The multifaceted neural architecture of pain modulation by emotion and cognition: a systematic review and meta-analysis
Authors' conclusion
Similar subjective pain changes can coexist with different brain activation patterns, reflecting diverse neural strategies. Whereas prefrontal cortex-driven descending modulation is one mechanism, introspective approaches can alter perception without involving prefrontal activity.
Study context
- Population
- Healthy individuals undergoing contextual (emotional/cognitive) modulation of pain; chronic pain studies excluded100 articles
- Participants
- 2,735 individuals
- Outcome
- Brain activity patterns underlying contextual pain modulation
Methodological detailsActivation Likelihood Estimation, convergence analysis
- Activation Likelihood Estimation
- Convergence analysis
Pooled result
As reported in the abstract
- Pattern 1: prefrontal activation with modified nociceptive cortical activity (deactivated in hypoalgesia, hyperactivated in hyperalgesia), consistent with top-down descending control
- Pattern 2: prefrontal mobilisation without nociceptive-area changes, consistent with 'perceptual decision bias'
- Pattern 3: irregular ventromedial prefrontal involvement and significant deactivation of dorsolateral and ventrolateral prefrontal areas
- Patterns 1–2 seen in attentional or expectation manipulations incl. placebo/nocebo; pattern 3 mainly in introspective/self-referential tasks (meditation, religious prayer, nostalgia)
- Three broad activity patterns
Original publication
The multifaceted neural architecture of pain modulation by emotion and cognition: a systematic review and meta-analysis. Br J Anaesth. Published 30 April 2026. doi:10.
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