Evoked pain intensity representation is distributed across brain systems: A multistudy mega-analysis

Information is coded in the brain at different scales for different phenomena: locally, distributed across regions and networks, and globally. For pain, the scale of representation is controversial. Although generally believed to be an integrated cognitive and sensory phenomenon implicating diverse brain systems, quantitative characterizations of which regions and networks are sufficient to represent pain are lacking. In this meta-analysis (or mega-analysis) using data from 289 participants across 10 studies, we use model comparison combined with multivariate predictive models to investigate the spatial scale and location of acute pain representation. We compare models based on (a) a single most pain-predictive module, either previously identified elementary regions or a single best large-scale cortical resting-state network module; (b) selected cortical-subcortical systems related to evoked pain in prior literature (9multi-system models9); and (c) a model spanning the full brain. We estimate the accuracy of pain intensity predictions using cross validation (7 studies) and subsequently validate in three independent holdout studies. All spatial scales convey information about pain intensity, but distributed, multi-system models better characterize pain representations than any individual region or network (e.g. multisystem models explain >20% more of individual subject pain ratings than the best elementary region). Full brain models showed no predictive advantage over multi-system models. These findings quantify the extent that representation of evoked pain experience is distributed across multiple cortical and subcortical systems, show that pain representation is not circumscribed by any elementary region or conical network, and provide a blueprint for identifying the spatial scale of information in other domains.