Endogenous and exogenous modulators of potentials evoked by a painful cutaneous laser (LEPs)

Little is known about the specific functions of the human cortical structures receiving nociceptive input, their relationship to various dimensions of pain, and the modulation of these inputs by attention. We now review studies demonstrating the subdural potentials evoked by a cutaneous laser stimulus which produces a pure pain sensation by selective activation of cutaneous nociceptors (LEPs). These LEPs were localized over human anterior and middle cingulate (A & MCC), somatosensory (SI) and parasylvian (PS) cortices. LEP, lesion and imaging data define pain-related elements within each of these structures: insula and parietal operculum within PS, anterior and middle cingulate cortex, and possibly Brodman's areas 3a, 3b and 1 within SI. LEPs recorded over each of these areas is modulated with laser intensity and evoked pain. Attention to the painful laser produces an increase in the amplitude of LEPs over all three cortical areas and emergence of a late positive potential over ACC alone. These studies provide clear evidence of human cortical structures receiving nociceptive input and the modulation of that input by exogenous (e.g. laser intensity) and endogenous factors (e.g. directed attention).