The Role of the Insula in Chronic Pain and Associated Structural Changes: An Integrative Review

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: April 18, 2024

Chronic pain affects a substantial portion of the global population, significantly impacting quality life and well-being. This condition involves complex mechanisms, including dysfunction autonomic nervous system, which plays crucial role in perception. The insula, key brain region involved processing, critical perception modulation. Lesions insula can result asymbolia, where remains intact but emotional responses are inappropriate. is anatomically functionally divided into anterior posterior regions, with processing nociceptive input based on intensity location before relaying it to for mediation. Understanding insula's intricate crucial, as encoding prediction errors mediating dimensions focus this review was synthesizing existing literature chronic associated structural changes. goal integrate findings from various sources provide comprehensive overview topic. search strategy included combination Medical Subject Headings (MeSH) relevant keywords related pain. following databases were surveyed: PubMed, Embase, Scopus, Web Science. We identified total 2515 articles, after Preferred Reporting Items Systematic Reviews Meta-Analyses (PRISMA) guideline eligibility criteria, 46 articles used synthesize review. Our study highlights pivotal changes, integrating diverse studies neuroimaging investigations. Beyond mere sensation, contributes awareness, attention, salience detection within network. Various conditions reveal alterations insular activity connectivity, accompanied by changes gray matter volume neurochemical profiles. Interventions targeting show promise alleviating symptoms. However, further research needed understand underlying aid developing more effective therapeutic interventions

Language: Английский

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How Instructions, Learning, and Expectations Shape Pain and Neurobiological Responses

Annual Review of Neuroscience, Journal Year: 2023, Volume and Issue: 46(1), P. 167 - 189

Published: March 14, 2023

Treatment outcomes are strongly influenced by expectations, as evidenced the placebo effect. Meta-analyses of clinical trials reveal that effects strongest in pain, indicating psychosocial factors directly influence pain. In this review, I focus on neural and psychological mechanisms which instructions, learning, expectations shape subjective address new experimental designs help researchers tease apart impact these distinct processes evaluate evidence regarding cognitive Studies modulate pain through parallel circuits include both pain-specific domain-general such those involved affect learning. then review how verbal instructions outcomes, including analgesia responses to pharmacological treatments, discuss implications for future work.

Language: Английский

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The role of expectations, control and reward in the development of pain persistence based on a unified model

eLife, Journal Year: 2023, Volume and Issue: 12

Published: March 27, 2023

Chronic, or persistent pain affects more than 10% of adults in the general population. This makes it one major physical and mental health care problems. Although is an important acute warning signal that allows organism to take action before tissue damage occurs, can become its role as a thereby inadequate. per definition, only be labeled after 3 months, trajectory from likely determined very early might even start at time injury. The biopsychosocial model has revolutionized our understanding chronic paved way for psychological treatments pain, which routinely outperform other forms treatment. suggests processes could also shaping targeting these prevent development pain. In this review, we develop integrative suggest novel interventions during trajectories, based on predictions model.

Language: Английский

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Hierarchical predictive coding in distributed pain circuits

Frontiers in Neural Circuits, Journal Year: 2023, Volume and Issue: 17

Published: March 3, 2023

Predictive coding is a computational theory on describing how the brain perceives and acts, which has been widely adopted in sensory processing motor control. Nociceptive pain involves large distributed network of circuits. However, it still unknown whether this completely decentralized or requires networkwide coordination. Multiple lines evidence from human animal studies have suggested that cingulate cortex insula (cingulate-insula network) are two major hubs mediating information afferents spinothalamic inputs, whereas subregions cortices distinct projections functional roles. In mini-review, we propose an updated hierarchical predictive framework for perception discuss its related computational, algorithmic, implementation issues. We suggest active inference as generalized algorithm, hierarchically organized traveling waves independent neural oscillations plausible mechanism to integrate bottom-up top-down across

Language: Английский

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An Enactive–Ecological Model to Guide Patient-Centered Osteopathic Care

Healthcare, Journal Year: 2022, Volume and Issue: 10(6), P. 1092 - 1092

Published: June 12, 2022

Osteopaths commonly face complexity and clinical uncertainty in their daily professional practice as primary contact practitioners. In order to effectively deal with complex presentations, osteopaths need possess well-developed reasoning understand the individual patient's lived experience of pain other symptoms how problem impacts personhood ability engage world. We have recently proposed (En)active inference an integrative framework for osteopathic care. The enactivist active frameworks underpin our hypothesis. Here, we present a clinically based interpretation hypothesis by considering ecological niche which care occurs. Active enables patients practitioners disambiguate each other's mental states. patients' states are unobservable must be inferred on perceptual cues such posture, body language, gaze direction response touch hands-on A robust therapeutic alliance centred cooperative communication shared narratives appropriate effective use enable contextualize experiences. Touch enhance alliance, state alignment, biobehavioural synchrony between patient practitioner. Therefore, osteopath-patient dyad provides alignment opportunities construction. Arguably, this can produce experiences reduce prominence given high-level prediction errors-and consequently, top-down attentional focus bottom-up sensory errors, thus minimizing free energy. This commentary paper primarily aims critically consider value appreciating complexities delivering person-centred

Language: Английский

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Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care

Frontiers in Behavioral Neuroscience, Journal Year: 2022, Volume and Issue: 16

Published: June 30, 2022

Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness the therapeutic alliance. In this hypothesis theory paper, we present an entwined model that combines touch alignment active inference to explain how brain develops “priors” necessary health care provider engage with patient effectively. We appeal empirically integrative neurophysiological behavioural mechanisms underwrite synchronous relationships through touch. Specifically, offer a formal framework understanding – explaining role of hands-on in developing alliance synchrony between providers their patients musculoskeletal care. first review importance its clinical facilitating formation solid regulating allostasis. then consider used clinically promote demonstrate empathy, overcome uncertainty, infer mental states others lens inference. conclude plays achieving successful outcomes adapting previous priors create intertwined beliefs. The ensuing may help healthcare field use strengthen alliance, minimise prediction errors (a.k.a., free energy), thereby recovery from physical psychological impairments.

Language: Английский

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No reliable gray matter alterations in idiopathic dystonia

Frontiers in Neurology, Journal Year: 2025, Volume and Issue: 16

Published: March 3, 2025

Background The structural brain abnormalities associated with idiopathic dystonia (ID) remain inadequately understood. Previous voxel-based morphometry (VBM) studies examining whole-brain gray matter (GM) volume alterations in patients ID have reported inconsistent and occasionally contradictory findings. Methods We performed a coordinate-based meta-analysis (CBMA) using the latest seed-based d mapping permutation of subject images (SDM-PSI) technique to identify consistent GM at level. Additionally, meta-regression analyses were conducted explore potential moderating effects age, gender, disease duration on volume. Results CBMA incorporated 27 VBM studies, comprising 32 datasets total 840 834 healthy controls. Our analysis did not or reliable ID. robustness these findings was confirmed through jackknife sensitivity analysis. Meta-regression revealed that significantly influenced right insula. Conclusion Based best practice guidelines for CBMA, we utilized most recent SDM-PSI algorithm perform new included larger group individuals However, contrast previous CBMAs, observe any suggest assessed by as an imaging marker may be reliable. This could attributed being functional disorder, inconsistency demographic clinical variations, differences protocols methods, small sample sizes. It is imperative control characteristics, employ standardized methodologies, enhance sizes future research.

Language: Английский

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Coordinates-based meta-analysis for vestibular migraine and the underlying mechanisms behind it

Frontiers in Neurology, Journal Year: 2025, Volume and Issue: 16

Published: April 9, 2025

Vestibular migraine (VM) is a leading cause of recurrent vertigo episodes. Voxel-based morphometry (VBM) reliable technique to analyze structural changes, particularly in gray matter (GM) volume, across various neurological conditions. Despite the growing amount neuroimaging data recent decades, comprehensive review GM alterations VM remains lacking. We conducted systematic three English-language databases (PubMed, Embase, and Web Science) two Chinese-language (China National Knowledge Infrastructure Wanfang) evaluate existing on volume patients. A coordinate-based meta-analysis (CBMA) was performed using latest algorithm, seed-based d mapping with permutation subject images (SDM-PSI), identify brain individual studies. Five studies (103 patients, 107 HCs) were included. The CBMA demonstrated significant reduction patients compared HCs, peak convergence left rolandic operculum (SDM-Z = -3.68, p-corrected 0.004, voxels 629; Brodmann area 48), extending posterior insula. Heterogeneity low (I2 19.35%), no publication bias detected (Egger's test: p 0.826). This confirms insula-operculum region Longitudinal standardized imaging protocols are needed clarify whether these changes causes or consequences VM. https://www.crd.york.ac.uk/prospero/, identifier CRD42021277684.

Language: Английский

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Comparing neural responses to cutaneous heat and pressure pain in healthy participants

Scientific Reports, Journal Year: 2025, Volume and Issue: 15(1)

Published: April 24, 2025

Abstract Even though acute pain comes in many different shapes and forms, a lot of experimental studies predominantly employ cutaneous heat pain. This makes comparison between types the link findings from these to clinical difficult. To bridge this gap, we investigated both cuff pressure using within-subject design combination with functional magnetic resonance imaging (fMRI). Noxious stimuli were applied 17-s duration at three intensities above threshold thermode computer-controlled device. Both modalities led contralateral activation anterior insula parietal operculum. Heat showed greater precentral gyrus, pontine reticular nucleus, dorsal posterior insula, whilst primary somatosensory cortex bilateral superior lobules. Most importantly, time course fMRI signal changes differed modalities, peaking first stimulus half, whereas prolonged increasing response across peak second half. Our suggest that lead common as well (temporal) patterns key processing regions.

Language: Английский

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Pain, from perception to action: A computational perspective

iScience, Journal Year: 2022, Volume and Issue: 26(1), P. 105707 - 105707

Published: Dec. 1, 2022

Pain is driven by sensation and emotion, in turn, it motivates decisions actions. To fully appreciate the multidimensional nature of pain, we formulate study pain within a closed-loop framework sensory-motor prediction. In this cycle, prediction plays an important role, as interaction between actual sensory experience shapes perception subsequently, action. Perspective, describe roles two prominent computational theories-Bayesian inference reinforcement learning-in modeling adaptive behaviors. We show that serves common theme these theories, each theories can explain unique aspects perception-action cycle. discuss how models improve our mechanistic understandings pain-centered processes such anticipation, attention, placebo hypoalgesia, chronification.

Language: Английский

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