Cognitive and emotional control of pain and its disruption in chronic pain

Abstract

Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind–body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states — important components of mind–body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.

Ethanol Increases Mechanical Pain Sensitivity in Rats via Activation of GABAA Receptors in Medial Prefrontal Cortex

“…More recently, we also demonstrated that the mPFC is involved in the mediation of empathy for pain in rats, a phenomenon in which the mechanical pain sensitivity and spinal nociceptive responses of rats are dramatically increased after social interaction with a cagemate (but not a non-cagemate) in pain [15]. These results imply that the mPFC is one of the key brain structures involved in the cognitive and emotional modulation of pain [11,15,16]. As for the action of ethanol in the central nervous system, some in vitro brain slice studies have shown that ethanol facilitates the release of neurotransmitters such as c-aminobutyric acid (GABA), dopamine, serotonin, and opioids, whereas it inhibits glutamate activity, resulting in alterations in behavior [1].…”

Approach to low back pain in conservative societies and developing countries

“…Psychological aspect is a major part in the management of low back pain in most western societies, which first require the use of depression screening questionnaires [9], but the screen for psychological aspect require the presence of sophisticated psychological management plan for the patients including the use of cognitive based therapy, mindfulness therapies [10]. In developing countries, these modalities are not always present, so addressing the yellow flags and managing them as possible will be more convenient than depression screening.…”

Migraine and Reward System—Or Is It Aversive?

“…Importantly, it is considered part of the limbic system and encodes emotional (dysphoria or negative affect) and motivational aspects of pain [62], as well as behavioral monitoring and response selection relevant to disadvantageous choices in addiction [63]. This region receives direct dopaminergic input from the VTA [64], and as such may reflect upon the altered state of cognitive control and motivation common to mood disorders comorbid with migraine.…”