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The Journal of Neuroscience, December 15, 2001, 21(24):9896-9903

Exacerbation of Pain by Anxiety Is Associated with Activity in a Hippocampal Network

Alexander Ploghaus^{1, 2}, Charvy Narain¹, Christian F. Beckmann¹, Stuart Clare¹, Susanna Bantick¹, Richard Wise¹, Paul M. Matthews¹, J. Nicholas P. Rawlins², and Irene Tracey¹

¹ Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom, and ² Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, United Kingdom

It is common clinical experience that anxiety about pain can exacerbate the pain sensation. Using event-related functional magnetic resonance imaging (FMRI), we compared activation responses to noxious thermal stimulation while perceived pain intensity was manipulated by changes in either physical intensity or induced anxiety. One visual signal, which reliably predicted noxious stimulation of moderate intensity, came to evoke low anxiety about the impending pain. Another visual signal was followed by the same, moderate-intensity stimulation on most of the trials, but occasionally by discriminably stronger noxious stimuli, and came to evoke higher anxiety. We found that the entorhinal cortex of the hippocampal formation responded differentially to identical noxious stimuli, dependent on whether the perceived pain intensity was enhanced by pain-relevant anxiety. During this emotional pain modulation, entorhinal responses predicted activity in closely connected, affective (perigenual cingulate), and intensity coding (mid-insula) areas. Our finding suggests that accurate preparatory information during medical and dental procedures alleviates pain by disengaging the hippocampus. It supports the proposal that during anxiety, the hippocampal formation amplifies aversive events to prime behavioral responses that are adaptive to the worst possible outcome.

Key words: hyperalgesia; hippocampus; classical fear conditioning; anterior cingulate; insula; causal associative learning; medial temporal lobe; surprise; aversive emotional learning; anticipation; functional neuroimaging

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Copyright © 2001 Society for Neuroscience  0270-6474/01/21249896-08$05.00/0

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