Recent animal studies reveal ascending nociceptive and descending modulatory pathways that may contribute to the affective–motivational aspects of pain and play a critical role in the modulation of ...pain. In humans, a reliable pattern of cerebral activity occurs during the subjective experience of pain. Activity within the anterior cingulate cortex and possibly in other classical limbic structures, appears to be closely related to the subjective experience of pain unpleasantness and may reflect the regulation of endogenous mechanisms of pain modulation.
Limbic structures, including the anterior cingulate cortex, participate in the affective and motivational modulation of pain.
L’art idolâtre la création autant qu’il exalte la liberté. Le droit, bien au contraire, borne et réprime. La religion, pour sa part, forge les convictions et singularise les perceptions. Voilà mises ...en scène la liberté d’expression, artistique, la liberté de religion, fragile, et la liberté de répression, encadrée. Ce triptyque évoque à lui seul les atermoiements du droit à l’égard de nombreux phénomènes artistiques controversés à l’échelle mondiale (les caricatures de Mahomet, Les Versets sataniques, les unes de Charlie Hebdo, les spectacles de Dieudonné, la pièce Golgotha Picnic…). Le présent ouvrage aborde les liens entre l’art et la liberté d’expression, la protection des identités religieuses par l’entremise du droit pénal et les contours de l’impunité juridique réservée à la satire. La réflexion à l’œuvre prend appui sur l’abrogation récente du crime de blasphème par de nombreux parlements pour sonder l’ampleur désormais dévolue à la protection de la liberté de religion des croyants. L’apparente libération de la parole incarnée par l’évacuation de cette infraction agit en trompe-l’œil. Nombreuses sont les juridictions qui constatent la résurgence de l’incrimination du blasphème sous le couvert d’infractions autres (incitation à la haine ou à la discrimination contre les croyants, dénigrement des religions, obscénité, indécence). La dissonance entre la jurisprudence de la Cour européenne des droits de l’homme et celle de la Cour suprême du Canada renvoie à une conception divergente de la conciliation parfois requise entre liberté d’expression et liberté de religion. L’occasion est donnée de s’interroger sur l’intensité du préjudice subi par le fidèle qui voit sa croyance vilipendée par un contempteur qui se réclame de la liberté d’expression ou de la liberté artistique. La présente étude dresse les lignes de partage entre la tolérance, l’outrance et l’interdit pénal.
Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after ...treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.
The insula is a complex structure involved in a wide range of functions. Tracing studies on nonhuman primates reveal a wide array of cortical connections in the frontal (orbitofrontal and prefrontal ...cortices, cingulate areas and supplementary motor area), parietal (primary and secondary somatosensory cortices) and temporal (temporal pole, auditory, prorhinal and entorhinal cortices) lobes. However, recent human tractography studies have not observed connections between the insula and the cingulate cortices, although these structures are thought to be functionally intimately connected. In this work, we try to unravel the structural connectivity between these regions and other known functionally connected structures, benefiting from a higher number of subjects and the latest state-of-the-art high angular resolution diffusion imaging (HARDI) tractography algorithms with anatomical priors. By performing an HARDI tractography analysis on 46 young normal adults, our study reveals a wide array of connections between the insula and the frontal, temporal, parietal and occipital lobes as well as limbic regions, with a rostro-caudal organization in line with tracing studies in macaques. Notably, we reveal for the first time in humans a clear structural connectivity between the insula and the cingulate, parahippocampal, supramarginal and angular gyri as well as the precuneus and occipital regions.
Abstract
Objective
Despite decades of research on the identification of specific characteristics of situations that trigger a physiological stress response (novelty, unpredictability, threat to the ...ego, and sense of low control NUTS), no integrative research has examined the validity of this framework applied to pain experiences. This study aimed to 1) explore the stressful characteristics of pain among individuals living with chronic pain and 2) examine whether the NUTS framework comprehensively captures the stressful nature of pain.
Subjects
Participants were 41 adult participants living with chronic pain.
Methods
Interviews in six focus groups were conducted in French using a semistructured interview guide. Participants first discussed how pain is stressful. Then, they were introduced to the NUTS framework and commented on the extent to which it captured their experience. The verbatim transcriptions of interviews were reviewed using reflexive thematic analysis. Analyses were conducted in French; quotes and themes were translated into English by a professional translator.
Results
The pain-NUTS framework adequately captured participants’ experiences. Multiple aspects of pain (pain intensity fluctuations, pain flare-up duration, pain quality and location, functional limitations, diagnosis and treatment) were associated with one or more stress-inducing characteristics. In addition, a second layer of meaning emerged in the context of chronic pain that provided contextual information regarding when, how, and why pain became more or less stressful.
Conclusions
The NUTS characteristics seem to offer a comprehensive framework to understand how pain and its context of chronicity can be a source of stress. This study provides preliminary support for the pain-NUTS framework to allow the formal integration of pain and stress research.
Concepts originating from ancient Eastern texts are now being explored scientifically, leading to new insights into mind/brain function. Meditative practice, often viewed as an emotion regulation ...strategy, has been associated with pain reduction, low pain sensitivity, chronic pain improvement, and thickness of pain-related cortices. Zen meditation is unlike previously studied emotion regulation techniques; more akin to ‘no appraisal’ than ‘reappraisal’. This implies the cognitive evaluation of pain may be involved in the pain-related effects observed in meditators. Using functional magnetic resonance imaging and a thermal pain paradigm we show that practitioners of Zen, compared to controls, reduce activity in executive, evaluative and emotion areas during pain (prefrontal cortex, amygdala, hippocampus). Meditators with the most experience showed the largest activation reductions. Simultaneously, meditators more robustly activated primary pain processing regions (anterior cingulate cortex, thalamus, insula). Importantly, the lower pain sensitivity in meditators was strongly predicted by reductions in functional connectivity between executive and pain-related cortices. Results suggest a functional decoupling of the cognitive-evaluative and sensory-discriminative dimensions of pain, possibly allowing practitioners to view painful stimuli more neutrally. The activation pattern is remarkably consistent with the mindset described in Zen and the notion of mindfulness. Our findings contrast and challenge current concepts of pain and emotion regulation and cognitive control; commonly thought to manifest through increased activation of frontal executive areas. We suggest it is possible to self-regulate in a more ‘passive’ manner, by reducing higher-order evaluative processes, as demonstrated here by the disengagement of anterior brain systems in meditators.
"L'art idolâtre la création autant qu'il exalte la liberté. Le droit, bien au contraire, borne et réprime. La religion, pour sa part, forge les convictions et singularise les perceptions. Voilà ...mises en scène la liberté d'expression, artistique, la liberté de religion, fragile, et la liberté de répression, encadrée. Ce triptyque évoque à lui seul les atermoiements du droit à l'égard de nombreux phénomènes artistiques controversés à l'échelle mondiale (les caricatures de Mahomet, Les Versets sataniques , les unes de Charlie Hebdo, les spectacles de Dieudonné, la pièce Golgotha Picnic. Le présent ouvrage aborde les liens entre l'art et la liberté d'expression, la protection des identités religieuses par l'entremise du droit pénal et les contours de l'impunité juridique réservée à la satire. La réflexion à l'œuvre prend appui sur l'abrogation récente du crime de blasphème par de nombreux parlements pour sonder l'ampleur désormais dévolue à la protection de la liberté de religion des croyants. L'apparente libération de la parole incarnée par l'évacuation de cette infraction agit en trompe-l'œil. Nombreuses sont les juridictions qui constatent la résurgence de l'incrimination du blasphème sous le couvert d'infractions autres (incitation à la haine ou à la discrimination contre les croyants, dénigrement des religions, obscénité, indécence). La dissonance entre la jurisprudence de la Cour européenne des droits de l'homme et celle de la Cour suprême du Canada renvoie à une conception divergente de la conciliation parfois requise entre liberté d'expression et liberté de religion. L'occasion est donnée de s'interroger sur l'intensité du préjudice subi par le fidèle qui voit sa croyance vilipendée par un contempteur qui se réclame de la liberté d'expression ou de la liberté artistique. La présente étude dresse les lignes de partage entre la tolérance, l'outrance et l'interdit pénal."--Résumé de l'éditeur.
Pain is a complex experience involving extensive interactions between brain and spinal cord processes. Various interventions that modulate pain, such as the application of a competing noxious ...stimulus (counterirritation), are thought to involve cerebrospinal regulation through diffuse noxious inhibitory controls (DNICs). However, no study has yet examined the relation between brain and spinal cord activity during counterirritation analgesia in humans. This fMRI study investigates brain responses to phasic painful electrical stimulation administered to the sural nerve to evoke a spinal nociceptive response (RIII reflex) before, during and after counterirritation induced by the immersion of the left contralateral foot in cold water. Responses are compared with a control condition without counterirritation. As expected, counterirritation produced robust pain inhibition with residual analgesia persisting during the recovery period. In contrast, RIII reflex amplitude was significantly decreased by counterirritation only in a subset of subjects. Modulatory effects of counterirritation on pain perception and spinal nociception were paralleled by decreased shock-evoked activity in pain-related areas. Individual changes in shock-evoked brain activity were specifically related to analgesia in primary somatosensory cortex (SI), anterior cingulate cortex and amygdala, and to RIII modulation in supplementary motor area and orbitofrontal cortex (OFC). Moreover, sustained activation induced by the counterirritation stimulus in the OFC predicted shock-pain decrease while sustained activity in SI and the periaqueductal gray matter predicted RIII modulation. These results provide evidence for the implication of at least two partly separable neural mechanisms underlying the effects of counterirritation on pain and spinal nociception in humans.
Facial expressions of pain are composed of a subset of pain-indicative muscle movements. Amongst this subset, contracting the muscles surrounding the eyes (orbicularis oculi muscle) is the most ...frequent response and has been linked specifically to pain intensity, a fundamental aspect of the sensory dimension of pain. To further explore this link, the present study used functional magnetic resonance imaging (fMRI) to test the hypothesis that orbicularis oculi activation during pain reflects the magnitude of brain responses in areas being involved in processing the sensory dimension of pain.
Facial and brain (BOLD) responses to experimentally-induced heat pain applied to the left lower leg were assessed in twenty-two healthy participants after verbal suggestions were given to specifically increase perceived pain intensity and in control conditions involving no suggestion.
Increases in pain intensity produced the expected changes in facial responses characterized by a stronger contraction of the orbicularis oculi muscle. A regression model further demonstrated that stronger increases in orbicularis oculi activity reflected a larger increase in the BOLD response to the noxious stimulus in the leg area of the primary somatosensory cortex (S1) and a larger decrease in medial prefrontal activity consistent with previous finding suggesting disinhibition. Importantly, the positive coupling of orbicularis oculi with S1 activity was not accounted for by changes in other facial muscles.
These results are consistent with the notion that facial expressions of pain differentially encode the multi-dimensional pain experience and reflect, at least partly, the activity of the spino-thalamo-cortical pathway targeting the primary somatosensory cortex.
•The face differentially encodes the sensory dimension of pain.•The sensory dimension of pain is captured in orbicularis oculi activity.•Pain-induced orbicularis oculi activity corresponds to S1 activity.
Recent theories have suggested that chronic pain could be partly maintained by maladaptive physiological responses of the organism facing a recurrent stressor. The present study examined the ...associations between basal levels of cortisol collected over seven consecutive days, the hippocampal volumes and brain activation to thermal stimulations administered in 16 patients with chronic back pain and 18 healthy control subjects. Results showed that patients with chronic back pain have higher levels of cortisol than control subjects. In these patients, higher cortisol was associated with smaller hippocampal volume and stronger pain-evoked activity in the anterior parahippocampal gyrus, a region involved in anticipatory anxiety and associative learning. Importantly, path modelling--a statistical approach used to examine the empirical validity of propositions grounded on previous literature--revealed that the cortisol levels and phasic pain responses in the parahippocampal gyrus mediated a negative association between the hippocampal volume and the chronic pain intensity. These findings support a stress model of chronic pain suggesting that the sustained endocrine stress response observed in individuals with a smaller hippocampii induces changes in the function of the hippocampal complex that may contribute to the persistent pain states.
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