Neuroimaging of Muscle Pain in Humans

Neuroimaging has provided important information on how acute and chronic pain is processed in the human brain. The pain experience is now known to be the final product of activity in distributed networks consisting of multiple cortical and subcortical areas. Due to the complex nature of the pain experience, a single cerebral representation of pain does not exist. Instead, pain depends on the context in which it is experienced and is generated through variable expression of the different aspects of pain in conjunction with modulatory influences. While considerable data have been generated about the supraspinal organization of cutaneous pain, little is known about how nociceptive information from musculoskeletal tissue is processed in the brain. This is in spite of the fact that pain from musculoskeletal tissue is more frequently encountered in clinical practice, poses a bigger diagnostic problem and is insufficiently treated. Differences are known to exist between acute pain from cutaneous and muscular tissue in both psychophysical responses as well as in physiological characteristics. The 2 tissue types also differ in pain sensitivity to the same stimuli and in their response to analgesic substances. In this review, characteristics of acute and chronic muscle pain will be presented together with a brief overview of the methods of induction and psychophysical assessment of muscle pain. Results from the neuroimaging literature concerned with phasic and tonic muscle pain will be reviewed. [J Chin Med Assoc 2009;72(6):285-293]