(Chronic) Pain and the Brain

Question 1

Which parts of the brain decide if we should pay attention to a stimulus (i.e. attention and focus)?

Answer 1

insula and cingulate

Question 2

Which parts of the brain decide if the sensation we are experiencing matters (i.e. emotional appraisal)?

Answer 2

limbic system

Question 3

What is the function of the insula?

Answer 3

inter-relates our understanding and perception of self with our perception of the environment

(i.e. how do we fit into this world?)

Question 4

What is the posterior insula responsible for?

Answer 4

identification/perception of stimulus

(i.e. do we feel something?)

Question 5

What is the middle insula responsible for?

Answer 5

ownership/relation of stimulus

(i.e. is that related to us?)

Question 6

What is the anterior insula responsible for?

Answer 6

redirecting attention or conscious awareness

(i.e. should I make us aware?)

Question 7

Which part of the insula is key in regulating pain sensation?

Answer 7

anterior insula

Question 8

Which side of the insula activates in response to the pain? Which structure is it jointly activated with?

Answer 8

• right insula responds to pain (contralateral)
• jointly activated with anterior cingulate

Question 9

What is the default mode network (DMN) responsible for? What is a key node in the DMN?

Answer 9

• DMN: balance between internal vs external focus/attention
• key node: posterior cingulate

Question 10

What are we focusing on when the DMN is active?

Answer 10

internal focus / mind wandering

Question 11

What are we focusing on when the DMN is inactive?

Answer 11

external focus / focus on outside world

Question 12

What does the posterior cingulate play a key role in?

Answer 12

linking hippocampal formation to high-level cortex

(i.e. integrates emotionally relevant stimuli with environmental cues)

Question 13

What is the anterior/middle cingulate responsible for?

Answer 13

• negative affect: experiences of negative emotion
• pain: nociception
• cognitive control: thinking/planning

activation likelihood estimate (ALE) overlap at anterior/middle cingulate

(i.e. how much do you care about the pain? –> DO YOU SUFFER?)

Question 14

Which side of the anterior/middle cingulate is activated in response to pain? Which structure is it jointly activated with?

Answer 14

• right (contralateral) side activated in response to pain
• jointly activated with anterior insula

Question 15

Function of the limbic system?

Answer 15

provides emotional-appraisal of our current position in time and space

Question 16

role of hippocampus in pain?

Answer 16

recall memory of a stimulus and the emotion associated with it

Question 17

which structures are affected in acute pain? chronic pain?

Answer 17

• acute: thalamus, insula, MCC, ACC (pain circuitry)
• chronic: amygdala, hippocampus, mPFC (emotional circuitry)

Question 18

What is the definition of pain (H.D. amendment)?

Answer 18

suffering or discomfort caused by physical or emotional injury

Question 19

Does constant exposure to pain strengthen or weaken the circuitry/pain cycle?

Answer 19

strengthen

Question 20

What does pain begin with? What does it lead to?

Answer 20

begins with nociception; leads to suffering (emotion)