Effective connectivity in pain. (A–C) For the θ frequency band, a decrease in effective connectivity from the pregenual anterior cingulate cortex (pgACC) to the left and right the left and right somatosensory cortex (SCC) was identified, while an increase in effective connectivity from the left and right the left and right SCC to the pgACC was found for chronic pain patients in comparison to controls subjects. (D) A correlation analysis between pain intensity perception the left and right SCC to pgACC demonstrates that more pain is related to less effective connectivity in chronic pain patients. (E–H) For the α frequency band, a decrease in effective connectivity from the pgACC to the left and right SSC as well as the dorsal anterior cingulate cortex (dACC) was found for chronic pain patients. In contrast, no difference in effective connectivity from the left and right SCC to the dACC to the pgACC was noted for chronic pain patients in comparison to controls subjects. (I) A positive correlation was identified between pain perception with effective connectivity from dACC to pgACC, indicating the higher pain intensities and distress correlate with increased effective connectivity from dACC to pgACC in chronic pain patients. No effect was obtained for the effective connectivity from pgACC to SCC (left and right) or from pgACC to dACC. (†P < 0.10, *P < 0.05, **P < 0.01, ***P < 0.001). For the radar plots, effective connectivity areas underlined indicate a significant effect (blue for pain distress, red for pain intensity).