scholarly journals Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Susanne Becker ◽  
Edita Navratilova ◽  
Frauke Nees ◽  
Stefaan Van Damme
Keyword(s):  
Chronic Pain ◽  
Brain Activity ◽  
Pain Processing ◽  
Cellular Mechanisms ◽  
Related Information ◽  
Current State ◽  
Chronic Pain Patients ◽  
Fear And Anxiety ◽  
Chronic Pain Conditions ◽  
Pain Patients

Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.

The Nature and Extent of Social Anxiety and Avoidance in Patients with Chronic Pain

2003 ◽  
Vol 9 (1) ◽  
pp. 52-72
Author(s):  
Renée F. Seebeck ◽  
Malcolm H. Johnson ◽  
Ross A. Flett
Keyword(s):  
Chronic Pain ◽  
Social Anxiety ◽  
Anxiety Sensitivity ◽  
Negative Evaluation ◽  
Fear Of Negative Evaluation ◽  
Social Avoidance ◽  
Social Distress ◽  
Chronic Pain Patients ◽  
Fear And Anxiety ◽  
Pain Patients

The present study explored the nature and extent of social anxiety and avoidance, anxiety sensitivity, and pain-related anxiety and avoidance in 46 clinic-referred chronic pain patients, compared with a community-based group reporting pain (n = 66) and healthy controls (n = 57). The chronic pain patients consistently reported higher levels of social distress, social avoidance, fear of negative evaluation, anxiety sensitivity, and pain-related anxiety and avoidance as compared with controls. Group differences in social distress, social avoidance, fear of negative evaluation, pain-related cognitive anxiety, and fear of cognitive and emotional dyscontrol, remained stable when pain severity was controlled for. Anxiety sensitivity was strongly related to both social and pain-related fears. The source of these social fears is examined in relation to the elevated pain-related fear and anxiety sensitivity also exhibited by chronic pain patients, and implications for treatment and rehabilitation are discussed.

scholarly journals The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study

Pain ◽  
2013 ◽  
Vol 154 (3) ◽  
pp. 468-475 ◽  
Author(s):  
Dimitri M.L. Van Ryckeghem ◽  
Geert Crombez ◽  
Liesbet Goubert ◽  
Jan De Houwer ◽  
Thomas Onraedt ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Attentional Bias ◽  
Predictive Value ◽  
Diary Study ◽  
Related Information ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Treating Chronic Pain with SSRIs: What Do We Know?

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Elias Patetsos ◽  
Emilia Horjales-Araujo
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Drug Class ◽  
Secondary Effects ◽  
Monoamine Neurotransmitter ◽  
Chronic Pain Patients ◽  
Chronic Pain Conditions ◽  
Pain Patients

Serotonin is a monoamine neurotransmitter that plays a major role in both nociception and mood regulation. Alterations in the 5-hydroxytryptophan (5HT) system have been reported in chronic pain patients. In recent years, Selective Serotonin Reuptake Inhibitors (SSRIs) have been suggested as an alternative treatment for chronic pain due to the fact that they are better tolerated presenting less secondary effects than other antidepressants such as tricyclic antidepressants. Although several clinical trials have been published, the effectiveness of SSRI as treatment for pain conditions is inconclusive. This review aims to summarise what is known, regarding the effectiveness of SSRI as a treatment for chronic pain conditions in adults. A total of 36 studies involving a total of 1898 participants were included in this review. Of the 36 trials included in the review, 2 used zimelidine as treatment, 3 used escitalopram, 4 used fluvoxamine, 4 used sertraline, 6 used citalopram, 8 used paroxetine, 9 used fluoxetine, and one used both citalopram and paroxetine. Because the trials included in this review are quite heterogeneous, only qualitative analyses were performed. SSRI seems to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions.

scholarly journals Chronic Pain Patients’ Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 530 ◽  
Author(s):  
Lee ◽  
Beom ◽  
Choi ◽  
Lee ◽  
Lee
Keyword(s):  
Chronic Pain ◽  
Eye Tracking ◽  
Attentional Bias ◽  
Pain Catastrophizing ◽  
Pain Clinic ◽  
Related Information ◽  
Chronic Pain Patients ◽  
Attentional Engagement ◽  
Pain Patients

Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus. Materials and Methods: Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs. Conclusions: The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed.

scholarly journals The Evolution of Neuromodulation in the Treatment of Chronic Pain: Forward-Looking Perspectives

Pain Medicine ◽  
2019 ◽  
Vol 20 (Supplement_1) ◽  
pp. S58-S68 ◽  
Author(s):  
Michael A Fishman ◽  
Ajay Antony ◽  
Michael Esposito ◽  
Timothy Deer ◽  
Robert Levy
Keyword(s):  
Chronic Pain ◽  
Technology Development ◽  
Burst Stimulation ◽  
The Past ◽  
Controlled Systems ◽  
Current State ◽  
Chronic Pain Patients ◽  
Specific Stimulation ◽  
Novel Target ◽  
Pain Patients

Abstract Background The field of neuromodulation is continually evolving, with the past decade showing significant advancement in the therapeutic efficacy of neuromodulation procedures. The continued evolution of neuromodulation technology brings with it the promise of addressing the needs of both patients and physicians, as current technology improves and clinical applications expand. Design This review highlights the current state of the art of neuromodulation for treating chronic pain, describes key areas of development including stimulation patterns and neural targets, expanding indications and applications, feedback-controlled systems, noninvasive approaches, and biomarkers for neuromodulation and technology miniaturization. Results and Conclusions The field of neuromodulation is undergoing a renaissance of technology development with potential for profoundly improving the care of chronic pain patients. New and emerging targets like the dorsal root ganglion, as well as high-frequency and patterned stimulation methodologies such as burst stimulation, are paving the way for better clinical outcomes. As we look forward to the future, neural sensing, novel target-specific stimulation patterns, and approaches combining neuromodulation therapies are likely to significantly impact how neuromodulation is used. Moreover, select biomarkers may influence and guide the use of neuromodulation and help objectively demonstrate efficacy and outcomes.

scholarly journals Modulation of the Somatosensory Evoked Potential by Attention and Spinal Cord Stimulation

2021 ◽  
Vol 12 ◽  
Author(s):  
Guiomar Niso ◽  
Marleen C. Tjepkema-Cloostermans ◽  
Mathieu W. P. M. Lenders ◽  
Cecile C. de Vos
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Brain Activity ◽  
Explorative Study ◽  
Brain Responses ◽  
Chronic Pain Patients ◽  
Electrical Pulses ◽  
Pain Patients

Introduction: Spinal Cord Stimulation (SCS) is a last-resort treatment for patients with intractable chronic pain in whom pharmacological and other treatments have failed. Conventional tonic SCS is accompanied by tingling sensations. More recent stimulation protocols like burst SCS are not sensed by the patient while providing similar levels of pain relief. It has been previously reported that conventional tonic SCS can attenuate sensory-discriminative processing in several brain areas, but that burst SCS might have additional effects on the medial, motivational-affective pain system. In this explorative study we assessed the influence of attention on the somatosensory evoked brain responses under conventional tonic SCS as well as burst SCS regime.Methods: Twelve chronic pain patients with an implanted SCS device had 2-weeks evaluation periods with three different SCS settings (conventional tonic SCS, burst SCS, and sham SCS). At the end of each period, an electro-encephalography (EEG) measurement was done, at which patients received transcutaneous electrical pulses at the tibial nerve to induce somatosensory evoked potentials (SEP). SEP data was acquired while patients were attending the applied pulses and while they were mind wandering. The effects of attention as well as SCS regimes on the SEP were analyzed by comparing amplitudes of early and late latencies at the vertex as well as brain activity at full cortical maps.Results: Pain relief obtained by the various SCS settings varied largely among patients. Early SEP responses were not significantly affected by attention nor SCS settings (i.e., burst, tonic, and sham). However, late SEP responses (P300) were reduced with tonic and burst SCS: conventional tonic SCS reduced P300 brain activity in the unattended condition, while burst SCS reduced P300 brain activity in both attended and unattended conditions.Conclusion: Burst spinal cord stimulation for the treatment of chronic pain seems to reduce cortical attention that is or can be directed to somatosensory stimuli to a larger extent than conventional spinal cord stimulation treatment. This is a first step in understanding why in selected chronic pain patients burst SCS is more effective than tonic SCS and how neuroimaging could assist in personalizing SCS treatment.

scholarly journals The Role of the Kynurenine Signaling Pathway in Different Chronic Pain Conditions and Potential Use of Therapeutic Agents

2020 ◽  
Vol 21 (17) ◽  
pp. 6045 ◽  
Author(s):  
Filip Jovanovic ◽  
Kenneth D. Candido ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Chronic Pain ◽  
Signaling Pathway ◽  
Peripheral Tissues ◽  
Chronic Pain Patients ◽  
The Central Nervous System ◽  
Chronic Pain Conditions ◽  
Pain Patients ◽  
Potential Use

Tryptophan (TRP) is an essential, aromatic amino acid catabolized by indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO) enzymes into kynurenine. The IDO enzyme is expressed in peripheral tissues and the central nervous system. Another enzyme of interest in the kynurenine signaling pathway is kynurenine 3-monooxygenase (KMO). The purpose of this review is to discuss the role of TRP and the kynurenine signaling pathway in different chronic pain patients. The IDO-1, IDO-2, and KMO enzymes and the kynurenine metabolite have been shown to be involved in the pathogenesis of neuropathic pain and other painful conditions (migraine, cluster headache, etc.) as well as depressive behavior. We highlighted the analgesic potential of novel agents targeting the enzymes of the kynurenine signaling pathway to explore their efficacy in both future basic science and transitional studies. Upcoming studies conducted on animal models will need to take into consideration the differences in TRP metabolism between human and non-human species. Since chronic painful conditions and depression have common pathophysiological patterns, and the kynurenine signaling pathway is involved in both of them, future clinical studies should aim to have outcomes targeting not only pain, but also functionality, mood changes, and quality of life.

scholarly journals Brain dysfunction in chronic pain patients assessed by resting-state electroencephalography

2019 ◽  
Author(s):  
Son Ta Dinh ◽  
Moritz M. Nickel ◽  
Laura Tiemann ◽  
Elisabeth S. May ◽  
Henrik Heitmann ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Resting State ◽  
Brain Activity ◽  
Control Group ◽  
Brain Areas ◽  
Frontal Brain ◽  
Disease Markers ◽  
Chronic Pain Patients ◽  
Gamma Frequencies ◽  
Pain Patients

AbstractChronic pain is a common and severely disabling disease whose treatment is often unsatisfactory. Insights into the brain mechanisms of chronic pain promise to advance the understanding of the underlying pathophysiology and might help to develop disease markers and novel treatments. Here, we systematically and comprehensively exploited the potential of electroencephalography (EEG) to determine abnormalities of brain function during the resting state in chronic pain. To this end, we performed state-of-the-art analyses of oscillatory brain activity, brain connectivity and brain networks in 101 patients of either sex suffering from chronic pain. The results show that global and local measures of brain activity did not differ between chronic pain patients and a healthy control group. However, we observed significantly increased connectivity at theta (4 – 8 Hz) and gamma (> 60 Hz) frequencies in frontal brain areas as well as global network reorganization at gamma frequencies in chronic pain patients. Furthermore, a machine learning algorithm could differentiate between patients and healthy controls with an above-chance accuracy of 57%, mostly based on frontal connectivity. These results implicate increased theta and gamma synchrony in frontal brain areas in the pathophysiology of chronic pain. While substantial challenges concerning accuracy, specificity and validity of potential EEG-based disease markers remain to be overcome, our study identifies abnormal frontal synchrony at theta and gamma frequencies as promising targets for non-invasive brain stimulation and/or neurofeedback approaches.

scholarly journals Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis

2017 ◽  
Author(s):  
Eduardo A. Garza-Villarreal ◽  
Victor Pando ◽  
Peter Vuust ◽  
Christine Parsons
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Sample Size ◽  
Meta Analysis ◽  
Measurement Instrument ◽  
Music Intervention ◽  
Post Intervention ◽  
Chronic Pain Patients ◽  
Chronic Pain Conditions ◽  
Pain Patients

AbstractMusic is increasingly used as an adjuvant for chronic pain management as it is not invasive, inexpensive, and patients usually report positive experiences with it. However, little is known about its clinical efficacy in chronic pain patients. In this systematic review and meta-analysis, we investigated randomized controlled trials (RCTs) of adult patients that reported any type of music intervention for chronic pain, chosen by the researcher or patient, lasting for any duration. Searches were performed using PsycINFO, Scopus and PubMed for RTCs published until the end of May 2016. The primary outcome was reduction in self-reported pain using a standardized pain measurement instrument reported post-intervention. The secondary outcomes were: quality of life measures, depression and anxiety measures, among others. The study was pre-registered with PROSPERO (CRD42016039837) and the meta-analysis was done using RevMan. We identified 768 titles and abstracts, and we included 14 RTCs that fulfilled our criteria. The sample size of the studies varied between 25 and 200 participants. We found that music reduced chronic pain, and depression, with higher effect size on pain and depression. We also found music had a higher effect when the participant chose the music in contrast with researcher-chosen music. The sample size of RCTs was small and sometimes with different outcome measures. Our analysis suggests that music may be beneficial as an adjuvant for chronic pain patients, as it reduces self-reported pain and its common co-morbidities. Importantly, the analgesic effect of music appears higher with self-chosen over researcher-chosen music.

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