Published ahead of print on September 5, 2008, doi:10.1164/rccm.200805-731OC Am. J. Respir. Crit. Care Med., Volume 178, Number 11, December 2008, 1173-1179 A more recent version of this article appeared on December 1, 2008
Submitted on May 14, 2008 Reduced Perception of Dyspnea and Pain After Right Insular Cortex LesionsDaniela Schon1,1 Department of Psychology, University of Hamburg, Hamburg, Germany, 2 Center for Clinical Neurosciences-Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3 Center for Clinical Neurosciences-Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 4 Department of Systems Neuroscience/Neuroimage Nord, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 5 Department of Psychology, University of Hamburg, Hamburg, Germany; Department of Systems Neuroscience/Neuroimage Nord, University Medical Center Hamburg-Eppendorf, Hamburg, Germany * To whom correspondence should be addressed. E-mail: andreas.vonleupoldt{at}uni-hamburg.de.
Rationale: The perception of dyspnea and pain show many similarities. Initial imaging studies suggested an important role of the insular cortex for the perception of both unpleasant sensations. However, little is still known about the cortical processing of dyspnea. Objectives: This study investigated the influence of lesions of the insular cortex on the perception of dyspnea and pain. Methods: In four patients with right-hemispheric insular cortex lesions, as assessed with computer tomography or magnetic resonance imaging, and four matched healthy controls, dyspnea was induced by resistive loaded breathing. Pain was induced by a cold-pressor test. Perceived intensity and unpleasantness of both sensations were rated on visual analogue scales. Measurements and Main Results: In contrast to healthy controls, lesion patients demonstrated reduced perceptual sensitivity for dyspnea, in particular for the unpleasantness of dyspnea (p<0.05). This was paralleled by reduced sensitivity for pain in lesion patients as reflected by smaller ratings of intensity and unpleasantness, higher sensory pain-thresholds and, in particular, higher affect-related pain-tolerance times (p<0.05). Conclusions: The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations. Key words: brain, dyspnea, insular cortex lesion, pain, perception
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