Abstract
A cognitive task, the n-back task, was used to interrogate the cognitive dimension of pain in patients with implanted dorsal root ganglion stimulators (DRGS). Magnetoencephalography (MEG) signals from thirteen patients with implanted DRGS were recorded at rest and while performing the n-back task at three increasing working memory loads with DRGS-OFF and the task repeated with DRGS-ON. MEG recordings were pre-processed, then power spectral analysis and source localization were conducted. DRGS resulted in a significant reduction in reported pain scores (mean 23%, p = 0.001) and gamma oscillatory activity (p = 0.036) during task performance. DRGS-induced pain relief also resulted in a significantly reduced reaction time during high working memory load (p = 0.011). A significant increase in average gamma power was observed during task performance compared to the resting state. However, patients who reported exacerbations of pain demonstrated a significantly elevated gamma power (F(3,80) = 65.011612, p < 0.001, adjusted p-value = 0.01), compared to those who reported pain relief during the task. Our findings demonstrate that gamma oscillatory activity is differentially modulated by cognitive load in the presence of pain, and this activity is predominantly localized to the prefrontal and anterior cingulate cortices in a chronic pain cohort.
Highlights
Pain is a multi-dimensional experience, traditionally described as consisting of sensory, affective and cognitive domains [1]
Our findings demonstrate the efficacy of dorsal root ganglion stimulators (DRGS) in alleviating the interruptive effect of pain on
0.028 load is reflected by enhanced gamma oscillatory activity, the effect of pain, and pain relief, can Dorsolateral Prefrontal cortex modulate gamma activity in the human prefrontal and anterior cingulate cortices
Summary
Pain is a multi-dimensional experience, traditionally described as consisting of sensory, affective and cognitive domains [1]. The cognitive dimension of pain has been demonstrated by investigating the roles that attention, distraction and memory play in altering pain perception [2,3]. Studies have shown that engaging attentional networks with cognitive loads can attenuate perceived pain for a given stimulus — a distraction mechanism of pain relief [4,5]. High-frequency gamma activity has long been associated with cognition and attention [8,9] but has been shown to encode ongoing pain [10,11]. Surgically implanted devices such as spinal cord stimulation have shown the potential to modulate cortical gamma (30–45 Hz) activity [12], supporting the hypothesis of supraspinal mechanisms of action for spinal, and potentially peripheral, neuromodulation
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