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Peer-reviewedCC BYEuropean journal of pain (London, England)

Pain Enhances the Auditory P2 but Attenuates Mismatch Response and P3a.

  • Alexandre Lehmann1,2,3,4
  • Marc Schönwiesner2,3,4,5,6
  • Pierre Rainville4,5,7,8
8 affiliations
  1. 1Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, Quebec, Canada.
  2. 2International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada.
  3. 3Center for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada.
  4. 4Department of Psychology, University of Montreal, Montreal, Quebec, Canada.
  5. 5Centre de Recherche en Neuropsychologie et Cognition, University of Montreal, Montreal, Quebec, Canada.
  6. 6Institute of Biology, Leipzig University, Leipzig, Germany.
  7. 7Département de Stomatologie, Université de Montréal, Montréal, Quebec, Canada.
  8. 8Centre de Recherche de L'institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada.
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Abstract

Background

Auditory input is known to modulate the perception of pain, yet the reciprocal influence, how pain affects auditory processing, remains less well understood. We investigated how continuous tonic pain dynamically alters auditory cortical responses in humans.Methods

Using a three-stimulus auditory oddball paradigm combined with EEG, we recorded event-related potentials (ERPs) while participants experienced thermal stimulation under three conditions: baseline, non-painful warmth, and pain. We examined multiple stages of auditory processing, including early sensory encoding (N1, P2), automatic deviance detection (MMN), and attentional reorienting (P3a).Results

Tonic pain modulated auditory ERPs in a stage- and component-specific manner. Compared to baseline and warm conditions, pain was associated with enhanced P2 responses to distractors and reduced MMN and P3a amplitudes, although no statistically significant differences in behavioural performance were observed. This pattern suggests enhanced early salience detection alongside reduced pre-attentive deviance detection and involuntary attentional shifts under pain. The warm condition selectively modulated N1 amplitude, indicating that some effects may be related to the affective and attentional demands of pain rather than somatosensory stimulation per se.Conclusions

Continuous tonic pain is associated with selective modulation of auditory processing, characterized by enhanced early sensory responsiveness and reduced higher-order attentional engagement. This biphasic neural pattern, observed in the absence of measurable behavioural differences, is consistent with predictive coding and salience network accounts of pain-attention interactions and highlights the sensitivity of ERPs for detecting pain-related neural reweighting. The absence of statistically significant behavioural effects should be interpreted with caution and may reflect relatively subtle or context-dependent influences of pain under the present task conditions.Significance statement

This study is among the first to systematically examine how experimentally induced tonic pain modulates distinct stages of auditory processing in healthy individuals using high-resolution ERPs, with a task design and hypothesis framework capable of teasing apart the cognitive mechanisms underlying these changes.

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Cite

BibTeXRIS
BibTeX
@article{lehmann2026pain,
  title = {{Pain Enhances the Auditory P2 but Attenuates Mismatch Response and P3a.}},
  author = {Alexandre Lehmann and Marc Schönwiesner and Pierre Rainville},
  journal = {European journal of pain (London, England)},
  year = {2026},
  month = oct,
  doi = {10.1002/ejp.70405},
  url = {https://europepmc.org/article/MED/42853237},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Pain Enhances the Auditory P2 but Attenuates Mismatch Response and P3a.
AU  - Alexandre Lehmann
AU  - Marc Schönwiesner
AU  - Pierre Rainville
PY  - 2026
DA  - 2026/10/01
JO  - European journal of pain (London, England)
DO  - 10.1002/ejp.70405
UR  - https://europepmc.org/article/MED/42853237
AB  - Background  Auditory input is known to modulate the perception of pain, yet the reciprocal influence, how pain affects auditory processing, remains less well understood. We investigated how continuous tonic pain dynamically alters auditory cortical responses in humans.Methods  Using a three-stimulus auditory oddball paradigm combined with EEG, we recorded event-related potentials (ERPs) while participants experienced thermal stimulation under three conditions: baseline, non-painful warmth, and pain. We examined multiple stages of auditory processing, including early sensory encoding (N1, P2), automatic deviance detection (MMN), and attentional reorienting (P3a).Results  Tonic pain modulated auditory ERPs in a stage- and component-specific manner. Compared to baseline and warm conditions, pain was associated with enhanced P2 responses to distractors and reduced MMN and P3a amplitudes, although no statistically significant differences in behavioural performance were observed. This pattern suggests enhanced early salience detection alongside reduced pre-attentive deviance detection and involuntary attentional shifts under pain. The warm condition selectively modulated N1 amplitude, indicating that some effects may be related to the affective and attentional demands of pain rather than somatosensory stimulation per se.Conclusions  Continuous tonic pain is associated with selective modulation of auditory processing, characterized by enhanced early sensory responsiveness and reduced higher-order attentional engagement. This biphasic neural pattern, observed in the absence of measurable behavioural differences, is consistent with predictive coding and salience network accounts of pain-attention interactions and highlights the sensitivity of ERPs for detecting pain-related neural reweighting. The absence of statistically significant behavioural effects should be interpreted with caution and may reflect relatively subtle or context-dependent influences of pain under the present task conditions.Significance statement  This study is among the first to systematically examine how experimentally induced tonic pain modulates distinct stages of auditory processing in healthy individuals using high-resolution ERPs, with a task design and hypothesis framework capable of teasing apart the cognitive mechanisms underlying these changes.
SN  - 1090-3801
SN  - 1532-2149
ER  -