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dc.contributor.authorMakovac, Elena
dc.contributor.authorVenezia, Alessandra
dc.contributor.authorHohenschurz-Schmidt, David
dc.contributor.authorDipasquale, Ottavia
dc.contributor.authorJackson, Jade B
dc.contributor.authorMedina, Sonia
dc.contributor.authorO'Daly, Owen
dc.contributor.authorWilliams, Steve Cr
dc.contributor.authorMcMahon, Stephen B
dc.contributor.authorHoward, Matthew A
dc.description.abstractThere is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored. Here, we sought to determine brain regions mediating ANS and descending pain control associations. Thirty participants underwent conditioned pain modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between ‘pressure-only’ and ‘pressure + cold’ stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain were acquired. Heart rate variability (HRV) was simultaneously recorded. Normalised low-frequency HRV (LF-HRVnu) and the CPM score were negatively correlated; individuals with higher LF-HRVnu during pain reported reductions in pain during CPM. PAG-ventro-medial prefrontal cortex (vmPFC) and PAG-rostral ventromedial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-vmPFC functional connectivity mediated the strength of the LF-HRVnu-CPM association. CPM response magnitude was also negatively correlated with vmPFC GM volume. Our multi-modal approach, using behavioural, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments.
dc.rightsAttribution 4.0 International
dc.subjectdescending pain modulation
dc.subjectheart rate variability
dc.subjectperiaqueductal grey
dc.subjectresting state
dc.subjectvoxel-based morphometry
dc.titleThe association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey.
prism.publicationNameThe Journal of Physiology
dc.contributor.orcidJackson, J.B. [0000-0002-9066-2627]
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MC_UU_00005/17)

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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International