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Medial Orbitofrontal De-Activation During Tonic Cold Pain Stimulation: A fMRI Study Examining the Opponent-Process Theory

Authors Bitar N, Dugré JR, Marchand S, Potvin S

Received 2 February 2020

Accepted for publication 22 May 2020

Published 8 June 2020 Volume 2020:13 Pages 1335—1347

DOI https://doi.org/10.2147/JPR.S248056

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Robert B. Raffa


Nathalie Bitar,1,2 Jules R Dugré,1,2 Serge Marchand,3,4 Stéphane Potvin1,2

1Research Center of the Institute of Mental Health of Montreal, Montreal, Canada; 2Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Canada; 3Genome Quebec, Montreal, Canada; 4Department of Surgery, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Canada

Correspondence: Stéphane Potvin
Research Center of the Institute of Mental Health of Montreal, 7331 Hochelaga, Montreal, Quebec H1N 3V2, Canada
Email stephane.potvin@umontreal.ca

Background: While the concomitant administration of painful and rewarding stimuli tends to reduce the perception of one another, recent evidence shows that pleasant pain relief is experience after the interruption of noxious stimuli. On neurobiological grounds, these opponent processes should translate into decreased activity in brain reward regions during nociceptive stimulation and increased activity in these regions after its interruption. While growing evidence supports the latter assumption, evidence is lacking in humans in support of the former.
Methods: Twenty-six healthy individuals underwent a functional magnetic resonance imaging (fMRI) session during which they were administered a cold pain stimulation, using a novel paradigm which consisted in a cold gel applied on the right foot of participants.
Results: After the interruption of noxious stimulation, participants experienced significant levels of pleasant pain relief. During cold pain stimulation, brain activations were observed in key regions of the pain matrix (eg, thalamus, primary somatosensory cortex and insula). Conversely, the medial orbitofrontal cortex was found to be de-activated. Medial orbitofrontal de-activations were negatively correlated with subclinical pain symptoms.
Discussion: Our results show that a key brain reward region (eg, medial orbitofrontal cortex) is de-activated during cold pain stimulation, a result which is consistent with one of the central assumptions of the opponent-process theory. On methodological grounds, our results show that the cold gel applied to the foot can be used to trigger activations in the pain matrix, and that the interruption of the cold pressor test elicits significant levels of pleasant pain relief. fMRI studies on pain–reward interactions in chronic pain patients are warranted.

Keywords: pain, reward, orbitofrontal cortex, fMRI, opponent-process theory, cold pressor test, pain relief, reward


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