Psychological processing in chronic pain: a neural systems approach

Abstract

Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology.

Keywords: Allostatic load; Amygdala; Anhedonia; Anterior cingulate cortex; Anxiety; Attention; Behavior; Brain; Catastrophizing; Chronic pain; Cognition; Depression; Fear; Hippocampus; Imaging; Insula; Interoception; Motivation; Neurocircuit; Nociception; Parietal cortex; Perception; Prefrontal cortex; Psychology; Reward.