Common cortical network for first and second pain.

We measured, with whole-scalp magnetoencephalography, evoked fields from 10 healthy subjects to 1-ms thulium-laser stimuli that selectively activated nociceptive nerve fibers. The stimuli were delivered to the dorsum of the subject's left hand. The earliest cortical responses peaked at 165 +/- 7 ms, agreeing with the conduction velocity of Adelta-fibers. To stimulate unmyelinated C-fibers, we modified the method of Bragard et al. [Bragard, D., Chen, A.C., Plaghki, L., 1996. Direct isolation of ultra-late (C-fibre) evoked brain potentials by CO2 laser stimulation of tiny cutaneous surface areas in man. Neurosci. Lett. 209, 81-84], by decreasing the total energy of the laser beam and by restricting the size of the stimulated skin area to 0.2-0.3 mm2. The earliest cortical responses to these stimuli peaked at 811 +/- 14 ms. Bilateral activation of the SII cortices was detected in all 10 subjects to Adelta and in 8 subjects to C stimuli, emphasizing the importance of the SII cortex in processing of pain. Additional activation was observed in the posterior parietal cortex (PPC), probably related to sensorimotor coordination targeted to produce precise motor acts that reduce or prevent the pain; the PPC activation may have been accentuated by the required continuous evaluation of the perceived pain. In contrast to some earlier studies, we did not observe activation of the primary somatosensory cortex (SI). Additional activations to both types of stimuli were detected in the cingulate cortex (three subjects) and in the bilateral insular cortex (two subjects). These results implicate that the nociceptive inputs mediated by the Adelta- and C-fibers are processed in a common cortical network in different time windows. Reliable temporospatial characterization of cortical responses to first and second pain offers a unique tool for basic and clinical neuroscience to study the two distinctive pain fiber systems at cortical level.