Behaviors related to Human Neural Activity during Experimental Vigilance to Pain

虽然在“特发性”和“伤害性”疼痛综合征中都发现对疼痛的警觉性异常增强， 对疼痛实验警戒的行为和神经特征知之甚少。我们建议 将人因研究(例如空中交通管制员)中的持续绩效任务(CPT)调整为 研究对疼痛的实验警觉性。在我们的任务中，受试者按下一个按钮来表示检测到疼痛 当靶标刺激出现在一系列非靶标非疼痛刺激中时，即CPT疼痛。 在CPT疼痛过程中，我们建议记录和分析直接来自大脑的局部场电位(LFP 通过放置在大脑上的电极治疗顽固性癫痫。这项技术是无与伦比的 分辨率但范围有限，因此补充了fMRI，后者分辨率较低，但调查整个大脑。 我们的前提是：在有痛苦目标的CPT(CPT疼痛)中，错误和唤醒调节行为和 神经因素对疼痛的警觉性，并影响中枢性卒中后疼痛(CePSP)。我们建议测试一下 假设：随着时间的推移，CPT疼痛的行为与神经激活和模块之间的相互作用有关 在网络中对疼痛保持警惕，而中风后行为的变化识别 对于这种行为以及CePSP的发展和症状都是必不可少的。像这样的网络可以是 以模块和模块之间的连接为特征的，通过它们的因果相互作用来识别。 我们的初步数据显示，随着时间的推移，在CPT疼痛中检测到的非目标和唤醒通常是 伴随着更多的疼痛。这些数据还表明顶叶脑电信号是对疼痛保持警惕的标志 与错误相关，表明顶层模块参与了分布式网络，以警惕 疼痛。尽管这些对LFP(或fMRI信号)的分析并不能证明模块对于警觉是必不可少的 对于疼痛来说，如果模块的损伤影响行为，则模块可以被识别为行为所必需的。 因此，我们建议研究中风的解剖(通过结构磁共振)和行为测量的CPT疼痛在 急性中风患者。我们将使用霍普金斯大学开发的一个软件包来分析病变 (LDDMM)与我们的长期合作伙伴Hillis博士合作，他在这一包的研究方面拥有丰富的经验 请注意。最后，我们的初步数据显示，在岛状结构的患者中，顶叶结构是不存在的。 发生CePSP的卒中患者，但不患CePSP的岛状卒中患者， 提示CePSP可能与顶叶、警戒机制有关。 这些拟议研究的结果可能会为神经科学对 疼痛，以及基于解剖学的疗法在治疗与高度警惕相关的疼痛综合征中， 以及对疼痛警觉性的客观仪器化测试。网络分析对提高警觉的潜力 通过网络分析对视觉神经科学的影响以及对发育的影响，提出了对疼痛的看法 用于治疗运动和精神障碍的新型外科和刺激疗法。

While abnormally increased Vigilance to pain is found in both ‘idiopathic’ and ‘nociceptive’ pain syndromes, the behavioral and neural characteristics of experimental Vigilance to pain are poorly understood. We propose to adapt a Continuous Performance Task (CPT) from Human Factors Research (e.g. air traffic controllers) to study Experimental Vigilance to pain. In our task, the subject pushes a button to indicate detection of painful target stimuli when they occur in a train of nontarget nonpainful stimuli, i.e. CPTpain. During a CPTpain, we propose to record and analyze local field potentials (LFP) directly from the brain through electrodes placed on the brain for the treatment of intractable epilepsy. This technique has unrivalled resolution but limited scope and so complements fMRI, which has lower resolution but surveys the whole brain. Our Premise is that: Errors and Arousal in a CPT with a painful target (CPTpain) mediate the behavioral and neural elements of Vigilance to pain, and affect Central Post Stroke Pain (CePSP). We propose to test the hypothesis that: Behaviors over time in a CPTpain are related to neural activations and interactions of modules in a network for Vigilance to pain, while changes in a behavior after a stroke identify the modules that are essential for that behavior, and for the development and symptoms of CePSP. Networks like this can be characterized by modules, and connections between modules as identified by their causal interactions. Our Preliminary Data shows that over time in a CPTpain detected nontargets and arousal are often associated with increased pain. These Data also suggest a Parietal EEG Signature for Vigilance to pain that is correlated with errors, suggesting that a Parietal module is involved in a distributed network for Vigilance to pain. Although these analyses of LFPs (or fMRI signals) do not prove that modules are essential for Vigilance to pain, a module can be identified as essential for a behavior if lesions of the module affect that behavior. Therefore, we propose to study stroke anatomy (by structural MRI) and behavioral measures in CPTpain in patients with acute strokes. We will use a software package developed at Hopkins for the analysis of lesions (LDDMM) with our long term collaborator, Dr. Hillis, who has broad experience with this package in studies of attention. Finally, our Preliminary Data demonstrates that Parietal structures are spared in patients with insular strokes who develop CePSP but are involved in patients with insular strokes who do not develop CePSP, which suggests a Parietal, Vigilance related mechanism for CePSP. The results of these proposed studies may frame testable hypotheses for the neuroscience of Vigilance to pain, and anatomically based therapies in the treatment of pain syndromes associated with Hypervigilance, and for an objective instrumented test of Vigilance to pain. The potential of analyses of networks for Vigilance to pain is suggested by the impact of network analyses on the neuroscience of vision, and on the development of novel surgical and stimulation therapies for the treatment of movement and psychiatric disorders.