Predicting transition to chronic pain
One page on PainSci cites Apkarian 2013: Mind Over Pain
PainSci notes on Apkarian 2013:
The gist of this complex paper is that the brain’s anatomic and functional properties predict development of chronic pain, and correlate with emotional state. It’s not necessarily correct, but it’s certainly interesting! It’s important to note that Apkarian is associated with some other particularly bad research (see Vachon-Presseau 2018).
As always, Todd Hargrove does an admirable job explaining research like this: see "To Predict Chronic Pain, Look to the Brain."
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
PURPOSE OF REVIEW: Most individuals who develop pain following an inciting event will return to a healthy state as the injury heals. However, a small percentage continue to suffer, that is, transition to chronic pain. Chronic pain may persist for years and is accompanied by cognitive abnormalities, as well as diminished quality of life. In animals, persistent pain is characterized by peripheral and spinal cord reorganization, and recent evidence in humans also indicates cortical reorganization. Yet, despite more than 30 years of research, there is little agreement on the neural mechanisms that mediate the transition from acute to chronic pain.
RECENT FINDINGS: In a longitudinal brain-imaging study, individuals who developed an intense back pain episode were followed over a 1-year period, during which pain and brain parameters were collected repeatedly. A smaller number of healthy individuals and chronic back pain patients were also studied concomitantly, as positive and negative controls. At the time of entry into the study, strength of synchrony between the medial prefrontal cortex and nucleus accumbens (i.e. functional connectivity) was predictive >80% accuracy) of individuals who subsequently transition to chronicity 1 year later.
SUMMARY: Properties of the brain's emotional learning circuitry predict the transition to chronic pain. The involvement of this circuitry in pain remains mostly unexplored. Future human and animal model studies are necessary to unravel underlying mechanisms driving pain chronicity, with the potential of advancing novel therapeutics for preventing pain chronification.
related content
- “Nociception, Pain, Negative Moods, and Behavior Selection,” Baliki et al, Neuron, 2015.
- “The Emotional Brain as a Predictor and Amplifier of Chronic Pain,” Vachon-Presseau et al, J Dent Res, 2016.
- “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits,” Hashmi et al, Brain, 2013.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. Wang 2025 BMJ.
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.