However, previous studies have found evidence for parallel processing of nociceptive stimuli in S1 and S2 (Liang et al., 2011; Ploner Bcl-xL apoptosis et al., 2009), so differences in latency of S1 and S2 coding seem unlikely. Finally, Porro et al.’s location judgements differed from ours in two respects. They used a restricted portion of the hand dorsum between the thumb and index that was not stimulated in our study. Their participants named which of four locations was stimulated, while our participants judged only the proximal/distal dimension of any of 16 stimuli. These differences in stimulation may account for the different results. Additional studies are required to investigate whether S1 and S2 are differentially

involved in different types of location judgement and to compare the effects of single-pulse TMS to S1 and S2 applied at various latencies after nociceptive stimulation. Nevertheless, our study also has limitations. First, the effect observed is relatively small, amounting to a 6.25% decrease in accuracy of intensity judgements following S2 stimulation, relative to vertex control. Pain intensity is notoriously variable, even when nociceptive input remains constant (e.g., Iannetti et al., 2005). Thus, while our results suggest that S2 is involved in the precision or discriminative coding of pain

intensity, the clinical importance of this effect remains to be determined. Moreover, clinical interventions generally aim at reducing pain levels, rather than reducing sensitivity to pain. In particular, the absence of any TMS-induced bias in perceived pain level Z-VAD-FMK manufacturer in our data suggests caution about any possible S2 interventions to reduce chronic pain. However, our result does help to answer a classic question in the basic science underlying pain. The question regarding whether parts of the ‘pain matrix’ produce nociceptive sensations and, if so, which ones, has long been controversial. Intracranial microstimulation studies previously suggested that only the insula and opercular regions were involved in the feeling of pain, because these Liothyronine Sodium are the only areas which sometimes can evoke pain sensations when stimulated (Ostrowsky et al.,

2002). Our results provide direct and causal evidence that S2 is also involved in coding pain intensity. Second, invasive recording and fMRI studies in humans show nociceptive-related activity both on the S2 surface (e.g., Mazzola et al., 2012), and more deeply in the parietal operculum and insula (e.g., Frot et al., 2007). Given the depth and spatial specificity of TMS effects (Jalinous, 1991) presumably our S2 stimulation mainly affected the superficial area of S2. Our results cannot therefore clarify whether deeper parts of S2, and surrounding operculo-inusular regions also contribute to pain perception. This comment of course applies to other TMS studies of S2, which used similar localisation methods to ours (Bolognini et al., 2011; Kanda et al., 2003).