Figure 3.

The evolution of the theoretical perspective in the study of the attentional modulations of pain. The ‘pain vs. attention center’. The first studies aimed at identifying which brain activations were related to pain and which ones to attention. Attention tasks and painful stimuli were often presented in separate blocks and differential activations taken to indicate that different brain regions elaborate pain perception (or nociceptive elaboration) and attentional tasks (e.g. Davis et al., 1997). ‘Interactions pain and attention (areas)’. Subsequent studies sought to determine which areas underpin the attentional modulation of pain. For this aim, noxious stimuli were applied during the execution of an attentional task and brain activations obtained in these conditions compared to brain activations elicited by noxious stimuli without a concomitant task (e.g. Bantick et al., 2002). ‘Interactions pain attention (networks)’. A further step moved the interest from single (or multiple areas) studied as working separately to brain networks. Attentional modulation of noxious stimuli were investigated by studying activation and deactivation of networks of areas (e.g. Seminowicz et al., 2007). ‘From activation to mechanisms’. The suggestion that cognitive factors, including attention, could modulate activity at the level of the spinal cord was proposed back in the 1960s. However, imaging evidence was available later on, showing reduced activations to noxious stimuli at the level of the spinal cord activations during the execution of a working memory task. These (de)activations were also used to predict pain reductions (Sprenger et al., 2012). ‘Multiple network dynamics’. More recently, it has been suggested that spontaneous mind wandering from pain is correlated with network dynamics, with strengthened or weakened function connectivity between the PAG and the DMN.