Reward responsiveness in patients with chronic pain

Abstract

Background: It is proposed that changes in reward processing in the brain are involved in the pathophysiology of pain based on experimental studies. The first aim of the present study was to investigate if reward drive and/or reward responsiveness was altered in patients with chronic pain (PCP) compared to controls matched for education, age and sex. The second aim was to investigate the relationship between reward processing and nucleus accumbens volume in PCP and controls. Nucleus accumbens is central in reward processing and its structure has been shown to be affected by chronic pain conditions in previous studies. Methods: Reward drive and responsiveness were assessed with the Behavioral Inhibition Scale/Behavioral Activation Scale, and nucleus accumbens volumes obtained from T1-weighted brain MRIs obtained at 3T in 19 PCP of heterogeneous aetiologies and 20 age-, sex-and education-matched healthy controls. Anhedonia was assessed with Beck's Depression Inventory II. Results: The PCP group had significantly reduced scores on the reward responsiveness, but not reward drive. There was a trend towards smaller nucleus accumbens volume in the PCP compared to control group. There was a significant positive partial correlation between reward responsiveness and nucleus accumbens volume in the PCP group adjusted for anhedonia, which was significantly different from the same relationship in the control group. Conclusions: Reward responsiveness is reduced in chronic pain patients of heterogeneous aetiology, and this reduction was associated with nucleus accumbens volume. Reduced reward responsiveness could be a marker of chronic pain vulnerability, and may indicate reduced opioid function.

Towards a science and practice of resilience in the face of pain

“…Recent research has for instance proposed reduced reward responsiveness as a neurobiological marker of chronic pain vulnerability (Denk et al, 2014;Elvemo et al, 2015). With regard to psychosocial risk mechanisms, the Fear-Avoidance Model has proliferated our knowledge on the development and treatment of pain-related disability and distress in adult and pediatric populations (Vlaeyen and Linton, 2000;Leeuw et al, 2007;Asmundson et al, 2012;Goubert and Simons, 2013).…”

Anxiety and Depression in Bidirectional Relations Between Pain and Smoking

“…Our review of the literature also indicated that these exemplary factors are highly relevant to chronic pain conditions and may serve as a model for understanding complex associations among pain, smoking, and additional transdiagnostic factors that could be identified in future research. Indeed, chronic pain patients have reported greater levels of anhedonia and decreased responsiveness to rewards, relative to healthy controls (Elvemo, Landrø, Borchgrevink, & Håberg, 2015), and distress tolerance has been implicated in emotion regulation and coping among persons with chronic pain (Hamilton, Karoly, & Kitzman, 2004). Moreover, decades of research have consistently demonstrated that greater levels of anxiety sensitivity predict a range of negative pain-related outcomes, including greater use of analgesic medications, greater cognitive bias toward pain experiences, and greater activation of fear-avoidance mechanisms (e.g., pain-related fear) that contribute to the development and maintenance of pain-related disability (e.g., Asmundson & Norton, 1995; Keogh & Cochrane, 2002; Wong et al, 2014).…”

Mindfulness is Associated With Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy

“…14–17 This phenomena may be explained from a cognitive perspective: a body of evidence suggests that pain (like other aversive experiences and negative emotional states) can narrow and tune attention towards present harms and potential threats. 18 This negative attentional bias, while evolutionarily conserved for its survival value, may result in a kind of “cognitive myopia”, preventing the individual from noticing and appreciating pleasant events and experiences.…”