PT  - JOURNAL ARTICLE
AU  - Enrico Schulz
AU  - Anne Stankewitz
AU  - Anderson M Winkler
AU  - Stephanie Irving
AU  - Viktor Witkovsky
AU  - Irene Tracey
TI  - Ultra-high field imaging reveals increased whole brain connectivity underpins cognitive strategies that attenuate pain
AID  - 10.1101/802306
DP  - 2019 Jan 01
TA  - bioRxiv
PG  - 802306
4099  - http://biorxiv.org/content/early/2019/10/11/802306.short
4100  - http://biorxiv.org/content/early/2019/10/11/802306.full
AB  - The perception of pain activates a number of brain regions and processes that are involved in its sensory, emotional, cognitive, and affective aspects; all of which require a flexible functional connectivity between local and distant brain regions. Here, we investigate how the attenuation of pain with cognitive interventions affects the strength of these connections by pursuing a whole brain approach in order to assess every cortical connection that contributes to successful pain relief.While receiving 40s trials of tonic cold pain, 22 healthy participants were asked to utilise three different pain attenuation strategies: (a) non-imaginal distraction by counting backwards in steps of seven, (b) imaginal distraction by imagining a safe place, and (c) cognitive reappraisal. During a 7T fMRI recording, participants were asked to rate their pain after each single trial. We related the trial-by-trial variability of the attenuation performance to the trial-by-trial functional connectivity of the cortical data. Across all three conditions, we found that a higher performance of pain attenuation was predominantly associated with higher functional connectivity between all regions.Of note, we observed an association between low pain and high connectivity for regions that belong to the core areas of pain processing, i.e. the insular and cingulate cortices. For one of the cognitive strategies (safe place), the performance success of pain attenuation was explained by diffusion tensor imaging metrics of increased white matter integrity.Therefore, successful cognitive interventions to ameliorate pain and improve clinical outcomes would require the strengthening of cortical connections.