Innovations In Clinical Neuroscience

MAY-JUN 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 5 – 6 , M A Y – J U N E 2 0 1 7 ] 11 ABSTRACT Pain, pruritus, and nausea are complex sensory and emotional physiological symptoms that can vary widely between people and even within an individual, depending on the context and meaning of the symptom and the psychological state of the person. This article reviews the acute neural transmission of pain, pruritus, and nausea symptoms, which can begin in the periphery and/or viscera. The subsequent multiple pathways in the central nervous system that become involved in the processing of these symptoms are also discussed. The authors describe human brain imaging studies that have revealed consistent cortical and subcortical networks activated by these symptoms, including sensory, limbic, and associative regions. In particular, the authors discuss information revealed by the studies regarding the primary somatosensory cortex, secondary somatosensory cortex, anterior cingulate cortex, insula, prefrontal cortex and thalamus, are the brain areas most commonly activated by noxious stimuli. Finally, the authors describe treatment options for chronic presentations of these symptoms, which are, in part, based on central nervous processing of these sensations. INTRODUCTION Heightened somatic awareness (HSA) refers to a greater than average awareness for a variety of physical sensations and symptoms. Individuals with HSA have a tendency to notice and report nonspecific symptoms, such as shortness of breath, presyncope, and a variety of chronic pain conditions, pruritus, and nausea. 1 While each sensation has unique neural transmission pathways to the spinal cord, there appears to be a convergent processing of these sensations at the level of the brain itself. As opposed to acute sensory symptoms, the perpetuation of chronic sensory symptoms has been linked to attributes other than the traditional neural transmission. For instance, HSA is strongly associated with negative affect (i.e., symptoms of depression and anxiety). 1 Between physical symptom reporting and the tendency to experience somatosensory distortion among patients with HSA, the link between HSA and negative effect is consistent with recent neurocognitive theories. 2 Another variable is alterations in neural transmission at the level of the spinal cord (i.e., peripheral and central sensitization). 3 A final variable to consider is alterations in neural transmission at the sensory processing level of the brain, here referred to as the "sensory neuromatrix." Sensory neuromatrix might be conceptualized as patterns of sensory system activation integrated aberrantly with activity (including emotional, cognitive, and modulatory processes) in brain systems, such as the anterior cingulate cortex, insular cortex, ventrolateral orbitofrontal by DAVID R. SPIEGEL, MD; ALEXANDER PATTISON, MD; ALEXIS LYONS, MD; UMER ANSARI, MD; AIDAN L. MCCROSKEY, MD; ERIC LUEHRS MD; LAUREN BARR, BS; and STEPHANIE LE, MD All authors are with the Department of Psychiatry and Behavioral Sciences at Eastern Virginia Medical School in Norfolk, Virginia. Innov Clin Neurosci. 2017;14(5–6):11–20 FUNDING: No funding was provided for the preparation of this article. FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: David R. Spiegel, MD; KEY WORDS: Pain, pruritus, nausea, central processing R E V I E W THE ROLE AND TREATMENT IMPLICATIONS of Peripheral and Central Processing of Pain, Pruritus, and Nausea in Heightened Somatic Awareness: A Review

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