Abstract
The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.
Highlights
Chronic pain involves the persistence of pain beyond 3 months, beyond the time required for usual tissue healing after injury [1]
We describe induced musical hallucinations associated with electrical stimulation of the rostral anterior cingulate cortex in two patients with refractory chronic neuropathic pain
In one patient who was a musical professional, these musical perceptions reflected a reemergence of previously quiescent internal musical imagery, while in the other patient the phenomenon was associated with hypnagogic states just before sleep
Summary
Chronic pain involves the persistence of pain beyond 3 months, beyond the time required for usual tissue healing after injury [1]. Moving beyond historical concepts framing pain primarily in terms of nociception, it is appreciated that chronic pain is associated with the integration of at least three dimensions including somatosensory, affective, and cognitive [2]. A central goal of chronic pain research has been to characterize the functional brain network underlying the subjective pain experience in a manner that corresponds to these dimensions [3, 4]. Chronic pain is intricately tied to attention. As part of the salience network, the ACC is functionally connected to the anterior insula and largely responsible for facilitating access to attention of salient stimuli, including motor, motivational, and mood response sensory inputs. As a potential nexus of affectiveemotional networks, the ACC has been studied as a key target for treating chronic neuropathic pain. Therapeutic results vary across studies [14,15,16], the ACC has been proposed as a target for brain stimulation
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