Social touch, is of great importance for social interactions and individual development and can promote interpersonal communication (Cascio et al., 2019; Jones and Glover, 2014). In conditions where social dysfunction occurs, such as autism, social touch is often perceived as unpleasant (Baranek et al., 2006; Ujiie and Takahashi, 2022). Touch perception is determined by the stimulation of low-threshold afferent fibers in the skin that innervate distinct classes of mechanoreceptors. While large myelinated Aβ fibers are densely packed in the fingertips and lips and subserve discriminative touch, unmyelinated C-touch (CT) fibers exist in hairy skin and only respond to low force/velocity (caress-like stroking) touch (Croy et al., 2016; McGlone et al., 2014). The latter fibers are specialized for the affective domain of touch and have evolved to signal the rewarding value of physical contact (Liljencrantz and Olausson, 2014; Pawling et al., 2017; Walker et al., 2017). Stimulation of the CT system primarily engages the insula via the spinothalamic tract and brain circuits involved in reward and social-emotional information processing such as the orbitofrontal cortex (OFC) and posterior superior temporal sulcus (pSTS) (Björnsdotter et al., 2014; Davidovic et al., 2016; Gordon et al., 2013; Morrison, 2016; Olausson et al., 2002; Olausson et al., 2010). Medium pressure touch in the form of hugging or massage can also be perceived as pleasant but mainly influences pressure receptors of non-CT fibers (Case et al., 2021; Field, 2010) and primarily targets the somatosensory cortex via the spinothalamic tract (McGlone et al., 2014). While neural substrates of pleasurable gentle stroking and medium pressure touch overlap to some extent they may also involve different parts of the somatosensory cortex and insula (Case et al., 2021).

The neuropeptide oxytocin (OT) plays a key role in the regulation of social cognition and the rewarding aspects of social stimuli, including social affective touch (Bartz et al., 2011; Kendrick et al., 2017; Rae et al., 2022; Wigton et al., 2015). There is a close association between OT and CT-targeted social touch (Moberg et al., 2020; Uvnäs-Moberg et al., 2014; Walker et al., 2017) and studies have shown that social touch, particularly administered as gentle stroking touch or medium pressure massage, can activate parvocellular oxytocinergic neurons (Okabe et al., 2015; Tang et al., 2020) and facilitate endogenous OT release in the saliva, blood or urine across species (Crockford et al., 2013; Holt-Lunstad et al., 2008; Li et al., 2019; Morhenn et al., 2012; Portnova et al., 2020; Vittner et al., 2018). Additionally, intranasal administration of OT in humans can modulate processing of social touch at both behavioral and neural levels. More specifically, intranasal OT enhances the perceived pleasantness and activity of the reward system and salience network in response to gentle social touch by a female in men (Scheele et al., 2014), by their partners rather than by an unfamiliar female (Kreuder et al., 2017), or during foot massage administered by a human but not by a machine (Chen et al., 2020b). Intranasal OT also enhances the pleasantness of gentle stroking touch administered indirectly via different materials independent of valence (Chen et al., 2020a). These findings consistently suggest that intranasal OT can enhance the hedonic properties of social touch. While previous studies have interpreted findings in terms of OT potentiating the rewarding effect of CT-targeted social touch, it is less clear whether it does the same for pleasant stimulation of non-CT fiber mechanoreceptors which can also be stimulated by social behaviors such as hugging and during medium pressure massage. Foot massage, for example, incorporates both gentle stroking and medium pressure massage and thus the observed release of OT (Li et al., 2019) and facilitatory effects of intranasal OT (Chen et al., 2020b) may be contributed by CT and non-CT fibers. There is some evidence that receiving frequent hugs can increase OT concentrations (Grewen et al., 2005; Light et al., 2005), although hugging is often accompanied by gentle stroking of the back or neck and so once again both CT and non-CT fibers may be involved. It therefore remains unclear which types of cutaneous afferent fibers are primarily involved in the functional effects of OT on social touch processing.

The mechanism(s) whereby intranasal OT produces its functional effects are currently a matter of debate (see Leng and Ludwig, 2016; Yao and Kendrick, 2022). A number of studies have established that intranasally administered OT can directly enter the brain via the olfactory and trigeminal nerves (see Lee et al., 2020; Quintana et al., 2021) and it has been widely assumed to be the main route whereby intranasal OT produces effects on brain and behavior. However, intranasally administered OT also enters the peripheral circulation after absorption by nasal and oral blood vessels and may produce functional effects by entering the brain after binding to the receptor for advanced glycation end products (RAGE) and crossing the blood brain barrier (BBB; Yamamoto and Higashida, 2020), or by vagal stimulation following stimulation of its receptors in the heart and gastrointestinal system (see Carter, 2014; Carter et al., 2020; Yao and Kendrick, 2022) or following stimulation of receptors in other organs. Indeed, in a recent study we have shown that reducing the entry of oxytocin into the peripheral circulation following intranasal administration using a vasoconstrictor prevents its effects on resting state electroencephalographic changes involving cross-frequency coupling (Yao et al., 2023). In the specific context of responses to tactile stimulation peripheral OT could influence OT receptors in keratinocytes in the skin which may act to modulate activity of responses of cutaneous sensory fibers (Baumbauer et al., 2015; Deing et al., 2013; Talagas and Misery, 2019) or in spinal dorsal route ganglion neurons which receive inputs from cutaneous sensory fibers and project to the brain via the spinothalamic tract (González-Hernández et al., 2017; Noguri et al., 2022).

Support for peripherally mediated routes have been found in animal model studies reporting functional effects of OT administered subcutaneously or intraperitoneally (see Yao and Kendrick, 2022), and in a previous study, we have shown similar effects of intranasal and oral (lingual) OT on visual attention and state anxiety (Zhuang et al., 2022). There may however also be some administration route-dependent functional effects of OT. For example, in monkeys intranasal and intravenous administration of OT have been reported to produce different patterns of regional perfusion (Lee et al., 2018), although in humans they produced similar neural effects (Martins et al., 2020b). Another recent study in humans has shown that intranasal and oral (lingual) OT have different effects on amygdala and putamen responses to emotional faces and on associated arousal (Kou et al., 2021). Thus, it is unclear whether the reported effects of exogenously administered OT on responses to social touch are mediated via direct entry into the brain or indirectly via increased concentrations in the peripheral circulation which subsequently influence the brain either by crossing the BBB or by acting on receptors in peripheral organs or nerves.

Against this background, the present study investigated firstly whether intranasal OT primarily enhanced the pleasantness and associated brain reward responses to touch exclusively targeting CT fibers (using gentle stroking touch) or primarily targeting non-CT fiber pressure mechanoreceptors (medium pressure massage without stroking). Secondly, the effects of intranasal OT were contrasted with those of oral (lingual) OT using the same dose of 24 IU to help establish whether OT was mainly acting via peripherally mediated routes (see Figure 1A for a complete study procedure). While intranasally administered OT can produce functional effects by either directly entering the brain or by increasing peripheral vascular system concentrations, oral OT administration can only do so by the latter. We therefore postulated that if equivalent effects of the two routes of administration are observed then the functional effects of OT are likely to be due to peripheral vascular increases. Behavioral responses to different types of touch were recorded using rating scales and neural responses were acquired using functional near-infrared spectroscopy (fNIRS) measures of oxygenated-hemoglobin chromophore concentration changes in cortical brain regions involved in reward (OFC), social cognition (STS) and somatosensory processing (somatosensory cortex - S1; Figure 1B–C). fNIRS is now widely used in neuroimaging (Pinti et al., 2020) and has the advantage that subjects are more comfortable and can move more than in an MRI scanner and can more easily be catheterized for taking blood samples during recordings. Although, fNIRS only measures activity changes in the superficial cortex it allows recordings to be made from three of the main touch processing regions, the OFC, STS and somatosensory cortex and has therefore often been used in studies investigating touch processing (Bennett et al., 2014; Cruciani et al., 2021; Li et al., 2019). Additionally, physiological measures of autonomic nervous system changes were recorded (skin conductance response - SCR and the electrocardiogram - ECG) and blood samples were taken for measurement of OT concentration changes. We hypothesized firstly that while subjects would find both the gentle stroking touch and medium pressure massage pleasurable, intranasal OT would particularly enhance behavioral and brain reward (OFC) and social processing (STS) region responses to gentle stroking touch targeting the CT fiber system in line with our previous studies (Chen et al., 2020a; Scheele et al., 2014) and not in response to the medium pressure massage targeting non-CT fibers. Secondly, based on recent studies comparing effects of intranasal and oral OT (Xu et al., 2022; Zhuang et al., 2022), we hypothesized that oral OT would have a similar effect to intranasal OT, thereby indicating that its effects were mediated by increased concentrations in the peripheral vasculature rather than by direct entry into the brain. Thirdly, we hypothesized that behavioral and neural effects of OT on social touch would be associated with treatment effects on peripheral plasma concentrations of the peptide, in line with observations in some previous studies (Martins et al., 2020b; Kou et al., 2021).

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The current study aimed firstly to establish whether effects of OT treatment on enhancing the perceived pleasantness of social touch were primarily in response to CT fiber stimulation or that of non-CT fibers. Our findings that OT only facilitated behavioral and neural responses to gentle stroking touch support the view that it is primarily influencing CT fiber mediated touch. The second aim of the study was to establish whether the route of exogenous OT administration is important. Here findings that similar functional effects of OT were produced after intranasal and oral administration, and that post-treatment changes in plasma OT concentrations significantly mediated behavioral effects, support the conclusion that the observed effects were primarily mediated by peripheral changes.

Gentle stroking touch and medium pressure massage were both perceived as pleasant although the medium pressure massage was rated more pleasant, stronger and more arousing and subjects were more willing to pay for it, possibly because the latter is closer to the familiar experience of normal massage. Medium pressure massage also produced greater increases in autonomic measures of arousal (SCR) and vagal tone (HRV), although gentle stroking touch increased heart rate slightly more. Additionally, the medium pressure massage produced greater oxy-Hb concentration changes in the S1 region, in line with the greater perceived stimulation intensity. However, both intranasal and oral OT selectively increased pleasantness ratings for the gentle stroking touch but not medium pressure massage. Consistent with our previous study (Chen et al., 2020b), there were no effects of OT on ratings of intensity, arousal, or willingness to pay, suggesting a specific modulation of hedonic pleasantness, and subjects were unable to guess if the touch/massage was administered by a male or female. Thus, in support of previous suggestions (Walker et al., 2017) OT may be selectively increasing the hedonic pleasure of touch primarily stimulating CT fibers rather than non-CT fiber pressure mechanoreceptors. Furthermore, the effects of both intranasal and oral OT on pleasantness ratings following the gentle stroking touch were correlated with, and mediated by, post-treatment increases in plasma OT concentrations.

Consistent with previous studies showing enhanced brain reward effects of intranasal OT during tactile stimulation (e.g. Chen et al., 2020a; Scheele et al., 2014), the present study found that both intranasal and oral administration of OT enhanced responses in the bilateral mlOFC during gentle stroking touch. Although subjects rated medium pressure massage as more pleasant it is possible that the greater responses to gentle stroking touch in the mOFC and mlOFC may reflect not only reward but also interactions with brain regions such as the cingulate cortex and insula which process social salience (see Rolls et al., 2020). Furthermore, both routes of OT administration enhanced pSTS responses to gentle stroking touch. This region is important for both touch and social cognition processing and pSTS responses are predictive of the perceived pleasantness of caress-like skin stroking (Davidovic et al., 2016). The specificity of pSTS responses to social touch is supported by previous observations that tactile stimuli using materials or by some kind of mechanical device did not report activations in this region (Boehme et al., 2019; Chen et al., 2020a; Li et al., 2019; Perini et al., 2015). The facilitation of pSTS activity may thus reflect encoding of social components of the CT-targeted gentle stroking touch in line with the reported effects of intranasal and oral OT on social cognition and attention (Le et al., 2020; Le et al., 2021; Yao et al., 2018; Zhuang et al., 2021; Zhuang et al., 2022). Interestingly, individuals with autism or higher autistic traits tend to find light social touch as the most aversive (Ujiie and Takahashi, 2022) and this corresponds to reduced responses in both the OFC and STS (Kaiser et al., 2016; Voos et al., 2013).

Plotting the time-course of responses in the mOFC and pSTS during gentle-stroking touch following OT treatment revealed that the main treatment effect was to prolong the neural response to the touch rather than the magnitude of the initial response. This may suggest that OT is acting to prolong the duration of the impact of the touch stimulation and possibly therefore facilitatory effects may have been even more pronounced for longer periods of touch. A classification analysis based on time courses revealed that responses in the three regions exhibiting significant changes during gentle-stroking touch (mOFC, mlOFC, STS) could significantly discriminate between both the intranasal and oral OT treatment groups and the PLC group (64–70% accuracy). Importantly however, the classification analysis did not find that activation in these three regions could discriminate between the intranasal and oral OT groups, further supporting the conclusion that the two routes of administration produced similar effects.

The finding in the current study that intranasal and oral administration of OT produced similar facilitation of behavioral and neural responses to gentle stroking touch provides further support for observations that some effects of exogenous treatment result from increased concentrations in the peripheral vascular system rather than following direct entry into the brain (Yao et al., 2023). One of the major considerations for studies choosing intranasal administration of OT has been from evidence that when administered by this route the peptide can gain direct access to the brain via the olfactory and trigeminal nerves (see Quintana et al., 2021; Yao and Kendrick, 2022). However, intranasal OT also increases concentrations of the peptide in peripheral blood, and accumulating evidence from both animal model and human studies support it having functional effects following administration via routes which only increase peripheral blood concentrations but do not permit direct entry into the brain (i.e. intravenous, intraperitoneal, subcutaneous and oral). Although, the intranasal administration route for OT produced significantly greater initial increases in plasma OT concentrations compared to an oral route in both the present study, and in two previous ones (Kou et al., 2021; Xu et al., 2022), this did not result in significant route-dependent differences, possibly due to the high doses involved. The broadly similar functional effects of intranasal and oral OT in the context of behavioral and neural responses to gentle stroking touch are also consistent with our previous findings for visual attention toward social and non-social stimuli (Zhuang et al., 2022; Xu et al., 2022), although there is also evidence for route-dependent effects of OT on neural and behavioral effects on responses to emotional faces (Kou et al., 2021).

The current study does not directly address the precise mechanism(s) whereby peripheral increases in OT concentrations facilitate neural and behavioral responses to gentle stroking touch via activation of CT fibers. However, despite original findings that only very small amounts of intravenously administered OT cross the BBB (Mens et al., 1983; Kendrick et al., 1986), the discovery that it can cross the BBB by binding to RAGE, and that RAGE knock out mice do not show brain and behavioral effects in response to peripherally administered OT (Higashida et al., 2019), has opened up a reconsideration of this route. Thus, observed neural and behavioral effects of OT could be via it entering the brain by crossing the BBB and acting on its receptors in the OFC and pSTS as well as in other associated regions (Quintana et al., 2021; Quintana et al., 2019). However, it is also possible that the effects of OT on neural and behavioral responses are mediated via stimulation of vagal afferents to the brain via receptors in the heart and gastrointestinal system (Carter, 2014; Carter et al., 2020). In agreement with a previous study (Triscoli et al., 2017) we found that CT-targeted touch increased HRV (reflecting vagal activity) compared with rest. Vagal stimulation can also produce extensive activation in the brain, including in the frontal cortex and STS (Chae et al., 2003; Iseger et al., 2020). Studies have reported that OT can influence both parasympathetic and sympathetic nervous system activity (Kemp et al., 2012; de Oliveira et al., 2012), although in line with some other studies (Martins et al., 2020b; Yao et al., 2023) we did not observe any effects of intranasal or oral OT on SCR, heart rate or HRV during touch stimulation in the present study. Another possibility is that OT might be directly acting of CT fibers in the skin to increase their sensitivity to touch. In rats, OT has been found to exert analgesic effects by influencing OT receptors in cutaneous nociceptive fibers in the dorsal route ganglion (C- and A-δ but not A-β fibers; González-Hernández et al., 2017). Keratinocytes in the skin also express OT receptors (Baumbauer et al., 2015; Deing et al., 2013) and can modulate responses of sensory neurons to touch (Talagas and Misery, 2019; Noguri et al., 2022). However, in our current study we did not observe any indication that OT increased the sensitivity of CT fibers to touch given that only ratings of pleasantness were affected and not those of intensity. Behavioral and physiological indices of arousal in response to touch were also unaffected. Clearly, further experiments will be needed to help disentangle these different potential routes whereby OT is influencing CT fiber mediated social touch processing.

The question of why OT only influences the pleasure of CT fiber and not non-CT fiber-mediated touch can also not be resolved in the current study. The touch stimulation protocols used specifically aimed to differentially influence the cutaneous fiber types and subjects were informed that they would receive two types of massage from a professional which varied only in terms of pressure in order to minimize any possible differences in psychological or emotional responses. Indeed, both types of touch were perceived as pleasant and other potential psychological factors such as the perceived gender of the person giving the massage had no influence on the effects of OT. Since, CT fiber and non-CT fiber projections both to and within the brain are dissociable to some extent (Case et al., 2021; Marshall et al., 2019; McGlone et al., 2014) it is possible that the CT fiber projection system has more OT receptors. However, at this point, we cannot entirely rule out additional influences of OT on brain regions involved in processing other psychological or emotional responses associated with the experience of social touch.

The current study still has some limitations. Firstly, although using the well-established fNIRS technique made it easier to administer touch stimulation and take blood samples during brain activity recording it has inherent limitations in terms of being restricted to measurement of changes in the superficial layers of the cortex and being unable to measure activity in deeper key touch, salience and reward processing regions (McGlone et al., 2012; Pinti et al., 2020). Secondly, applying the gentle stroking touch and medium pressure massage onto subjects’ legs for 15 min while they were sitting on a chair in a controlled manner is not as natural as in normal social interactions. Thirdly, we were unable to directly measure the actual pressure applied during the massage although intensity ratings were relatively similar across subjects and a professional masseur was used. Finally, it is possible that more frequent sampling of blood OT concentrations would have revealed increases during the touch and massage conditions.

In summary, our findings demonstrate that OT administered either intranasally or orally equivalently enhanced both pleasantness and medial OFC and pSTS responses to gentle stroking touch targeting CT fibers but not to medium pressure massage targeting non-CT fibers. Moreover, the facilitatory effects of OT on pleasantness ratings were significantly mediated by post-treatment changes in plasma OT concentrations. These findings support the conclusion that exogenously administered OT selectively facilitates neural and behavioral responses to stimulation of CT fibers during social touch via peripheral-mediated routes rather than by direct entry into the brain. Touch and massage interventions are increasingly demonstrated to have beneficial effects on brain development and function and it is likely that their effects on OT release and signaling play a major role in this (Li et al., 2022). Our findings demonstrating that OT treatment can facilitate behavioral and brain responses to gentle social touch/massage therefore may have important translational therapeutic implications for using OT-based interventions in individuals with aberrant responses to social touch such as in autism.

Individual data is plotted in Figure 2, 4 and 5. The group-level statistics are plotted in Figure 2, 3 and 6. The source data for Figure 2-6 of this study is available on Open Science Framework (https://osf.io/cykru/). The code for the condition decoding analysis (Figure 5 and Figure 5-figure supplement 1) was initially from Emberson et al., 2017 (https://teammcpa.github.io/EmbersonZinszerMCPA/) and revised for group classification analysis.

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Author details

1. Yuanshu Chen

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Conceptualization, Data curation, Software, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing - original draft, Project administration, Writing - review and editing

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0001-8500-7647

2. Haochen Zou

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Investigation

   Competing interests

   No competing interests declared

3. Xin Hou

   School of Educational Sciences, Chongqing Normal University, Chongqing, China

   Contribution

   Formal analysis, Visualization, Methodology

   Competing interests

   No competing interests declared

4. Chuimei Lan

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Investigation

   Competing interests

   No competing interests declared

5. Jing Wang

   West China School of Pharmacy, Sichuan University, Chengdu, China

   Contribution

   Investigation

   Competing interests

   No competing interests declared

6. Yanan Qing

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Investigation

   Competing interests

   No competing interests declared

7. Wangjun Chen

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Investigation

   Competing interests

   No competing interests declared

8. Shuxia Yao

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Conceptualization, Supervision, Visualization, Methodology, Project administration, Writing - review and editing

   For correspondence

   yaoshuxia@uestc.edu.cn

   Competing interests

   No competing interests declared

9. Keith M Kendrick

   The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China

   Contribution

   Conceptualization, Resources, Supervision, Funding acquisition, Methodology, Writing - original draft, Project administration, Writing - review and editing

   For correspondence

   k.kendrick.uestc@gmail.com

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0002-0371-5904

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