Reduced Perception of Dyspnea and Pain after Right Insular Cortex Lesions
Abstract
Rationale: The perception of dyspnea and pain show many similarities. Initial imaging studies suggested an important role of the insular cortex for the perception of both sensations. However, little is known about the cortical processing of dyspnea. Objectives: This study investigated the influence of lesions of the insular cortex on the perception of dyspnea and pain. Methods: Dyspnea was induced by resistive loaded breathing in four patients with right-hemispheric insular cortex lesions, as assessed with computer tomography or magnetic resonance imaging, and four matched healthy control subjects. Pain was induced by a cold-pressor test. Perceived intensity and unpleasantness of both sensations were rated on visual analog scales. Measurements and Main Results: In contrast to healthy control subjects, patients with lesions demonstrated reduced perceptual sensitivity for dyspnea, in particular for the unpleasantness of dyspnea (P < 0.05). This was paralleled by reduced sensitivity for pain in patients with lesions, as reflected by smaller ratings of intensity and unpleasantness, higher sensory pain-thresholds, and, in particular, higher affect-related pain tolerance times (P < 0.05). Conclusions: The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations.
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Neural integration of breathlessness occurs in cortico-limbic regions of the brain, which are influenced by thoughts and emotions, further modulating breathlessness perception.
“Neural integration occurs in cortico-limbic regions of the brain, which are influenced by thoughts and emotions, further modulating breathlessness perception.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [15]
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- Authors
- Schön, D., Rosenkranz, M., Regelsberger, J., Dahme, B., Büchel, C., & von Leupoldt, A.
- Affiliations
- Universität Hamburg (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- Department of Psychology, University of Hamburg
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-12-01
- Volume
- 178
- Issue
- 11
- Pages
- 1173-1179
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1964018211
- Cited by
- 91
- References
- 54
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 6 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 5
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- insula, dyspnea perception, pain perception, unpleasantness, pain tolerance, cold pressor test, resistive breathing, sensory processing, brain lesions
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cerebral Cortex, Cerebral Infarction, Dyspnea, Female, Humans, Middle Aged, Case-Control Studies, Pain Threshold
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