Kortikale repräsentation von schmerz

Contrary to the traditional view that the cerebral cortex is not involved in pain perception an extensive cortical network associated with pain processing has been revealed during the past decades. This network consistently includes the primary (S1) and secondary somatosensory cortices (S2), the insular cortex, and the anterior cingulate cortex (ACC). These cortical areas are organized in parallel and contribute to different dimensions of pain experience. The S1 cortex is mainly involved in discriminative aspects of pain, while the S2 cortex seems to have an important role in cognitive aspects of pain perception. The insula has been proposed to be involved in autonomic reactions to noxious stimuli and in pain-related learning and memory. The ACC is closely related to pain affect and may subserve the integration of general affect, cognition, and response selection. Furthermore, first pain appears to be particularly related to activation of S1 whereas second pain is closely related to ACC activation.