The pain matrix: Reloaded or reborn as we image tonic pain using arterial spin labelling

Tracey, Irene; Johns, Emily

doi:10.1016/j.pain.2009.11.009

Cited by 83 publications

(72 citation statements)

References 12 publications

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“…However, brain measures associated with ongoing pain can be quite different from those that correlate with evoked pain 64 . PET-based or ASL-based measurements of cerebral blood flow 105 can be used to examine ongoing clinical pain, because these techniques are quantitative and do not require delivery of an external stimulus. Early ASL studies were limited by relatively weak blood flow measurement signals, which typically needed to be boosted by manipulations that increase pain 106 , but modern ASL methods, scanners and analyses, along with improved experimental paradigms, compensate for this limitation.…”

Section: Hyperalgesiamentioning

confidence: 99%

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

et al. 2017

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624 | OCTOBER 2017 | VOLUME 13 www.nature.com/nrneurol CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . NeuroethicsA field that studies the implications of neuroscience for human self-understanding, ethics, and policy. Arterial spin labellingAn MRI-based brain imaging technique that detects cerebral blood flow based on magnetic tagging of blood.Nevertheless, diverse groups -including patients, researchers, clinicians, pharmaceutical and medical device companies, insurers and the legal communityseek methods for evaluating chronic pain besides selfreporting. Patients seek objective testing to demonstrate the reality of an invisible condition that is sometimes subject to doubt, researchers seek brain imaging markers that provide scientific, diagnostic and prognostic information that cannot be provided by patient self-reporting, and legal representatives and officials seek techniques to supplement self-reporting and objectively support or challenge claims related to chronic pain. Brain imaging technologies, including functional MRI (fMRI), PET, EEG and magnetoencephalography (MEG), have the potential to provide objective measurements of patterns of brain activity that underlie perceptual experiences (BOX 1). Consequently, some people are looking to brain imaging to provide a window into the experience of chronic pain, particularly because testimony based on fMRI was deemed to be admissible as evidence of pain in a 2015 state trial court in the USA 10,11 . This case was highly publicized, although the judgement was not published so no legal precedent was set, and the grounds on which the fMRI evidence was admitted were criticized by established experts in brain imaging studies of pain 10,11 . In this context, the development of a brain imaging test for chronic pain [12][13][14] has real-world consequences, so appropriate criteria for the use of such a test must be defined. Importantly, the way in which brain imaging evidence might be implemented in legal cases strongly depends on laws that vary greatly between countries. Therefore, examination of the capability of so-called 'pain-o-meter' brain imaging tests is critical, as is consideration of the use of such technology in light of societal views, neuroethics and legal issues. Thus, the aims of this Consensus Statement are to recommend criteria for the evaluation of neuroimaging measures of chronic pain, and to discuss the technical, biological, neuroethical and legal challenges related to establishing brain-based tests for chronic pain. MethodsA presidential task force of the International Association for the Study of Pain (IASP) was established in 2015 to examine the feasibility of a brain-imaging-based diagnostic test for chronic pain. The task force had three purposes: to consider the capacity of brain imaging (in particular fMRI), on the basis of its technical and physiological constraints, to detect whether an individual has chronic pain; to place th...

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Section: Hyperalgesiamentioning

confidence: 99%

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

et al. 2017

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“…Although there are many differences in activation patterns across studies, a consistent cortical and subcortical network has emerged that involves sensory, limbic, associative and motor areas, which some scientists refer to as the "pain matrix" (5). The most commonly activated regions are the primary and secondary somatosensory cortices (S1 and S2, respectively), anterior cingulate cortex (ACC), insular cortex (IC), prefrontal cortex (PFC), thalamus, basal ganglia, and cerebellum (see Figure 1).…”

Section: Defining a Pain Network In The Brainmentioning

confidence: 99%

Pain imaging in health and disease — how far have we come?

Schweinhardt

Bushnell²

2010

J. Clin. Invest.

188

145

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Since modern brain imaging of pain began 20 years ago, networks in the brain related to pain processing and those related to different types of pain modulation, including placebo, have been identified. Functional and anatomical connectivity of these circuits has begun to be analyzed. Imaging in patients suggests that chronic pain is associated with altered function and structural abnormalities in pain modulatory circuits. Moreover, biochemical alterations associated with chronic pain are being identified that provide information on cellular correlates as well as potential mechanisms of structural changes. Data from these brain imaging studies reinforce the idea that chronic pain leads to brain changes that could have functional significance.

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“…It should be noted that the concept of a pain matrix is not meant to suggest a rigid regulatory pathway but rather conceptually represents a collection of brain regions that are involved in neurological functions, including cognition, emotion, motivation, and sensation as well as pain. These regions, acting together in the context of modulation of nociception, appear to give rise to the experience of pain (10). It is noted that analgesic drugs as well as expectation, distraction, emotional context, and other factors engage several nodes of the pain matrix to change the pain experience.…”

mentioning

confidence: 99%

Central modulation of pain

Ossipov¹,

Dussor²,

Porreca³

2010

J. Clin. Invest.

866

728

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It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for "top-down" modulatory circuits that profoundly change the sensory experience of pain.

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The pain matrix: Reloaded or reborn as we image tonic pain using arterial spin labelling

Cited by 83 publications

References 12 publications

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

Pain imaging in health and disease — how far have we come?

Central modulation of pain

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