Neural correlates of perceptual difference between itching and pain: A human fMRI study

It has been wondered why we can discriminate between itching and pain as different sensations. Several researchers have investigated neural mechanisms underlying their perceptual differences, and found that some C fibers and spinothalamic tract neurons had different sensitivity between itching and pain. These findings suggest that such differences in ascending pathways are partly associated with perceptual difference between itching and pain. However, it was still unclear how our brains distinguish itching from pain. Thus, by functional magnetic resonance imaging (fMRI) time series analysis, we investigated the neural substrates of perceptual differences between itching and pain. The anterior cingulate cortex, the anterior insula, the basal ganglia and the pre-supplementary motor area were commonly activated by itching and pain. Neural activity in the posterior cingulate cortex (PCC) and the posterior insula associated with itching was significantly higher than that associated with pain and significantly proportional to itching sensation. Pain, but not itching, induced an activation of the thalamus for several minutes, and neural activity of this brain region significantly correlated to pain sensation. These findings demonstrate that the difference in the sensitivity of PCC, the posterior insula and the thalamus between itching and pain would be responsible for the perceptual difference between these sensations. The previous itching studies did not observe an activation of the secondary somatosensory cortex (S2) by itching. However, we observed that an activation of S2 by pain was not significantly different from that by itching, indicating that S2 was associated with not only pain but also itching.