New developments in the understanding and management of persistent pain
One page on PainSci cites Flor 2012: Chronic Pain as a Conditioned Behaviour
PainSci notes on Flor 2012:
This paper explores evidence that people with chronic pain have altered brains and wonky perception. They “propose” this because the evidence is indirect and incomplete. The brain changes seen in pain patients certainly exist, but their meaning is unclear: they might be cause and/or effect, and they may or may not have useful clinical implications. But this author believes that they “require new treatments that focus on the alteration of central pain memories and maladaptive body perception.”
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: It is proposed that central rather than peripheral factors may be important in pain chronicity. We review recent empirical findings on these processes and discuss implications for treatment and prevention.
RECENT FINDINGS: The literature on neuroimaging of pain and on learning processes shows that learning-induced functional and structural brain changes involving sensorimotor, as well as limbic and frontal, areas are important in the transition from acute to chronic pain. These alterations share many similarities with brain changes in emotional disorders and the specificity for pain needs to be determined. Further important contributors to chronic pain may be disturbed processing of the body image, impaired multisensory integration and faulty feedback from interoceptive processes. These findings have led to new treatment approaches that focus on the extinction of aversive memories, restoration of the body image and normal brain function and include approaches such as brain stimulation, mirror training, virtual reality applications or behavioral extinction training.
SUMMARY: We propose that chronic pain is characterized by learning-related and memory-related plastic changes of the central nervous system with concomitant maladaptive changes in body perception. These alterations require new treatments that focus on the alteration of central pain memories and maladaptive body perception.
related content
- “The human amygdala and pain: evidence from neuroimaging,” Simons et al, Hum Brain Mapp, 2014.
- “In search of conditioned pain: an experimental analysis,” Kang et al, Pain, 2023.
- “Do clinicians think that pain can be a classically conditioned response to a non-noxious stimulus?,” Madden et al, Manual Therapy, 2016.
- “Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis,” Madden et al, Pain Med, 2016.
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:
- 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.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.