Nociceptive local field potentials recorded from the human insula are not specific for nociception

Introduction. Insular lesions can alter pain perception, and direct electrical stimulation of the insula can generate pain-related sensations. Furthermore, direct intracerebral recordings have shown that nociceptive stimulation can elicit robust local field potentials (LFPs) in the insula, interpreted as reflecting activity specifically involved in the encoding of pain and temperature sensations. Aims. Taking advantage of the high spatial resolution of direct intracerebral recordings performed in humans, our aim was to assess whether the insula exhibits responses that are specific to nociceptive stimulation. Methods. Six patients were investigated using depth electrodes implanted at different locations, comprising the anterior and posterior insula, for a total of 62 insular sites. Participants received brief stimuli belonging to each of the following four modalities: nociceptive laser stimuli, non-nociceptive tactile stimuli, auditory stimuli, and visual stimuli. The stimuli were delivered in blocks, both on the right and on the left side of the body. Results. All four types of stimuli elicited consistent LFPs in the posterior and anterior insula, appearing as large biphasic waves. The spatial distribution of the responses elicited by nociceptive stimulation at the different insular contacts was indistinguishable from the spatial distribution of the responses elicited by non-nociceptive tactile, auditory and visual stimulation. Conclusions Our results indicate that, in both the posterior and the anterior insula, LFPs elicited by transient nociceptive stimuli reflect cortical activities that are unspecific for pain. Importantly, this conclusion is not incompatible with the possible involvement of the insula in pain perception.