Brain, Vol 121, Issue 5 931-947, Copyright © 1998 by Oxford University Press
MJ Iadarola, KF Berman, TA Zeffiro, MG Byas-Smith, RH Gracely, MB Max and GJ Bennett
The PET H2 15O-bolus method was used to image regional brain activity in
normal human subjects during intense pain induced by intradermal injection
of capsaicin and during post-capsaicin mechanical allodynia (the perception
of pain from a normally non-painful stimulus). Images of regional cerebral
blood flow were acquired during six conditions: (i) rest; (ii) light
brushing of the forearm; (iii) forearm intradermal injection of capsaicin,
(iv) and (v) the waning phases of capsaicin pain; and (vi) allodynia.
Allodynia was produced by light brushing adjacent to the capsaicin
injection site after ongoing pain from the capsaicin injection had
completely subsided. Capsaicin treatment produced activation in many
discrete brain regions which we classified as subserving four main
functions: sensation-perception (primary somatosensory cortex, thalamus and
insula); attention (anterior cingulate cortex); descending pain control
(periaqueductal grey); and an extensive network related to sensory-motor
integration (supplementary motor cortex, bilateral putamen and insula,
anterior lobe and vermis of the cerebellum and superior colliculus).
Comparison of the noxious and non-noxious stimuli yielded several new
insights into neural organization of pain and tactile sensations. Capsaicin
pain, which had no concomitant tactile component, produced little or no
activation in secondary somatosensory cortex (SII), whereas light brushing
produced a prominent activation of SII, suggesting a differential
sensitivity of SII to tactile versus painful stimuli. The cerebellar vermis
was strongly activated by capsaicin, whereas light brush and experimental
allodynia produced little or no activation, suggesting a selective
association with C-fibre stimulation and nociceptive second-order spinal
neurons. The experimental allodynia activated a network that partially
overlapped those activated by both pain and light brush alone. Unlike
capsaicin-induced pain, allodynia was characterized by bilateral activation
of inferior prefrontal cortex, suggesting that prefrontal responses to pain
are context dependent.
ARTICLES
Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET
Pain and Neurosensory Mechanisms Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20892-4410, USA.
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