Understanding the Brain in Chronic Pain

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Understanding the Brain in Chronic Pain

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 19, Issue 4

Abstract

Chronic pain conditions cause among the highest levels of disability and lost work days of any class of disorders. The efficacy of current treatments has been disappointing. It has long been the hope of patients and pain clinicians that the pathophysiology of chronic pain would be better understood and lead to more effective treatments. A major step toward realizing those hopes has occurred with the identification of a brain circuit for pain. Despite longstanding controversy about the level of involvement of cortical structures in pain, we now know that there is a discreet network of cortical and subcortical structures that we recognize a pain network in the brain. The network is multilevel, involves somatosensory cortex as well as other areas, and serves as a substrate for human experience of pain [1-3]. Here are the major components of the brain network for pain, roughly in order of activation by experimental or clinical pain: thalamus, secondary Somatosensory Cortex (SII), insular cortex, anterior cingulate cortex, primary Somatosensory Cortex (SI), and ventromedial prefrontal cortex. It is at first surprising that one of the later areas activated is primary Somatosensory Cortex (SI), where most body sensation is based. This late activation, however, also underscores a fundamental feature of pain; that is, it is suffering as much or more than specific bodily sensation. The sequence of activation in the pain network first sounds an alarm that there is pain somewhere in the body and potential threat (SII), then increases body awareness (insula), next focuses attention on pain (anterior cingulate), then finally provides sensory features and location of pain (SI). The pain network in the brain therefore identifies a core feature of pain. Pain has an emotional quality, a level of suffering, not present in typical sensations that register in the post-central gyrus, where primary somatosensory cortex is found. Structures deeper than the post-central gyrus are in involved in the pain network as well as specific areas of prefrontal cortex. These deeper structures, namely insular and anterior cingulate cortex, are not only activated in pain, but also in body-focused anxiety and depression. Ventromedial prefrontal cortex is also activated in both painful and depressive states [4].

Authors and Affiliations

Mitchell J Cohen

Keywords

Journals on Medical Research Top Medical Open Access Journal Journals on Biomedical Science Journals on Cancer Medicine Journals on Medical Drug and Therapeutics American Journal of Otolaryngology International Journal of Otorhinolaryngology and Head and Neck Journal of Otolaryngology - Head & Neck Surgery Otolaryngology Journals

EP ID EP622426
DOI 10.26717/BJSTR.2019.19.003340
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