Inc.

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“…For example, two reports suggested that volitional dampening of ACC activity would decrease cigarette cravings (Canterberry et al, 2013;Li et al, 2012); however, both experiments feature deficient designs that make it difficult to determine what -e.g., feedback or mental strategy -actually accounted for the decreased desire to smoke (Thibault et al, 2015). Another example draws on analgesia: whereas one study demonstrated that modulation of ACC activity was independent of behavioral parameters such as perceived pain intensity (Rance, Ruttorf, Nees, Rudi Schad, & Flor, 2014), another study found that control over activity in both the ACC and the anterior insula decreased pain perception (Emmert et al, 2014).…”

Section: Fmrimentioning

confidence: 99%

“…Interestingly, looking across experiments we find many cases of distinct protocols encouraging regulation in opposing directions. For example, many experiments train participants to up-regulate anterior insular activity to increase valence ratings (Caria, Sitaram, Veit, Begliomini, & Birbaumer, 2010;Lawrence et al, 2014;Ruiz et al, 2013;Sitaram et al, 2014), while other studies encourage down-regulation to decrease pain perception (Emmert et al, 2014;Rance, Ruttorf, Nees, Rudi Schad, & Flor, 2014) or subdue a phobia (Zilverstand, Sorger, Sarkheil, & Goebel, 2015).…”

Section: Future Stepsmentioning

confidence: 99%

The self-regulating brain and neurofeedback: Experimental science and clinical promise

Thibault

Lifshitz

Raz

2016

Cortex

193

198

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Neurofeedback, one of the primary examples of self-regulation, designates a collection of techniques that train the brain and help to improve its function. Since coming on the scene in the 1960s, electroencephalography-neurofeedback has become a treatment vehicle for a host of mental disorders; however, its clinical effectiveness remains controversial. Modern imaging technologies of the living human brain (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous research protocols that utilize such methodologies begin to shed light on the underlying mechanisms that may facilitate more effective clinical applications. In this paper we focus on recent technological advances in the field of human brain imaging and discuss how these modern methods may influence the field of neurofeedback. Toward this end, we outline the state of the evidence and sketch out future directions to further explore the potential merits of this contentious therapeutic prospect.

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Real time fMRI feedback of the anterior cingulate and posterior insular cortex in the processing of pain

Cited by 41 publications

References 50 publications

High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain

High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain

The neurobiology of emotion regulation in posttraumatic stress disorder: Amygdala downregulation via real‐time fMRI neurofeedback

The self-regulating brain and neurofeedback: Experimental science and clinical promise

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