Investigating peri-limb interaction between nociception and vision using spatial depth

Perceptual simultaneity between nociceptive and visual stimuli depends on their spatial congruence

To protect our body against physical threats, it is important to integrate the somatic and extra-somatic inputs generated by these stimuli. Temporal synchrony is an important parameter determining multisensory interaction, and the time taken by a given sensory input to reach the brain depends on the length and conduction velocity of the specific pathways through which it is transmitted. Nociceptive inputs are transmitted through very slow conducting unmyelinated C and thinly myelinated Aδ nociceptive fibers. It was previously shown that to perceive a visual stimulus and a thermo-nociceptive stimulus applied on the hand as coinciding in time, the nociceptive stimulus must precede the visual one by 76 ms for nociceptive inputs conveyed by Aδ fibers and 577 ms for inputs conveyed by C fibers. Since spatial proximity is also hypothesized to contribute to multisensory interaction, the present study investigated the effect of spatial congruence between visual and nociceptive stimuli. Participants judged the temporal order of visual and nociceptive stimuli, with the visual stimuli flashed either next to the stimulated hand or next to the opposite unstimulated hand, and with nociceptive stimuli evoking responses mediated by either Aδ or C fibers. The amount of time by which the nociceptive stimulus had to precede the visual stimulus for them to be perceived as appearing concomitantly was smaller when the visual stimulus occurred near the hand receiving the nociceptive stimulus as compared to when it occurred near the contralateral hand. This illustrates the challenge for the brain to process the synchrony between nociceptive and non-nociceptive stimuli to enable their efficient interaction to optimize defensive reaction against physical dangers.

Effects of spatial attention and limb position on the cortical interaction of bilateral noxious inputs

Bilateral noxious inputs interact in the brain to provide a better representation of physical threat. In the present study, we investigated the effects of spatial attention and limb position on this interaction. Painful laser stimuli were applied randomly on the right hand or on both hands, while varying spatial attention (focal or overall) and limb position (hands near or far from each other). Pain perception and laser-evoked potentials (N1, N2, P2) were compared between conditions in 27 healthy volunteers. Compared with unilateral stimulation, bilateral stimulation increased pain (p = .004), the N2 (p = .0015) and P2 (p < .001) amplitude. The effects on pain and the P2 were greater when hands were in the near compared with the far position (p < .05). The effect on pain was also greater for overall compared with focal pain rating (p = .003). In addition, the N1 amplitude was greater for bilateral stimulation when hands were in the far compared with the near position (p = .01). These results show that increased brain responses and pain for bilateral compared with unilateral noxious stimulation are modulated differentially by spatial attention and limb position. This suggests that the integration of noxious inputs occurs through partially independent pain-related processes, that it is modulated by limb position, and that it is partially independent of pain perception. We propose that this is necessary to produce coordinated, flexible and adapted defensive responses.

Measuring the sensitivity of tactile temporal order judgments in sighted and blind participants using the adaptive psi method

Spatial locations of somatosensory stimuli are coded according to somatotopic (anatomical distribution of the sensory receptors on the skin surface) and spatiotopic (position of the body parts in external space) reference frames. This was mostly evidenced by means of temporal order judgment (TOJ) tasks in which participants discriminate the temporal order of two tactile stimuli, one applied on each hand. Because crossing the hands generates a conflict between anatomical and spatial responses, TOJ performance is decreased in such posture, except for congenitally blind people, suggesting a role of visual experience in somatosensory perception. In previous TOJ studies, stimuli were generally presented using the method of constant stimuli-that is, the repetition of a predefined sample of stimulus-onset asynchronies (SOA) separating the two stimuli. This method has the disadvantage that a large number of trials is needed to obtain reliable data when aiming at dissociating performances of groups characterized by different cognitive abilities. Indeed, each SOA among a large variety of different SOAs should be presented the same number of times irrespective of the participant's performance. This study aimed to replicate previous tactile TOJ data in sighted and blind participants with the adaptive psi method in order to validate a novel method that adapts the presented SOA according to the participant's performance. This allows to precisely estimate the temporal sensitivity of each participant while the presented stimuli are adapted to the participant's individual discrimination threshold. We successfully replicated previous findings in both sighted and blind participants, corroborating previous data using a more suitable psychophysical tool.

No Evidence for an Effect of the Distance Between the Hands on Tactile Temporal Order Judgments

Localizing somatosensory stimuli is an important process, as it allows us to spatially guide our actions toward the object entering in contact with the body. Accordingly, the positions of tactile inputs are coded according to both somatotopic and spatiotopic representations, the latter one considering the position of the stimulated limbs in external space. The spatiotopic representation has often been evidenced by means of temporal order judgment (TOJ) tasks. Participants' judgments about the order of appearance of two successive somatosensory stimuli are less accurate when the hands are crossed over the body midline than uncrossed but also when participants' hands are placed close together when compared with farther away. Moreover, these postural effects might depend on the vision of the stimulated limbs. The aim of this study was to test the influence of seeing the hands, on the modulation of tactile TOJ by the spatial distance between the stimulated limbs. The results showed no influence of the distance between the stimulated hands on TOJ performance and prevent us from concluding whether vision of the hands affects TOJ performance, or whether these variables interact. The reliability of such distance effect to investigate the spatial representations of tactile inputs is questioned.

Investigating perceptual simultaneity between nociceptive and visual stimuli by means of temporal order judgments

Multisensory interactions between pain and vision allow us to adapt our behavior to optimize detection and reaction against bodily threats. Interactions between different sensory inputs are enhanced when they are perceived closely in space and time. However, thermo-nociceptive and visual stimuli are conveyed to the cortex through specific pathways with their own conduction velocity. The present experiment aims to measure the necessary asynchrony between a nociceptive stimulus and a visual stimulus for both to be perceived as occurring simultaneously. Healthy volunteers performed a temporal order judgment task during which they discriminated the temporal order between a laser-induced nociceptive stimulus applied on one hand dorsum and a visual stimulus presented next to the stimulated hand. Laser stimulus temperature selectively activated Aδ- and/or C- fiber afferents. In order to be perceived as occurring simultaneously with a visual stimulus, a thermo-nociceptive input selectively conveyed by C-fiber afferents must precede the visual stimulus by 577 ms on average, while the stimulus-evoked input conveyed by Aδ-fiber afferents must precede it by 76 ms on average. This experiment focuses on the necessary asynchrony between thermo-nociceptive and visual inputs for them to be perceived simultaneously, to optimize the conditions under which they interact closely. Since C-fibers are unmyelinated, the asynchrony between a C-fiber stimulus and a visual stimulus is much greater than the asynchrony between a nociceptive stimulus additionally activating Aδ-fibers and that same visual stimulus. It is crucial to consider these discrepancies in further studies interested in multisensory interactions.

Seeing or not Seeing Where Your Hands Are. The Influence of Visual Feedback About Hand Position on the Interaction Between Nociceptive and Visual Stimuli

Examining the mechanisms underlying crossmodal interaction between nociceptive and visual stimuli is crucial to understand how humans handle potential bodily threats in their environment. It has recently been shown that nociceptive stimuli can affect the perception of visual stimuli, provided that they occur close together in external space. The present study addresses the question whether these crossmodal interactions between nociceptive and visual stimuli are mediated by the visually perceived proximity between the visual stimuli and the limb on which nociceptive stimuli are applied, by manipulating the presence vs. absence of visual feedback about the position of the stimulated limb. Participants performed temporal order judgments on pairs of visual stimuli, shortly preceded by nociceptive stimuli, either applied on one hand or both hands simultaneously. The hands were placed near the visual stimuli and could either be seen directly, seen through a glass barrier, or hidden from sight with a wooden board. Unilateral nociceptive stimuli induced spatial biases to the advantage of visual stimuli presented near the stimulated hand, which were greater in the conditions in which the hands were seen than in the condition in which vision was prevented. Spatial biases were not modulated by the presence of the glass barrier, minimizing the possibility that the differential effect between the vision and no-vision conditions is solely due to the presence of the barrier between the hands and the visual stimuli. These findings highlight the importance of visual feedback for determining spatial mapping between nociceptive and visual stimuli for crossmodal interaction.

Testing the exteroceptive function of nociception: The role of visual experience in shaping the spatial representations of nociceptive inputs

Adequately localizing pain is crucial to protect the body against physical damage and react to the stimulus in external space having caused such damage. Accordingly, it is hypothesized that nociceptive inputs are remapped from a somatotopic reference frame, representing the skin surface, towards a spatiotopic frame, representing the body parts in external space. This ability is thought to be developed and shaped by early visual experience. To test this hypothesis, normally sighted and early blind participants performed temporal order judgment tasks during which they judged which of two nociceptive stimuli applied on each hand's dorsum was perceived as first delivered. Crucially, tasks were performed with the hands either in an uncrossed posture or crossed over body midline. While early blinds were not affected by the posture, performances of the normally sighted participants decreased in the crossed condition relative to the uncrossed condition. This indicates that nociceptive stimuli were automatically remapped into a spatiotopic representation that interfered with somatotopy in normally sighted individuals, whereas early blinds seemed to mostly rely on a somatotopic representation to localize nociceptive inputs. Accordingly, the plasticity of the nociceptive system would not purely depend on bodily experiences but also on crossmodal interactions between nociception and vision during early sensory experience.

Unimodal and crossmodal extinction of nociceptive stimuli in healthy volunteers

Nociception, the physiological mechanisms specifically processing information about noxious and potentially painful stimuli, has the double function to warn about potential body damages (interoception) and about the cause of such potential damages (exteroception). The exteroceptive function is thought to rely on multisensory integration between somatic and extra-somatic stimuli, provided that extra-somatic stimuli occur near the stimulated body area. To corroborate this hypothesis, we succeeded to show in healthy volunteers that the perception of nociceptive stimuli applied on one hand can be extinguished, as compared to single presentation, by the simultaneous application of nociceptive stimuli on the opposite hand, as well as by the presentation of visual stimuli near the opposite hand. On the contrary, visual stimuli presented near the same stimulated hand facilitated the perception of nociceptive stimuli. This nociceptive extinction phenomenon indicates that the perception of noxious events does not merely rely on the specific activation of the nociceptive system, but also depends on other sensory experiences about the body and the space around it.

Modulation of exteroceptive electromyographic responses in defensive peripersonal space

The cutaneous silent period (CSP) to noxious finger stimulation constitutes a robust spinal inhibitory reflex that protects the hand from injury. In certain conditions, spinal inhibition is interrupted by a brief burst-like electromyographic activity, dividing the CSP into two inhibitory phases (I1 and I2). This excitatory component is termed long-loop reflex (LLR) and is presumed to be transcortical in origin. Efficient defense from environmental threats requires sensorimotor integration between multimodal sensory afferents and planning of defensive movements. In the defensive peripersonal space (DPPS) immediately surrounding the body, we interact with objects and persons with increased alertness. We investigated whether CSP differs when the stimulated hand is in the DPPS of the face compared with a distant position. Furthermore, we investigated the possible role of vision in CSP modulation. Fifteen healthy volunteers underwent CSP testing with the handheld either within 5 cm from the nose (near) or away from the body (far). Recordings were obtained from first dorsal interosseous muscle following index (D2) or little finger (D5) stimulation with varying intensities. A subgroup of subjects underwent CSP recordings in near and far conditions, both with eyes open and with eyes closed. No inhibitory CSP parameter differed between stimulation in near and far conditions. LLRs occurring following D2 stimulation were significantly larger in near than far conditions at all stimulus intensities, irrespective of subjects seeing their hand. Similar to the hand-blink reflex, spinally organized protective reflexes may be modulated by corticospinal facilitatory input when the hand enters the DPPS of the face. NEW & NOTEWORTHY The present findings demonstrate for the first time that a spinally organized protective reflex, the cutaneous silent period (CSP), may be modulated by top-down corticospinal facilitatory input when the stimulated hand enters the defensive peripersonal space (DPPS) of the face. In particular, the cortically mediated excitatory long-loop reflex, which may interrupt the CSP, is facilitated when the stimulated hand is in the DPPS, irrespective of visual control over the hand. No spinal inhibitory CSP parameter differs significantly in or outside the DPPS.

No perceptual prioritization of non-nociceptive vibrotactile and visual stimuli presented on a sensitized body part

High frequency electrical conditioning stimulation (HFS) is an experimental method to induce increased mechanical pinprick sensitivity in the unconditioned surrounding skin (secondary hyperalgesia). Secondary hyperalgesia is thought to be the result of central sensitization, i.e. increased responsiveness of nociceptive neurons in the central nervous system. Vibrotactile and visual stimuli presented in the area of secondary hyperalgesia also elicit enhanced brain responses, a finding that cannot be explained by central sensitization as it is currently defined. HFS may recruit attentional processes, which in turn affect the processing of all stimuli. In this study we have investigated whether HFS induces perceptual biases towards stimuli presented onto the sensitized arm by using Temporal Order Judgment (TOJ) tasks. In TOJ tasks, stimuli are presented in rapid succession on either arm, and participants have to indicate their perceived order. In case of a perceptual bias, the stimuli presented on the attended side are systematically reported as occurring first. Participants performed a tactile and a visual TOJ task before and after HFS. Analyses of participants' performance did not reveal any prioritization of the visual and tactile stimuli presented onto the sensitized arm. Our results provide therefore no evidence for a perceptual bias towards tactile and visual stimuli presented onto the sensitized arm.

Does Body Perception Shape Visuospatial Perception?

How we perceive our body is shaped by sensory experiences with our surrounding environment, as witnessed by poor performance in tasks during which participants judge with their hands crossed the temporal order between two somatosensory stimuli, one applied on each hand. This suggests that somatosensory stimuli are not only processed according to a somatotopic representation but also a spatiotopic representation of the body. We investigated whether the perception of stimuli occurring in external space, such as visual stimuli, can also be influenced by the body posture and somatosensory stimuli. Participants performed temporal order judgements on pairs of visual stimuli, one in each side of space, with their hands uncrossed or crossed. In Experiment 1, participants’ hands were placed either near or far from the visual stimuli. In Experiment 2, the visual stimuli were preceded, either by 60 ms or 360 ms, by tactile stimuli applied on the hands placed near the visual stimuli. Manipulating the time interval was intended to activate either a somatotopic or a spatiotopic representation of somatic inputs. We did not obtain any evidence for an influence of body posture on visual temporal order judgment, suggesting that body perception is less relevant for processing extrabody stimuli than the reverse.