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The Journal of Neuroscience, November 22, 2006, 26(47):12165-12173; doi:10.1523/JNEUROSCI.3576-06.2006

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Behavioral/Systems/Cognitive
Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain

Marwan N. Baliki,¹ Dante R. Chialvo,¹ Paul Y. Geha,¹ Robert M. Levy,² R. Norman Harden,⁵ Todd B. Parrish,³ and A. Vania Apkarian^1,4

¹Departments of Physiology, ²Neurosurgery, ³Radiology, and ⁴Anesthesia, and ⁵Rehabilitation Institute of Chicago, Lurie Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611

Correspondence should be addressed to A. Vania Apkarian, Department of Physiology, Northwestern University Medical School, 5-120 Ward Building, 303 East Chicago Avenue, Chicago, IL 60611. Email: a-apkarian{at}northwestern.edu

Living with unrelenting pain (chronic pain) is maladaptive and is thought to be associated with physiological and psychological modifications, yet there is a lack of knowledge regarding brain elements involved in such conditions. Here, we identify brain regions involved in spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n = 13 and n = 11), and contrast brain activity between spontaneous pain and thermal pain (CBP and healthy subjects, n = 11 each). Continuous ratings of fluctuations of spontaneous pain during functional magnetic resonance imaging were separated into two components: high sustained pain and increasing pain. Sustained high pain of CBP resulted in increased activity in the medial prefrontal cortex (mPFC; including rostral anterior cingulate). This mPFC activity was strongly related to intensity of CBP, and the region is known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. In contrast, the increasing phase of CBP transiently activated brain regions commonly observed for acute pain, best exemplified by the insula, which tightly reflected duration of CBP. When spontaneous pain of CBP was contrasted to thermal stimulation, we observe a double-dissociation between mPFC and insula with the former correlating only to intensity of spontaneous pain and the latter correlating only to pain intensity for thermal stimulation. These findings suggest that subjective spontaneous pain of CBP involves specific spatiotemporal neuronal mechanisms, distinct from those observed for acute experimental pain, implicating a salient role for emotional brain concerning the self.

Key words: chronic pain; prefrontal cortex; thermal pain; emotion; BOLD; atrophy

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Received June 16, 2005; revised Oct. 13, 2006; accepted Oct. 16, 2006.

Correspondence should be addressed to A. Vania Apkarian, Department of Physiology, Northwestern University Medical School, 5-120 Ward Building, 303 East Chicago Avenue, Chicago, IL 60611. Email: a-apkarian{at}northwestern.edu

This article has been cited by other articles:

				I. Tracey Imaging pain Br. J. Anaesth., July 1, 2008; 101(1): 32 - 39. [Abstract] [Full Text] [PDF]

				M. N. Baliki, P. Y. Geha, A. V. Apkarian, and D. R. Chialvo Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics J. Neurosci., February 6, 2008; 28(6): 1398 - 1403. [Abstract] [Full Text] [PDF]

				E. J. CHURCH and T. G. ODLE Diagnosis and Treatment Of back Pain Radiol. Technol., November 1, 2007; 79(2): 126 - 151. [Abstract] [Full Text] [PDF]

				B. S. McEwen Physiology and Neurobiology of Stress and Adaptation: Central Role of the Brain Physiol Rev, July 1, 2007; 87(3): 873 - 904. [Abstract] [Full Text] [PDF]

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