Brain Imaging of Pain

  • Massimo CauloEmail author
  • Valerio Maruotti
  • Antonio Ferretti


The brain is the principal processor of internal and external sensory experiences including pain. Pain is a multidimensional experience influenced by complex interactions among multiple processes including nociception (the afferent neural activity transmitting sensory information about noxious stimuli), cognitive appraisals (expectation, attention), and emotional aspects (affect).

Noninvasive structural and especially functional imaging techniques (PET, MEG, MRI and fMRI, ASL, NIRS) provide insight into the pathophysiology of pain in healthy and in pathologies. The poor relationship between tissue damage on structural MRI and pain has shifted the concept of pain from a localized to a more complex phenomenon based on interactions of multiple brain regions. Anatomical and physiological studies in animals, as well as functional imaging studies in humans, have shown that multiple cortical and subcortical areas are activated by painful stimuli, the pain matrix. This is not a fixed arrangement of structures but rather a fluid system composed of several interacting networks subserving in peripheral nociception, central processing, cortical modulation, and cognitive-emotional and psychological qualities.


Pain Magnetic resonance imaging Functional magnetic resonance imaging Pain matrix Functional connectivity 

Supplementary material

Video 2.1a

Wallenberg syndrome: axial FLAIR MR sequence shows a hyperintense ischemic lesion in the left posterolateral medulla oblongata. (MOV 2319 kb)

Video 2.1b

Wallenberg syndrome:axial T2 MR sequence shows a hyperintense ischemic lesion in the left posterolateral medulla oblongata. (MOV 2354 kb)

Video 2.2a

Thalamic stroke: axial FLAIR MR sequence shows a hyperintense ischemic lesion in the left lateral thalamus. (MOV 1873 kb)

Video 2.2b

Thalamic stroke: axial T2 MR sequence shows a hyperintense ischemic lesion in the left lateral thalamus. (MOV 2277 kb)

Video 2.3a

Cervical spinal cord lesion in a patient with multiple sclerosis: sagittal T2 MR sequence shows a hyperintense demyelinating lesion at C5–6. (MOV 1096 kb)

Video 2.3b

Cervical spinal cord lesion in a patient with multiple sclerosis: axial T2 MR sequence shows a hyperintense demyelinating lesion in the posterior columns. (MOV 1200 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Massimo Caulo
    • 1
    • 2
    Email author
  • Valerio Maruotti
    • 2
    • 3
  • Antonio Ferretti
    • 1
    • 2
  1. 1.Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of ChietiChietiItaly
  2. 2.ITAB - Institute of Advanced Biomedical TechnologiesUniversity “G. d’Annunzio” of ChietiChietiItaly
  3. 3.Neurology DepartmentIRCCS NeuromedPozzilliItaly

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