TY - JOUR
T1 - Fast left prefrontal rTMS acutely suppresses analgesic effects of perceived controllability on the emotional component of pain experience
AU - Borckardt, Jeffrey J.
AU - Reeves, Scott T.
AU - Frohman, Heather
AU - Madan, Alok
AU - Jensen, Mark P.
AU - Patterson, David
AU - Barth, Kelly
AU - Smith, A. Richard
AU - Gracely, Richard
AU - George, Mark S.
N1 - Funding Information:
None of the authors have any equity ownership in any Brain Stimul device company. The present study was funded by the National Institute for Neurological Disorders and Stroke at the National Institutes of Health.
Funding Information:
Dr. Borckardt receives funding from the National Institutes Health (NINDS, NINR, NIDA), the South Carolina Translational Research Program, The American Society for Gastrointestinal Endoscopy, and The Obesity Society (Covidien). The present study was funded by the National Institute for Neurological Disorders and Stroke. Dr. George reports research grants in the past 5 years from NIH, Glaxo-Smith Kline, Jazz Pharmaceuticals, Brainsway, Cephos, and Force Protection. He has been an unpaid advisor to Brainsonix, Brainsway, Neuronetics, Neostim and Neosync (as they make products related to TMS), and a paid advisor to Jazz, Cyberonics, Neuropace, and Puretech ventures. The full amount of his advisory income has never been more than 10% of his university salary. MUSC has 2 patent applications in Dr. George’s name on combining TMS with MRI imaging. Dr. Patterson receives funding from NIAMS and NIGMS, Dr. Jensen receives funding from NIHCD, and Dr. Gracely receives funding from NIAMS and NINDS at NIH.
PY - 2011/1
Y1 - 2011/1
N2 - The prefrontal cortex may be a promising target for transcranial magnetic stimulation (TMS) in the management of pain. It is not clear how prefrontal TMS affects pain perception, but previous findings suggest that ventral lateral and medial prefrontal circuits may comprise an important part of a circuit of perceived controllability regarding pain, stress, and learned helplessness. Although the left dorsolateral prefrontal cortex is a common TMS target for treating clinical depression as well as modulating pain, little is known about whether TMS over this area may affect perceived controllability. The present study explored the immediate effects of fast TMS over the left dorsolateral prefrontal cortex on the analgesic effects of perceived pain controllability. Twenty-four healthy volunteers underwent a laboratory pain task designed to manipulate perception of pain controllability. Real TMS, compared with sham, suppressed the analgesic benefits of perceived control on the emotional dimension of pain, but not the sensory/discriminatory dimension. Findings suggest that, at least acutely, fast TMS over the left dorsolateral prefrontal cortex may interrupt the perceived-controllability effect on the emotional dimension of pain experience. Although it is not clear whether this cortical area is directly involved with modulating perceived controllability or whether downstream effects are responsible for the present findings, it appears possible that left dorsolateral prefrontal TMS may produce analgesic effects by acting through a cortical perceived-control circuit regulating limbic and brainstem areas of the pain circuit. Despite evidence that prefrontal TMS can have analgesic effects, fast left prefrontal TMS appears to acutely suppress analgesia associated with perceived-control. This effect may be limited to the emotional dimension of pain experience.
AB - The prefrontal cortex may be a promising target for transcranial magnetic stimulation (TMS) in the management of pain. It is not clear how prefrontal TMS affects pain perception, but previous findings suggest that ventral lateral and medial prefrontal circuits may comprise an important part of a circuit of perceived controllability regarding pain, stress, and learned helplessness. Although the left dorsolateral prefrontal cortex is a common TMS target for treating clinical depression as well as modulating pain, little is known about whether TMS over this area may affect perceived controllability. The present study explored the immediate effects of fast TMS over the left dorsolateral prefrontal cortex on the analgesic effects of perceived pain controllability. Twenty-four healthy volunteers underwent a laboratory pain task designed to manipulate perception of pain controllability. Real TMS, compared with sham, suppressed the analgesic benefits of perceived control on the emotional dimension of pain, but not the sensory/discriminatory dimension. Findings suggest that, at least acutely, fast TMS over the left dorsolateral prefrontal cortex may interrupt the perceived-controllability effect on the emotional dimension of pain experience. Although it is not clear whether this cortical area is directly involved with modulating perceived controllability or whether downstream effects are responsible for the present findings, it appears possible that left dorsolateral prefrontal TMS may produce analgesic effects by acting through a cortical perceived-control circuit regulating limbic and brainstem areas of the pain circuit. Despite evidence that prefrontal TMS can have analgesic effects, fast left prefrontal TMS appears to acutely suppress analgesia associated with perceived-control. This effect may be limited to the emotional dimension of pain experience.
KW - Control
KW - Pain
KW - Prefrontal cortex
KW - TMS
KW - Transcranial magnetic stimulation
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U2 - 10.1016/j.pain.2010.10.018
DO - 10.1016/j.pain.2010.10.018
M3 - Article
C2 - 21122992
AN - SCOPUS:78650419331
VL - 152
SP - 182
EP - 187
JO - Pain
JF - Pain
SN - 0304-3959
IS - 1
ER -