Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review

Abstract

An emerging technique in chronic pain research is MRI, which has led to the understanding that chronic pain patients display brain structure and function alterations. Many of these altered brain regions and networks are not just involved in pain processing, but also in other sensory and particularly cognitive tasks. Therefore, the next step is to investigate the relation between brain alterations and pain related cognitive and emotional factors. This review aims at providing an overview of the existing literature on this subject. Pubmed, Web of Science and Embase were searched for original research reports. Twenty eight eligible papers were included, with information on the association of brain alterations with pain catastrophizing, fear-avoidance, anxiety and depressive symptoms. Methodological quality of eligible papers was checked by two independent researchers. Evidence on the direction of these associations is inconclusive. Pain catastrophizing is related to brain areas involved in pain processing, attention to pain, emotion and motor activity, and to reduced top-down pain inhibition. In contrast to pain catastrophizing, evidence on anxiety and depressive symptoms shows no clear association with brain characteristics. However, all included cognitive or emotional factors showed significant associations with resting state fMRI data, providing that even at rest the brain reserves a certain activity for these pain-related factors. Brain changes associated with illness perceptions, pain attention, attitudes and beliefs seem to receive less attention in literature. Significance: This review shows that maladaptive cognitive and emotional factors are associated with several brain regions involved in chronic pain. Targeting these factors in these patients might normalize specific brain alterations.

Differences in white matter structure and cortical thickness between patients with traumatic and idiopathic chronic neck pain: Associations with cognition and pain modulation?

“…Although this study has found innovative WM structural differences in the left tapetum in CWAD patients compared with healthy con- (Coppieters et al, , 2016Lutz et al, 2008). Indeed, the role of longer pain duration, maladaptive pain cognitions, depressive and anxiety symptoms, cognitive deficits and medication use on structural brain alterations in chronic pain conditions has been reported in literature (Coppieters et al, 2016; Diaz-Piedra, Guzman, Buela-Casal, & Catena, 2016;Hsu et al, 2009;Luerding et al, 2008;Malfliet et al, 2017).…”

“…It can be hypothesized that both chronic neck pain groups differ in terms of pain duration, report less maladaptive pain cognitions (e.g., pain catastrophizing), depressive and anxiety symptoms, cognitive problems, and medication use compared with other chronic pain conditions such as fibromyalgia in which more extensive WM structural alterations have been revealed compared with healthy controls (Coppieters et al, ; Lutz et al, ). Indeed, the role of longer pain duration, maladaptive pain cognitions, depressive and anxiety symptoms, cognitive deficits and medication use on structural brain alterations in chronic pain conditions has been reported in literature (Coppieters et al, ; Diaz‐Piedra, Guzman, Buela‐Casal, & Catena, ; Hsu et al, ; Luerding et al, ; Malfliet et al, ).…”

“…In CINP patients there is less evidence for maladaptive pain cognitions, cognitive problems and frequent medication use (e.g., narcotic analgesics) (Coppieters et al, a,b). It could be that the extent of debilitating associated symptoms beside the chronic pain is associated with the more extensive structural brain alterations shown in other chronic pain conditions (Coppieters et al, ; Malfliet et al, ). In addition, no evidence for CS or objective cognitive deficits, and the nontraumatic origin of pain in CINP patients could play a role in the lack of GM and WM structural differences between women with CINP and controls.…”

Cognitive Impairment in Patients with Chronic Neuropathic or Radicular Pain: An Interaction of Pain and Age

“…Thus, there may be a highly complex relationship between duration of pain, analgesic treatment and cognitive-task performance, an investigation of which was beyond the scope of the present study. There is also emerging evidence of positive adaptive plasticity that may derive from psychological interventions for chronic pain or use of specific coping strategies (see for example, Braden et al, 2016; Lazaridou et al, 2017; Malfliet et al, 2017) so that improvements in these psychological processes over time may explain a decreasing effect of pain despite increasing chronicity.…”

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

“…1), including areas that are associated with coding information about noxious stimuli and reactions to noxious stimuli, the modulation of such information, the production of affective interpretations, attentional and emotional responses, and decisionmaking 19,27,[32][33][34] . These brain areas include somatosensory, insular, cingulate and prefrontal cortices, and subcortical areas, including the amygdala, hippo campus, hypothalamus, ventral striatum, thalamus, periaqueductal grey, rostroventral medulla, numerous other brainstem areas and the cerebellum 19,27,31,32,[35][36][37] .…”