Schmitgen Ashlyn, Saal Jeremy, Sankaran Narayan, Desai Maansi, Joseph Isabella, Starr Philip, Chang Edward F, Shirvalkar Prasad
Division of Pain Medicine, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States.
UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.
Front Neurol. 2021 May 4;12:669172. doi: 10.3389/fneur.2021.669172. eCollection 2021.
The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.
前扣带回皮质（ACC）在慢性疼痛所涉及的功能性脑网络中发挥着广泛作用。尽管电刺激ACC治疗难治性慢性疼痛的作用机制尚不清楚，但已有人提出将其作为一种治疗方法。由于据报道，刺激ACC会产生许多不同的行为和感知反应，因此该区域可能在感觉和情绪整合以及调节内在产生的感知状态方面发挥着多种作用。在本病例系列中，我们报告了两名难治性慢性疼痛患者在接受ACC电刺激后出现了主观音乐幻觉（MH）。在对一名患者进行的单病例分析中，我们确定了将MH与非MH状态以及涉及听音乐的任务区分开来的神经活动（局部场电位）。音乐幻觉与ACC中α波段活动减少和γ波段活动增加有关。听相似的音乐会使ACC的α和γ功率发生不同变化，这扩展了先前的研究结果，即内在产生的感知现象由ACC中的神经回路支持。我们在幻知觉现象的背景下讨论这些发现，并提出一个框架，据此慢性疼痛可被解释为一种持续的内在产生的感知。
