Moreover, the prefrontal area is linked to cognitive
and attentional processing of pain stimuli.26,27,31 The
subgenual anterial cingulate gyrus (sACC) and insula
have been implicated in emotional processes that mediate
effective responses to pain stimuli.31,32 Further,
although these regions differ in location, they overlap
functionally,31 which is consistent with studies that have
addressed chronic pain.28,33,34 An MR spectroscopy
study by Stanwell et al.17 agrees that critical effective
emotional circuits, such as the anterior cingulate cortex
and insulae, change significantly between SCI patients
with and without pain.