Decision-making in the context of pain

Clinical and behavioural evidence has shown that the threat value of pain biases decisions about whether a stimulus is perceived as painful or not, and if yes, how intense is the sensation. This thesis aims to investigate the neural mechanisms underlying the effect of perceived threat on perceptual decisions about pain. The first study investigates the neural mechanisms underlying the effect of threat on the decision about the quality of the sensation, i.e., whether it is perceived as painful or not. The perception of pain (relative to no pain) was associated with activation in the anterior insula as well as an increased connectivity between this region and the mid-cingulate cortex (MCC). Activity in the MCC was correlated with the threat-related bias to perceived pain. In the second study, probabilistic tractography was performed with diffusion tensor imaging to investigate the structural connectivity between subdivisions of the insula and other pain-related regions. Additional analyses revealed that the structural connectivity between the anterior insula and the MCC, and between the posterior insula and somatosensory cortices, is positively correlated with the threat-related bias toward pain. In the third study, a multivariate pattern analysis (MVPA) was performed to investigate whether pain can be decoded from functional neuroimaging data acquired during the anticipation and during the receipt of pain. The results show that pain can be predicted by the pattern of neural activity in the right anterior insula during anticipation and stimulation. The fourth study investigated the effect of uncertainty about the stimulation intensity as a form of threat on the perceived intensity of pain. Uncertainty was found to be associated with an increased activation in the anterior insula. Overall, these findings suggest that a neural network consisting of the anterior insula and the MCC plays a key role in decisions about the quality and the quantity of nociceptive sensation. Results from the MVPA analysis support the notion that perceptual decisions are encoded by a distributed network of brain regions. The variability in anatomical connections between these regions may account for the individual differences in the susceptibility to a threat-mediated bias toward pain