Emotional and sensory focus as mediators of dental pain among patients differing in desired and felt dental control.

Giving patients instructions to focus on sensory (vs emotional) stimuli during a root canal procedure significantly reduced self-reported pain, but only among patients who were classified as having strong desire for control and low felt control in dental situations. Among patients with low felt control and low desire for control, sensory-focus instructions produced greater pain reports than did emotion-focus instructions. Finally, high desire–low felt patients reported higher levels of expected pain before treatment than did other patient subgroups. These data suggested limiting conditions for H. Leventhal's (1982) theory of emotion and supported the idea that desire for control might moderate the effects of perceived control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain-related cerebral potentials in response to acute painful electrical stimulation in sheep

OBJECTIVE: To examine associations between late event-related cerebral potential amplitudes and behavioural responses to noxious electrical stimulation as an indicator of acute pain in sheep. DESIGN: Analysis of variance for the effects of stimulus intensity on the behaviour and event-related cerebral potential variables. PROCEDURE: Ninety-six brief constant current electrical pulse trains were presented to the front left leg of eight sheep at four intensities (2.5 to 10 mA) in a randomised order. An event-related cerebral potential and a graded flinch response were recorded for each stimulus and the 24 event-related cerebral potentials at each intensity were averaged to produce a mean waveform. Various components of this waveform were analysed and changes in these measures and the sheep's flinch response, as stimulus intensity increased, were determined. RESULTS: Both the flinch response and some event-related cerebral potential components, that is, peak amplitudes 114 [N1], 187 [P1], 318 [P2] and 230 [Pm] ms after stimulus onset, were significantly affected as stimulus intensity increased. CONCLUSION: These corresponding behavioural and event-related cerebral potential changes indicate the usefulness of using changes in the event-related cerebral potential to measure acute pain in sheep.     

Application of focused ultrasound for research on pain

Exteroceptive silent periods (ESPs) of masseter muscle activity evoked by electrical stimulation of the mental nerve were studied over a large range of prepain intensities and at pain threshold in 44 normal subjects. Seven levels of stimulus intensity, based on individual sensory and pain thresholds, were applied and the relationship between ESPs, stimulus intensity and perception, as manifested by the subjective verbal response, was investigated. The analysis revealed that the occurrence of ESPs was not related to the stimulus intensity at the pain threshold. There were individually different patterns of progressive response to increasing current intensities within the pre-pain range in many cases. On the other hand, almost half of all the subjects investigated showed no or only occasional ESPs. In view of this variability the concept of ESPs being a nociceptive behavioural response has to be questioned.     

Responses of cutaneous A-fiber nociceptors to noxious cold

Responses of cutaneous nociceptors to natural stimuli, particularly mechanical and heat stimuli, have been well documented. Although nociceptors are excited by noxious cold stimuli, there have been few studies of their stimulus-response functions for cold stimuli over a wide range of stimulus temperatures. Furthermore, the proportion of nociceptors excited by noxious cold is not clear. In the present study, we examined responses of mechanosensitive A delta-nociceptors and low-threshold mechanoreceptors to a wide range of cold stimuli that included stimulus temperatures <0 degrees C. Electrophysiological recordings were made from single primary afferent fibers in the saphenous nerves of anesthetized rats. Cutaneous sensory receptors were classed according to their conduction velocity and subgrouped functionally according to their responses evoked by mechanical, heat, and cold stimuli (0 degrees C). Responses evoked by a wide range of cold stimulus intensities that included stimuli considered innocuous and noxious (painful) were then assessed. Stimuli of 20 to -20 degrees C were delivered to the receptive field via a 1-cm2 contact thermode from a base temperature of 32 degrees C. Stimuli were applied in descending order of 2 degrees C decrements. Stimulus ramp rate was 5 degrees C/s, and stimulus temperatures were applied for a duration of 10 s. A total of 90 A fibers was studied, of which 61 were nociceptors and had conduction velocity in the A delta-range (2-30 m/s). Nociceptors were classed initially as mechanical, mechanoheat, and mechanocold nociceptors. The remaining 29 fibers were low-threshold mechanoreceptors with conduction velocity in the A delta- or A beta-range (>30 m/s). These were subgrouped according to their adaptive properties as slowly or rapidly adapting, and according to whether they were excited by hair movement (hair follicle afferent fibers). All nociceptors were excited by noxious cold. Only 30% of nociceptors were considered sensitive to cold on initial classification with the use of a cold stimulus of 0 degrees C. However, all nociceptors were excited by stimulus intensities <0 degreesC. Response thresholds for cold ranged from 14 to -18 degrees C (-4.6 +/- 1.07 degrees C, mean +/- SE). The total number of impulses, discharge rate, and peak discharge increased monotonically as intensity of cold stimuli increased. Power functions were used to determine the rate at which the number of impulses increased as stimulus intensity increased. The slopes of power funcions ranged from 0.12 to 2.28 (mean 1.07 +/- 0.13). Most mechanoreceptors were not excited by cold stimuli. The only types of mechanoreceptors that responded reliably to cold stimuli were the slowly adapting mechanoreceptors. Responses usually occurred during the temperature ramp when the skin temperature was decreasing. There was no evidence that mechanoreceptors encoded the intensity of cold stimuli at intensities above or below 0 degrees C, because evoked responses did not increase with intensity of cold stimuli. It is concluded that the proportion of cutaneous A delta-nociceptors excited by noxious cold stimuli has been underestimated in previous studies. All nociceptors were excited by stimulus temperatures <0 degrees C and encoded the intensity of cold stimuli. It is therefore likely that cutaneous A delta-nociceptors contribute to the sensation of cold pain, particularly pain produced by stimulus temperatures <0 degrees C.     

Instructional demands and ratings of overt and hidden pain during hypnotic analgesia.

16 highly hypnotizable (Carlton University Responsiveness to Suggestion Scale) undergraduates rated the intensity of cold pressor pain during a baseline trial and again during 3 hypnotic analgesia trials. During each analgesia trial, Ss were instructed to give overt reports that reflected consciously experienced pain and covert reports that reflected the intensity of "hidden" pain. Treatment instructions administered before the 1st analgesia trial did not specify the relationship between overt and covert pain. Instructions given before the remaining 2 analgesia trials indicated that hidden pain would be either more or less intense than overt pain. Until they were given explicit information about the relative intensities of the pain, Ss reported no differences in the magnitude of overt and covert pain, contrary to the dissociation hypothesis of hypnotic analgesia. Consistent with social psychological formulations of the hidden observer phenomenon, Ss reported both higher covert than overt pain and lower covert than overt pain, depending on the instructions they were administered. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain sensation during cold stimulation of the teeth: differential reflection of A delta and C fibre activity?

Cold stimuli of varying intensities were randomly applied to upper middle incisors of 12 healthy young subjects for a mean duration of 2 min by individually adapted thermodes the temperatures of which ranged from +30 degrees C to -30 degrees C. The subjects were asked to rate the magnitude of their pain sensations during application of the stimuli by means of a linear potentiometer according to a category scale. After each stimulus, they were asked to describe the quality of their pain sensations. Cold stimulation of the teeth evoked pain sensations were reproducible that in subsequent trials and could be graded according to stimulation intensity. Below certain individually different threshold thermode temperatures the onset of a stimulus was followed, after a short latency (1.6 +/- 1 sec), by a sharp and shooting pain sensation which immediately decreased after reaching its maximum value while the stimulus was still present. The mean maxima of the pain intensities were correlated to the thermode temperature. In general, this first pain component was followed by a second one (latency: 29.9 +/- 6.3 sec) with a lower threshold temperature, less of an increase in rate and lower magnitude. This was described as a dull, burning pain which was difficult to localize. The human pain ratings are compared to recordings of intradental nerve fibres in the cat and, under the assumption that the response behaviour of human pulpal nerve fibres is comparable to that of the cat, we hypothesize that the first pain component is evoked by intradental A delta fibres exhibiting their typical phasic response behaviour and firing during the initial steep temperature decrease. After some seconds, intradental temperature reached values sufficient to evoke C-fibre activity associated with the second pain component.     

Risk for hypertension and pain sensitivity in adolescent boys.

Reduced pain perception has been observed in many studies of spontaneously hypertensive rats and human hypertensive patients. To determine whether a reduced sensitivity to pain could be observed in a group of clearly normotensive individuals who may be at risk for hypertension, a mild to moderate pain stimulus was administered to 177 14-year-old boys. Boys with a normatively elevated resting systolic blood pressure tolerated mechanical finger pressure significantly longer than boys with lower blood pressure. As well, boys with both normatively elevated resting systolic blood pressure and a parental history of hypertension reported significantly less pain during finger pressure than lower risk participants. These findings could not be explained by personality factors and suggest that hypertension-related hypoalgesia is associated with processes involved in the development of the disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stimulus quality affects expression of the acoustic startle response and prepulse inhibition in mice.

The relationship between stimulus intensity and startle response magnitude (SIRM) can assess the startle reflex and prepulse inhibition (PPI) with advantages over more commonly used methods. The current study used the SIRM relationships in mice to determine differences between white noise and pure tone (5 kHz) stimuli. Similarly to rats, the SIRM relationship showed a sigmoid pattern. The SIRM-derived reflex capacity (RMAX) and response efficacy (slope) of the white noise and pure tone stimuli in the absence of prepulses were equivalent. However, the pure tone startle response threshold (DMIN) was increased whereas the stimulus potency (1/ES??) was decreased when compared to white noise. Prepulses of both stimulus types inhibited RMAX and increased DMIN, but the white noise prepulses were more effective. Both stimulus intensity gating and motor capacity gating processes are shown to occur, dependent on prepulse intensity and stimulus onset asynchrony. Prepulse intensities greater than 10 dB below the startle threshold appear to produce PPI via stimulus intensity gating, whereas a motor capacity gating component appears at prepulse intensities near to the startle threshold. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amino-terminal identity of co-existent amyloid and non-amyloid immunoglobulin kappa light chain deposits. A human disease to study alterations of protein conformation

The sizes of the motor-evoked potentials (MEPs) and the durations of the silent periods after transcranial magnetic stimulation were examined in biceps brachii, brachioradialis and adductor pollicis in human subjects. Stimuli of a wide range of intensities were given during voluntary contractions producing 0-75% of maximal force (maximal voluntary contraction, MVC). In adductor pollicis, MEPs increased in size with stimulus intensity and with weak voluntary contractions (5% MVC), but did not grow larger with stronger contractions. In the elbow flexors, MEPs grew little with stimulus intensity, but increased in size with contractions of up to 50% of maximal. In contrast, the duration of the silent period showed similar changes in the three muscles. In each muscle it increased with stimulus intensity but was unaffected by changes in contraction strength. Comparison of the responses evoked in biceps brachii by focal stimulation over the contralateral motor cortex with those evoked by stimulation with a round magnetic coil over the vertex suggests an excitatory contribution from the ipsilateral cortex during strong voluntary contractions.     

Intensity dependence of perceived duration: Data, theories, and neural integration.

Evaluates 2 theoretical models suggested to explain studies of the effect of stimulus intensity on the perceived duration of brief light flashes. Some studies found a direct relationship between the 2 variables; others found an indirect relationship. Each model suggests that an additional variable interacts with stimulus intensity. Proposed variables have included the nature of the judgment and the absolute intensity. The present evaluation indicates that both of the proposed variables play a role and that a melding of the models could best account for this phenomenon. The melding incorporates known time- and intensity-dependent characteristics of neural integration into the behavioral performance. The evaluation also indicates that future experiments on this problem will be most informative if they (a) give particular attention to the role of instructions, (b) explore an adequate range of intensities, and (c) strictly control adaptive state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suramin increases p53 protein levels but does not activate the p53-dependent G1 checkpoint

Dental somatosensory evoked potentials (SEPs) corresponding to the stimulus intensity levels were recorded at 6 different levels of intensity presented in a randomized order. The relationships between the amplitude of the late SEP component with latency between 150 and 300 msec and each stimulus intensity level were also compared in conditions of randomized intensity and constant intensity. The amplitude of the late component increased significantly with the increased stimulus intensity both in the randomized and constant intensity stimulation. The amplitude of the late component in the randomized stimulation with a 1-sec interstimulus interval (ISI) increased in the same manner as that in the constant intensity condition with a 1-sec ISI. The randomized stimulation with the prolonged ISI increased the amplitude of the late component. The latency of the late positive component significantly increased with the randomized stimulation with a 3-sec ISI. This phenomenon might be attributable to the psychological contamination. SEP recording in the randomized dental stimulation with a 1-sec ISI may have applications in neuropharmacological research or physiological research on pain and evaluation of the effects of analgesics, anesthetics, acupuncture and transcutaneous electrical nerve stimulation (TENS).     

Integration of health care economics for addiction treatment in clinic care

Visceral pain is a substantial, clinical problem but unfortunately few experimental models are available to study this phenomenon in man. In the present study we inserted a stimulation catheter 5-10 cm into the ileo-sigmoidostomy of nine patients. The catheter contained six small, flexible electrodes separated by 4 mm. The gut was stimulated by single burst, repeated burst (five stimuli delivered at 2 Hz), or continuous burst stimuli (4 Hz for 30, 60, 90, and 120 s). The sensation (ST), pain detection (PDT), and pain tolerance (PTT) thresholds to single/repeated burst stimuli were determined. The location/size/sensitivity of referred pain after repeated/continuous stimulation were characterized. The brain potentials to single burst stimuli and to increasing stimulus intensity were measured. ST to single burst stimuli was easy to determine (8 mA) and to reproduce. The patients found it difficult to determine the PDT and PTT to single burst stimuli, however both thresholds were easily determined for repeated burst stimuli. The pain thresholds to single burst stimuli were twice as high as the thresholds to repeated burst stimuli, indicating the importance of central temporal summation for visceral pain. Minor changes in the stimulus location resulted in changes of the referred pain projection site. The words most frequently selected (78%) from the McGill Pain Questionnaire to describe repeated burst stimulations were shooting, pricking, flashing, and boring. The amplitude of the brain potentials increased at increasing stimulus intensity. A stimulus intensity giving an initial pain rating of around 5 on a 0-10 visual analog scale (VAS) was used for continuous stimulation. A general increase of the pain intensity and the area of referred pain was found during this stimulation. It was concluded that electrical stimulation of the human gut provokes pain and especially long sequences of visceral stimuli are adequate to evoke referred pain mimicking pain profiles of pathologic origin.     

Multidimensional scaling reveals two dimensions of thermal pain.

Used the individual differences scaling model of multidimensional scaling to explore the dimensions of thermal pain. 20 male undergraduates made 66 similarity judgments to all pairs of 12 different thermal stimulus intensities ranging from zero to noxious. Results reveal a 2-dimensional group stimulus space. The major dimension ordered the stimuli with respect to their intensity. This quantitative, strength-of-sensation dimension may be interpreted as indicating how weak or strong a stimulus feels, apart from any secondary qualities of warmth or pain. The 2nd dimension was related to the qualitative aspects of the stimuli and contained 2 attributes: (1) a pain attribute ranging from just detectable warmth to painful and (2) a warm–hot attribute running from just detectable warmth to hot. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional characteristics of lateral interactions between rods in the retina of the snapping turtle

1. Intracellular recordings were made of the slow hyperpolarizing light responses of single rods in the retina of the snapping turtle. Physiological criteria used to identify rods were verified by intracellular injections of Procion Yellow. 2. The amplitudes of the responses elicited by fixed intensity flashes increased as the stimulus was enlarged to a diameter of 300 mum. Scattered light was found incapable of accounting for this effect, which must result from summative interaction of rods with neighbouring receptors. Effects of summative interaction were observed even at stimulus intensities that produced maximal responses. Enlarging the diameter of the higher intensity stimuli from 100 to 300 mum increased the peak response amplitude by almost 50%; it also produced a distinct initial peak of the response which we term overshoot. The amplitude of this overshoot was graded with stimulus size. 3. Complete intensity-response relationships were determined using stimulus diameters of 100 and 750 mum for each rod. With the smaller stimulus the intensity response range was 4-5 log units, and with the larger stimulus this was increased to 5-0 log units. For intensities below about 60 quanta/mum2 per flash (514 nm) the amplitudes elicited by the large stimulus followed a sigmoid-shaped curve. However, at higher intensities an additional lobe appeared on the intensity-response relationship. The appearance of this lobe correlated with the emergence of the overshoot on the response wave form. 4. Determinations of rod flash sensitivity (mV per quantum per mum2) showed that it increased with stimulus size up to a stimulus diameter of about 300 mum. With diameters between 50 and 150 mum, a linear relationship existed between the flash sensitivity and stimulus area. Absolute quantal sensitivities increased with stimulus area by a factor of 26, from a value of 28 muV per photoisomerization per rod with a stimulus 25 mum in diameter, to 720 muV per photoisomerization per rod with a stimulus 300 mum in diameter. 5. By comparison, red-sensitive cones showed increased sensitivity as a function of stimulus size only up to a stimulus diameter of 120 mum. Their over-all sensitivity was lower than that of rods and proved linear with stimulus diameter rather than with stimulus area. 6. Simultaneous recordings were made from rod-cone pairs to determine whether the overshoot, and hence the lobe on the amplitude-intensity function, could result from a cone input to the rod response. The time course of the cone response proved much too rapid to fit the overshoot of the rod response. 7. The spectral sensitivity of the dark-adapted rod response closely followed the difference spectrum of the rod photopigment for wave-lengths greater than 450 nm. This was true throughout the intensity range of the response, including low intensities where response averaging was necessary. 8. At low response amplitudes (approximately 1 mV), about 70% of the 40 rods tested showed responses to long wave-length stimuli consisting of two components...     

Anatomic-physiologic principles of pain

Pain, particularly chronic pain, arises from the interaction of multiple simultaneously operating physiologic processes. The current understanding of the anatomy and physiology of pain is limited to a characterization of pathways and does not explain why a particular stimulus is felt as pain of a particular kind and intensity. In this article, we trace the afferent pain pathways from periphery (reception) to center (perception), i.e., from peripheral nerve, through the spinal cord and brain stem, to the thalamus and cerebral cortex. A number of neurosurgical procedures for the treatment of pain are discussed, and their anatomic basis is explained.     

Amphetamine-induced disruption of latent inhibition depends on the nature of the stimulus

It is well documented that latent inhibition (LI), i.e. slower conditioning to a stimulus that had been repeatedly pre-exposed without consequences, compared to a non-pre-exposed stimulus, is prevented by amphetamine. Recently, we found that the effects of amphetamine on LI, as assessed in an off-baseline conditioned emotional response (CER) procedure, depend on the nature of the pre-exposed stimulus, irrespective of reinforcer intensity. Because these results contrast with a recent finding that a reduction in reinforcer intensity reversed amphetamine-induced attenuation of LI in an on-baseline CER procedure, the present study investigated the effects of amphetamine on LI as a function of the nature of the pre-exposed stimuli and shock intensity, using an on-baseline CER procedure. The effects of amphetamine on post-shock suppression of drinking as well as on activity, were monitored throughout the stages of the CER procedure. Experiment 1 used a 5 s steady light as the pre-exposed and conditioned stimulus, and two shock intensities in conditioning, and Experiment 2 used a 10 s flashing light and two shock intensities. Amphetamine disrupted LI with a steady light at both low and high shock intensities, but failed to disrupt LI with a flashing light at both shock intensities. In addition, the drug disrupted LI in Experiment 3, which increased the duration of the steady light to 10 s and used only low shock intensity, but failed to affect LI in Experiment 4 which used the flashing light on the background of darkness or of light, and only high shock intensity. The effects of amphetamine on LI were not related to its effects on behavioural suppression after footshock, or on activity.     

Development of brightness preferences in young chicks: Effects on brightness discrimination learning.

Conducted 7 experiments with a total of 256 1-3 day old Vantress * Arbor Acre chicks to investigate the effects of interactions between the S and its sensory environment on both emergence of brightness preferences and modification by conditioning. In a simultaneous brightness discrimination, Ss were rewarded with heat for approaching either a bright or dim stimulus. Results indicate (a) brightness preference was so stable that it could not be eliminated by incubating, hatching, and rearing in the dark; (b) light experience significantly increased this preference; and (c) modification of this preference by heat reinforcement depended on age of S, prior rearing condition, sensory stimulation between testing sessions, and the length of interval between testing sessions. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' internal representations of their therapists.

Thirteen adults in long-term individual psychotherapy were interviewed regarding their internal representations (defined as bringing to awareness the internalized "image") of their therapists. Results indicated that in the context of a good therapeutic relationship, clients' internal representations combined auditory, visual, and kinesthetic (i.e., felt presence) modalities; were triggered when clients thought about past or future sessions, or when distressed; occurred in diverse locations; and varied in frequency, duration, and intensity. Clients felt positively about their representations and used them to introspect or influence therapy within sessions, beyond sessions, or both. The frequency of, comfort with, and use of clients' internal representations increased over the course of therapy, and the representations benefited the therapy and therapeutic relationship. Therapists tended not to take a deliberate role in creating clients' internal representations, and few clients discussed their internal representations with their therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Zatebradine: pharmacokinetics of a novel heart-rate-lowering agent after intravenous infusion and oral administration to healthy subjects

Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital thrombophilia

Previous functional imaging studies have demonstrated a number of discrete brain structures that increase activity with noxious stimulation. Of the commonly identified central structures, only the anterior cingulate cortex shows a consistent response during the experience of pain. The insula and thalamus demonstrate reasonable consistency while all other regions, including the lentiform nucleus, somatosensory cortex and prefrontal cortex, are active in no more than half the current studies. The reason for such discrepancy is likely to be due in part to methodological variability and in part to individual variability. One aspect of the methodology which is likely to contribute is the stimulus intensity. Studies vary considerably regarding the intensity of the noxious and non-noxious stimuli delivered. This is likely to produce varying activation of central structures coding for the intensity, affective and cognitive components of pain. Using twelve healthy volunteers and positron emission tomography (PET), the regional cerebral blood flow (rCBF) responses to four intensities of stimulation were recorded. The stimulation was delivered by a CO2 laser and was described subjectively as either warm (not painful), pain threshold just painful), mildly painful or moderately painful. The following group subtractions were made to examine the changing cerebral responses as the stimulus intensity increased: (1) just painful - warm; (2) mild pain - warm; and (3) moderate pain - warm. In addition, rCBF changes were correlated with the subjective stimulus ratings. The results for comparison '1' indicated activity in the contralateral prefrontal (area 10/46/44), bilateral inferior parietal (area 40) and ipsilateral premotor cortices (area 6), possibly reflecting initial orientation and plans for movement. The latter comparisons and correlation analysis indicated a wide range of active regions including bilateral prefrontal, inferior parietal and premotor cortices and thalamic responses, contralateral hippocampus, insula and primary somatosensory cortex and ipsilateral perigenual cingulate cortex (area 24) and medial frontal cortex (area 32). Decreased rCBF was observed in the amygdala region. These responses were interpreted with respect to their contribution to the multidimensional aspects of pain including fear avoidance, affect, sensation and motivation or motor initiation. It is suggested that future studies examine the precise roles of each particular region during the central processing of pain.