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1.
Proc Natl Acad Sci U S A ; 121(25): e2310433121, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38857402

RESUMO

Pleasure and pain are two fundamental, intertwined aspects of human emotions. Pleasurable sensations can reduce subjective feelings of pain and vice versa, and we often perceive the termination of pain as pleasant and the absence of pleasure as unpleasant. This implies the existence of brain systems that integrate them into modality-general representations of affective experiences. Here, we examined representations of affective valence and intensity in an functional MRI (fMRI) study (n = 58) of sustained pleasure and pain. We found that the distinct subpopulations of voxels within the ventromedial and lateral prefrontal cortices, the orbitofrontal cortex, the anterior insula, and the amygdala were involved in decoding affective valence versus intensity. Affective valence and intensity predictive models showed significant decoding performance in an independent test dataset (n = 62). These models were differentially connected to distinct large-scale brain networks-the intensity model to the ventral attention network and the valence model to the limbic and default mode networks. Overall, this study identified the brain representations of affective valence and intensity across pleasure and pain, promoting a systems-level understanding of human affective experiences.


Assuntos
Encéfalo , Imageamento por Ressonância Magnética , Dor , Prazer , Humanos , Prazer/fisiologia , Masculino , Feminino , Dor/fisiopatologia , Dor/psicologia , Adulto , Encéfalo/fisiologia , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Adulto Jovem , Tonsila do Cerebelo/fisiologia , Tonsila do Cerebelo/diagnóstico por imagem , Emoções/fisiologia , Córtex Pré-Frontal/fisiologia , Córtex Pré-Frontal/diagnóstico por imagem , Afeto/fisiologia
2.
Proc Natl Acad Sci U S A ; 121(14): e2401959121, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38547065

RESUMO

The contents and dynamics of spontaneous thought are important factors for personality traits and mental health. However, assessing spontaneous thoughts is challenging due to their unconstrained nature, and directing participants' attention to report their thoughts may fundamentally alter them. Here, we aimed to decode two key content dimensions of spontaneous thought-self-relevance and valence-directly from brain activity. To train functional MRI-based predictive models, we used individually generated personal stories as stimuli in a story-reading task to mimic narrative-like spontaneous thoughts (n = 49). We then tested these models on multiple test datasets (total n = 199). The default mode, ventral attention, and frontoparietal networks played key roles in the predictions, with the anterior insula and midcingulate cortex contributing to self-relevance prediction and the left temporoparietal junction and dorsomedial prefrontal cortex contributing to valence prediction. Overall, this study presents brain models of internal thoughts and emotions, highlighting the potential for the brain decoding of spontaneous thought.


Assuntos
Mapeamento Encefálico , Encéfalo , Humanos , Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Emoções , Córtex Pré-Frontal , Giro do Cíngulo , Imageamento por Ressonância Magnética/métodos
3.
Nat Commun ; 14(1): 3540, 2023 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-37321986

RESUMO

Rumination is a cognitive style characterized by repetitive thoughts about one's negative internal states and is a common symptom of depression. Previous studies have linked trait rumination to alterations in the default mode network, but predictive brain markers of rumination are lacking. Here, we adopt a predictive modeling approach to develop a neuroimaging marker of rumination based on the variance of dynamic resting-state functional connectivity and test it across 5 diverse subclinical and clinical samples (total n = 288). A whole-brain marker based on dynamic connectivity with the dorsomedial prefrontal cortex (dmPFC) emerges as generalizable across the subclinical datasets. A refined marker consisting of the most important features from a virtual lesion analysis further predicts depression scores of adults with major depressive disorder (n = 35). This study highlights the role of the dmPFC in trait rumination and provides a dynamic functional connectivity marker for rumination.


Assuntos
Transtorno Depressivo Maior , Adulto , Humanos , Imageamento por Ressonância Magnética/métodos , Córtex Pré-Frontal/diagnóstico por imagem , Encéfalo , Mapeamento Encefálico
4.
Appl Psychol Health Well Being ; 15(2): 466-478, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-35851762

RESUMO

Increasing evidence suggests a significant impact of higher psychological well-being (PWB) on health outcomes; however, such associations have been studied exclusively in middle-aged to older adults. This study examined the aging effect on PWB measures as well as the moderating effect of age on the link between PWB and inflammation, using salivary markers by comparing the younger adults (n = 127; Mage = 22.98 years) versus older adults (n = 75; Mage = 75.60 years). Older adults showed significantly lower levels of PWB, particularly regarding purpose in life and personal growth. Moreover, higher purpose in life was associated with lower salivary IL-1ß and IL-6 (b = 0.83, p < .001; b = 0.81, p < .01) only in the older adult group but not in younger adults. These findings highlight the potential buffering effect of the sense of living well on physiological pathways in later life.


Assuntos
Envelhecimento , Bem-Estar Psicológico , Pessoa de Meia-Idade , Humanos , Idoso , Adulto Jovem , Adulto , Envelhecimento/fisiologia , Inflamação
5.
Int J Mol Sci ; 23(20)2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36293125

RESUMO

Sensory processing is a complex neurological process that receives, integrates, and responds to information from one's own body and environment, which is closely related to survival as well as neurological disorders. Brain-wide networks of sensory processing are difficult to investigate due to their dynamic regulation by multiple brain circuits. Optogenetics, a neuromodulation technique that uses light-sensitive proteins, can be combined with functional magnetic resonance imaging (ofMRI) to measure whole-brain activity. Since ofMRI has increasingly been used for investigating brain circuits underlying sensory processing for over a decade, we systematically reviewed recent ofMRI studies of sensory circuits and discussed the challenges of optogenetic fMRI in rodents.


Assuntos
Imageamento por Ressonância Magnética , Optogenética , Optogenética/métodos , Imageamento por Ressonância Magnética/métodos , Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Percepção
6.
Elife ; 112022 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-36173388

RESUMO

Pain is constructed through complex interactions among multiple brain systems, but it remains unclear how functional brain networks are reconfigured over time while experiencing pain. Here, we investigated the time-varying changes in the functional brain networks during 20 min capsaicin-induced sustained orofacial pain. In the early stage, the orofacial areas of the primary somatomotor cortex were separated from other areas of the somatosensory cortex and integrated with subcortical and frontoparietal regions, constituting an extended brain network of sustained pain. As pain decreased over time, the subcortical and frontoparietal regions were separated from this brain network and connected to multiple cerebellar regions. Machine-learning models based on these network features showed significant predictions of changes in pain experience across two independent datasets (n = 48 and 74). This study provides new insights into how multiple brain systems dynamically interact to construct and modulate pain experience, advancing our mechanistic understanding of sustained pain.


Assuntos
Imageamento por Ressonância Magnética , Rede Nervosa , Encéfalo , Mapeamento Encefálico , Capsaicina , Humanos , Vias Neurais , Dor
7.
Sci Adv ; 8(35): eabn8616, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36044582

RESUMO

Self-relevant concepts are major building blocks of spontaneous thought, and their dynamics in a natural stream of thought are likely to reveal one's internal states that are important for mental health. Here, we conducted a functional magnetic resonance imaging experiment (n = 62) to examine brain representations and dynamics of self-generated concepts in the context of spontaneous thought using a newly developed free association-based thought sampling task. The dynamics of conceptual associations were predictive of individual differences in general negative affectivity, replicating across multiple datasets (n = 196). Reflecting on self-generated concepts strongly engaged brain regions linked to autobiographical memory, conceptual processes, emotion, and autonomic regulation, including the medial prefrontal and medial temporal subcortical structures. Multivariate pattern-based predictive modeling revealed that the neural representations of valence became more person-specific as the level of perceived self-relevance increased. Overall, this study sheds light on how self-generated concepts in spontaneous thought construct inner affective states and idiosyncrasies.

8.
Proc Natl Acad Sci U S A ; 119(23): e2119931119, 2022 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-35658082

RESUMO

Pain is a primary driver of action. We often must voluntarily accept pain to gain rewards. Conversely, we may sometimes forego potential rewards to avoid associated pain. In this study, we investigated how the brain represents the decision value of future pain. Participants (n = 57) performed an economic decision task, choosing to accept or reject offers combining various amounts of pain and money presented visually. Functional MRI (fMRI) was used to measure brain activity throughout the decision-making process. Using multivariate pattern analyses, we identified a distributed neural representation predicting the intensity of the potential future pain in each decision and participants' decisions to accept or avoid pain. This neural representation of the decision value of future pain included negative weights located in areas related to the valuation of rewards and positive weights in regions associated with saliency, negative affect, executive control, and goal-directed action. We further compared this representation to future monetary rewards, physical pain, and aversive pictures and found that the representation of future pain overlaps with that of aversive pictures but is distinct from experienced pain. Altogether, the findings of this study provide insights on the valuation processes of future pain and have broad potential implications for our understanding of disorders characterized by difficulties in balancing potential threats and rewards.


Assuntos
Tomada de Decisões , Dor , Recompensa , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Humanos , Imageamento por Ressonância Magnética
9.
Neuroimage ; 258: 119355, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35660000

RESUMO

How do we incorporate contextual information to infer others' emotional state? Here we employed a naturalistic context-dependent facial expression estimation task where participants estimated pleasantness levels of others' ambiguous expression faces when sniffing different contextual cues (e.g., urine, fish, water, and rose). Based on their pleasantness rating data, we placed participants on a context-dependency continuum and mapped the individual variability in the context-dependency onto the neural representation using a representational similarity analysis. We found that the individual variability in the context-dependency of facial expression estimation correlated with the activity level of the pregenual anterior cingulate cortex (pgACC) and the amygdala and was also decoded by the neural representation of the ventral anterior insula (vAI). A dynamic causal modeling revealed that those with higher context-dependency exhibited a greater degree of the modulation from vAI to the pgACC. These findings provide novel insights into the neural circuitry associated with the individual variability in context-dependent facial expression estimation and the first empirical evidence for individual variability in the predictive accounts of affective states.


Assuntos
Expressão Facial , Imageamento por Ressonância Magnética , Emoções , Giro do Cíngulo , Humanos , Percepção
10.
PLoS Biol ; 20(5): e3001620, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35500023

RESUMO

Information is coded in the brain at multiple anatomical scales: locally, distributed across regions and networks, and globally. For pain, the scale of representation has not been formally tested, and quantitative comparisons of pain representations across regions and networks are lacking. In this multistudy analysis of 376 participants across 11 studies, we compared multivariate predictive models to investigate the spatial scale and location of evoked heat pain intensity representation. We compared models based on (a) a single most pain-predictive region or resting-state network; (b) pain-associated cortical-subcortical systems developed from prior literature ("multisystem models"); and (c) a model spanning the full brain. We estimated model accuracy using leave-one-study-out cross-validation (CV; 7 studies) and subsequently validated in 4 independent holdout studies. All spatial scales conveyed information about pain intensity, but distributed, multisystem models predicted pain 20% more accurately than any individual region or network and were more generalizable to multimodal pain (thermal, visceral, and mechanical) and specific to pain. Full brain models showed no predictive advantage over multisystem models. These findings show that multiple cortical and subcortical systems are needed to decode pain intensity, especially heat pain, and that representation of pain experience may not be circumscribed by any elementary region or canonical network. Finally, the learner generalization methods we employ provide a blueprint for evaluating the spatial scale of information in other domains.


Assuntos
Encéfalo , Imageamento por Ressonância Magnética , Encéfalo/fisiologia , Mapeamento Encefálico/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Dor , Medição da Dor
11.
Curr Biol ; 32(13): 2834-2847.e5, 2022 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-35609604

RESUMO

Although pain-related excessive fear is known to be a key factor in chronic pain disability, which involves the anterior cingulate cortex (ACC), little is known about the downstream circuits of the ACC for fear avoidance in pain processing. Using behavioral experiments and functional magnetic resonance imaging with optogenetics at 15.2 T, we demonstrate that the ACC is a part of the abnormal circuit changes in chronic pain and its downstream circuits are closely related to modulating sensorimotor integration and generating active movement rather than carrying sensory information. The projection from the ACC to the dorsolateral and lateral parts of the periaqueductal gray (dl/lPAG) especially enhances both reflexive and active avoidance behavior toward pain. Collectively, our results indicate that increased signals from the ACC to the dl/lPAG might be critical for excessive fear avoidance in chronic pain disability.


Assuntos
Dor Crônica , Substância Cinzenta Periaquedutal , Giro do Cíngulo , Humanos , Imageamento por Ressonância Magnética/métodos , Optogenética
12.
Nat Neurosci ; 25(6): 749-759, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35637368

RESUMO

Characterizing cerebral contributions to individual variability in pain processing is crucial for personalized pain medicine, but has yet to be done. In the present study, we address this problem by identifying brain regions with high versus low interindividual variability in their relationship with pain. We trained idiographic pain-predictive models with 13 single-trial functional MRI datasets (n = 404, discovery set) and quantified voxel-level importance for individualized pain prediction. With 21 regions identified as important pain predictors, we examined the interindividual variability of local pain-predictive weights in these regions. Higher-order transmodal regions, such as ventromedial and ventrolateral prefrontal cortices, showed larger individual variability, whereas unimodal regions, such as somatomotor cortices, showed more stable pain representations across individuals. We replicated this result in an independent dataset (n = 124). Overall, our study identifies cerebral sources of individual differences in pain processing, providing potential targets for personalized assessment and treatment of pain.


Assuntos
Mapeamento Encefálico , Encéfalo , Encéfalo/diagnóstico por imagem , Córtex Cerebral , Humanos , Imageamento por Ressonância Magnética , Dor/diagnóstico por imagem
13.
Nat Neurosci ; 25(6): 760-770, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35637370

RESUMO

The brain contains both generalized and stimulus-type-specific representations of aversive events, but models of how these are integrated and related to subjective experience are lacking. We combined functional magnetic resonance imaging with predictive modeling to identify representations of generalized (common) and stimulus-type-specific negative affect across mechanical pain, thermal pain, aversive sounds and aversive images of four intensity levels each. This allowed us to examine how generalized and stimulus-specific representations jointly contribute to aversive experience. Stimulus-type-specific negative affect was largely encoded in early sensory pathways, whereas generalized negative affect was encoded in a distributed set of midline, forebrain, insular and somatosensory regions. All models specifically predicted negative affect rather than general salience or arousal and accurately predicted negative affect in independent samples, demonstrating robustness and generalizability. Common and stimulus-type-specific models were jointly important for predicting subjective experience. Together, these findings offer an integrated account of how negative affect is constructed in the brain and provide predictive neuromarkers for future studies.


Assuntos
Mapeamento Encefálico , Encéfalo , Afeto , Mapeamento Encefálico/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Dor
14.
J Exp Psychol Gen ; 151(3): 628-642, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34498906

RESUMO

How do thoughts arise, unfold, and change over time? Are the contents and dynamics of everyday thought rooted in conceptual associations within one's semantic networks? To address these questions, we developed the Free Association Semantic task (FAST), whereby participants generate dynamic chains of conceptual associations in response to seed words that vary in valence. Ninety-four adults from a community sample completed the FAST task and additionally described and rated six of their most frequently occurring everyday thoughts. Text analysis and valence ratings revealed similarities in thematic and affective content between FAST concept chains and recurrent autobiographical thoughts. Dynamic analyses revealed that individuals higher in rumination were more strongly attracted to negative conceptual spaces and more likely to remain there longer. Overall, these findings provide quantitative evidence that conceptual associations may act as a semantic scaffold for more complex everyday thoughts, and that more negative and less dynamic conceptual associations in ruminative individuals mirror maladaptive repetitive thoughts in daily life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Semântica , Adulto , Humanos
15.
Psychol Med ; 52(13): 2632-2640, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-33315005

RESUMO

BACKGROUND: Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years. METHODS: Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis. RESULTS: The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels. CONCLUSIONS: Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.


Assuntos
Transtornos Psicóticos , Adolescente , Humanos , Estudos Prospectivos , Transtornos Psicóticos/psicologia , Análise de Sobrevida , Diagnóstico Precoce , Análise por Conglomerados
16.
Pain ; 163(6): 1130-1138, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34433768

RESUMO

ABSTRACT: A commonly held belief suggests that turning one's attention away from pain reduces it, whereas paying attention to pain increases it. However, some attention-based therapeutic strategies for pain, such as mindfulness-based interventions, suggest that paying attention to painful stimuli can reduce pain, resulting in seemingly contradictory conclusions regarding attention and pain. Here, we investigated the analgesic effects of attention modulation and provide behavioral and neural evidence that paying attention to pain can reduce pain when attention is directed toward the specific features of painful stimuli. The analgesic effects of paying attention to painful stimuli were mediated by the primary somatosensory cortex and goal-directed attention regions in the prefrontal and parietal cortex. These findings suggest that suppressing early somatosensory processing through top-down modulation is the key mechanism of the analgesic effects of paying attention to painful stimuli, providing evidence that pain itself can be used as a component of pain management.


Assuntos
Manejo da Dor , Dor , Analgésicos , Mapeamento Encefálico , Humanos , Medição da Dor , Lobo Parietal
17.
Neuroimage ; 247: 118844, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-34942367

RESUMO

Identifying biomarkers that predict mental states with large effect sizes and high test-retest reliability is a growing priority for fMRI research. We examined a well-established multivariate brain measure that tracks pain induced by nociceptive input, the Neurologic Pain Signature (NPS). In N = 295 participants across eight studies, NPS responses showed a very large effect size in predicting within-person single-trial pain reports (d = 1.45) and medium effect size in predicting individual differences in pain reports (d = 0.49). The NPS showed excellent short-term (within-day) test-retest reliability (ICC = 0.84, with average 69.5 trials/person). Reliability scaled with the number of trials within-person, with ≥60 trials required for excellent test-retest reliability. Reliability was tested in two additional studies across 5-day (N = 29, ICC = 0.74, 30 trials/person) and 1-month (N = 40, ICC = 0.46, 5 trials/person) test-retest intervals. The combination of strong within-person correlations and only modest between-person correlations between the NPS and pain reports indicate that the two measures have different sources of between-person variance. The NPS is not a surrogate for individual differences in pain reports but can serve as a reliable measure of pain-related physiology and mechanistic target for interventions.


Assuntos
Mapeamento Encefálico/métodos , Imageamento por Ressonância Magnética/métodos , Nociceptividade/fisiologia , Dor/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
18.
IEEE Signal Process Mag ; 39(4): 107-118, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36712588

RESUMO

Predictive modeling of neuroimaging data (predictive neuroimaging) for evaluating individual differences in various behavioral phenotypes and clinical outcomes is of growing interest. However, the field is experiencing challenges regarding the interpretability of the results. Approaches to defining the specific contribution of functional connections, regions, or networks in prediction models are urgently needed, which may help explore the underlying mechanisms. In this article, we systematically review the methods and applications for interpreting brain signatures derived from predictive neuroimaging based on a survey of 326 research articles. Strengths, limitations, and the suitable conditions for major interpretation strategies are also deliberated. In-depth discussion of common issues in existing literature and the corresponding recommendations to address these pitfalls are provided. We highly recommend exhaustive validation on the reliability and interpretability of the biomarkers across multiple datasets and contexts, which thereby could translate technical advances in neuroimaging into concrete improvements in precision medicine.

19.
J Stroke ; 23(3): 297-311, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34649376

RESUMO

The neurological symptoms of stroke have traditionally provided the foundation for functional mapping of the brain. However, there are many unresolved aspects in our understanding of cerebral activity, especially regarding high-level cognitive functions. This review provides a comprehensive look at the pathophysiology of post-stroke cognitive impairment in light of recent findings from advanced imaging techniques. Combining network neuroscience and clinical neurology, our research focuses on how changes in brain networks correlate with post-stroke cognitive prognosis. More specifically, we first discuss the general consequences of stroke lesions due to damage of canonical resting-state large-scale networks or changes in the composition of the entire brain. We also review emerging methods, such as lesion-network mapping and gradient analysis, used to study the aforementioned events caused by stroke lesions. Lastly, we examine other patient vulnerabilities, such as superimposed amyloid pathology and blood-brain barrier leakage, which potentially lead to different outcomes for the brain network compositions even in the presence of similar stroke lesions. This knowledge will allow a better understanding of the pathophysiology of post-stroke cognitive impairment and provide a theoretical basis for the development of new treatments, such as neuromodulation.

20.
Nat Med ; 27(1): 174-182, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398159

RESUMO

Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.


Assuntos
Biomarcadores/análise , Neuroimagem Funcional/métodos , Medição da Dor/métodos , Adolescente , Adulto , Agentes Aversivos/toxicidade , Capsaicina/toxicidade , Conectoma/métodos , Conectoma/estatística & dados numéricos , Dor Facial/fisiopatologia , Feminino , Neuroimagem Funcional/estatística & dados numéricos , Humanos , Dor Lombar/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Dor/fisiopatologia , Medição da Dor/estatística & dados numéricos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Paladar/efeitos dos fármacos , Paladar/fisiologia , Adulto Jovem
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