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Facing pain is effortful: key role of the supplementary motor area and anterior midcingulate cortex

Monti, I.; Picard, M.-E.; Mangin, T.; Bergevin, M.; Gruet, M.; Baudry, S.; Otto, R.; Chen, J.-I.; Roy, M.; Rainville, P.; Pageaux, B.

2026-04-21 neuroscience
10.64898/2026.04.17.719211 bioRxiv
Show abstract

Pain captures attention and interferes with executive and motor processes but task performance may be preserved at the cost of more effort. In a preregistered fMRI study, 40 participants performed a visuomotor force-matching task at two force levels under individually calibrated painful or non-painful thermal stimulation, while reporting the intensity of perceived effort. Maintaining task performance under pain was associated with increased perceived effort and recruited brain regions involved in pain modulation and cognitive control. Region-of-interest analysis showed perceived effort was consistently linked to decreased anterior midcingulate cortex activity, whereas supplementary motor area contributions varied depending on its role in motor execution or pain processing. Across experimental condition, motor, pain-modulatory and cognitive-control regions were associated with effort perception. Independently of condition, effort perception was modulated by ventromedial prefrontal cortex and ventral striatum. These findings indicate that effort perception reflects brain activity within areas involved in motor, executive and valuation processes.

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