Towards a theory of chronic pain
By Apkar Vania Apkarian, Marwan N. Baliki, Paul Geha. Progress in neurobiology, 2008
860 citations recorded by the source corpus.
In this review we integrate recent human and animal studies from the viewpoint of chronic pain. First, we briefly review the impact of chronic pain on society and address current pitfalls of its definition and clinical management. Second, we examine pain mechanisms via nociceptive information transmission cephalad and its impact and interaction with the cortex. Third, we present recent discoveries on the active role of the cortex in chronic pain, with findings indicating that the human cortex continuously reorganizes as it lives in chronic pain. We also introduce data emphasizing that distinct chronic pain conditions impact on the cortex in unique patterns. Fourth, animal studies regarding nociceptive transmission, recent evidence for supraspinal reorganization during pain, the necessity of descending modulation for maintenance of neuropathic behavior, and the impact of cortical manipulations on neuropathic pain is also reviewed. We further expound on the notion that chronic pain can be reformulated within the context of learning and memory, and demonstrate the relevance of the idea in the design of novel pharmacotherapies. Lastly, we integrate the human and animal data into a unified working model outlining the mechanism by which acute pain transitions into a chronic state. It incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronic pain conditions within a single model.
Subfields: Cognitive Neuroscience, Pharmacology, Physiology
View Paper: https://www.semanticscholar.org/paper/624742d61e07a28ccf6477a4350d07c0d7cbc860
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Citations in the corpus
- Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain (2010, background): “We have previously argued that chronic pain can be viewed as a state of continuous learning coupled with reduced opportunity for forgetting [2,3,72].”
- Phantom percepts: Tinnitus and pain as persisting aversive memory networks (2011, methodology): “The continuous experience of pain produces continuous aversive emotional associations and does not provide an opportunity for extinction of the memory of pain (84).”
- Neuroimaging of the Periaqueductal Gray: State of the Field (2011, background): “Specifically, either altered inhibition or increased facilitation of modulatory circuits including the PAG is postulated to contribute to the chronic pain state (Apkarian et al., 2009).”