Deconstructing Pain: Sensory and Cognitive Manipulations of Pain are Mediated by Distinct Systems

Cognitive strategies can strongly modulate emotion and pain. However, it is unclear whether cognition primarily influences core affective processes or later decision and valuation processes. We combined fMRI imaging with an experimental pain paradigm, and concurrently manipulated both the intensity of noxious input and a cognitive reappraisal of pain. Both manipulations strongly influenced reported pain, but they did so via two distinct brain pathways. The effects of stimulus intensity were mediated by a distributed brain network recently shown to predict physical pain with over 90% sensitivity and specificity across four studies. Cognitive reappraisal had no effect on activity in this network. Instead, cognitive effects on pain were mediated through a pathway connecting the nucleus accumbens and ventromedial prefrontal cortex. This pathway was unresponsive to noxious input, and has been broadly implicated in valuation and emotional appraisal. These findings suggest that sensory and cognitive manipulations influence pain through distinct brain pathways