The Role and Treatment Implications of Peripheral and Central Processing of Pain, Pruritus, and Nausea in Heightened Somatic Awareness: A Review

Abstract

Pain, pruritus, and nausea are complex sensory and emotional physiological symptoms that can vary widely between people and even within an individual, depending on the context and meaning of the symptom and the psychological state of the person. This article reviews the acute neural transmission of pain, pruritus, and nausea symptoms, which can begin in the periphery and/or viscera. The subsequent multiple pathways in the central nervous system that become involved in the processing of these symptoms are also discussed. The authors describe human brain imaging studies that have revealed consistent cortical and subcortical networks activated by these symptoms, including sensory, limbic, and associative regions. In particular, the authors discuss information revealed by the studies regarding the primary somatosensory cortex, secondary somatosensory cortex, anterior cingulate cortex, insula, prefrontal cortex and thalamus, are the brain areas most commonly activated by noxious stimuli. Finally, the authors describe treatment options for chronic presentations of these symptoms, which are, in part, based on central nervous processing of these sensations.

Keywords: Pain; central processing; nausea; pruritus.

FIGURE 1.

Summary of brain areas involved in emotional, cognitive, and visceral-somatic sensations across multiple neural circuits