Increasing pain levels are associated with possible desegregation of the default mode network and the prefrontal cortex as well as alterations in default mode network connectivity during rest in adolescents with pain, according to a study published in NeuroImage: Clinical.

The default mode network of the brain is involved in internally-driven, self-referential thought and is deactivated during external attention-demanding, task-based processes. This network includes regions of the hippocampus and parahippocamal cortex, posterior cingulate, prefrontal cortex, and lateral parietal and temporal cortices.

Adolescents and young adults between 12 and 20 years with varying levels of pain frequency and intensity were enrolled in this study from both a pediatric pain clinic and the community (N=86). Pain frequency was assessed on a 0 to 5 categorical scale, whereas pain intensity was measured on an 11-point numerical rating scale which ranged from 0 to 10. Pain frequency ranged from none to daily (median, weekly), whereas pain intensity ranged from scores of 0 to 7 (median, 3).

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Participants underwent resting state functional magnetic resonance imaging. An independent components analysis found a robust default mode network that included anterior and posterior aspects. Individuals with greater pain frequency had greater default mode network to superior frontal gyrus connectivity. In addition, adolescents with greater pain intensity had lesser default mode network to cerebellum (lobule VIII) connectivity at rest (voxel-wise P <.001). There was no significant association between demographic variables and default mode network connectivity.

Limitations of this study were the small sample size as well as the inclusion of mostly white participants with higher-than-average IQ and socioeconomic stats.

“In addition to shedding light on the underlying neurocircuitry associated with pain in adolescents, the results of this study may provide neurobiological targets for future pain treatment strategies in adolescents,” the researchers concluded.


Jones SA, Morales AM, Holley AL, Wilson AC, Nagel BJ. Default mode network connectivity is related to pain frequency and intensity in adolescents. Neuroimage Clin. doi: 10.1016/j.nicl.2020.102326