Background

BACKGROUND: PAIN, PSYCHOLOGY AND THE ROLE OF NEUROSCIENCE

 

Many patients with chronic pain have a combination of recurrent acute pain and chronic ongoing pain, variable evidence of tissue damage and differences in cognitive and mood symptoms. Physiological mechanisms dont perfectly map to these symptoms and involve variability in nociceptive, inflammatory, neuropathic and central mechanisms.

Pain and psychology

Psychological factors have a profound influence on how we experience pain. To sufferers of chronic pain lasting many months or years, this fact is a double-edged sword, with the potential to be both detrimental and empowering. Anxiety and depression are common afflictions of people with chronic pain, which only makes life ever more unmanageable and may actually make the pain worse. On the other hand, mental states (and their biological substrates in the brain) that contribute to anxiety, depression and pain can be influenced in a positive and potentially therapeutic direction with the help of psychological advice, training and therapy.

 

Evidence-based and actively researched examples span from online learning programmes for better self-management of pain, to more intensive group-based training programmes available in the community (e.g. see our research on mindfulness training) to more complex interventions such as cognitive-behavioural therapy (CBT). The latter are commonly incorporated into multi-disciplinary pain management programmes (PMP) available in specialist hospitals (including the Walton Centre in Liverpool, which runs the first established, longest-running and one of the most innovative PMPs in the UK).

 

Neuroscience research: the benefits

How can neuroscience help in the endeavour to provide better therapy for patients, but also empower them with new psychological tools to better manage their pain? We are at a very early stage in understanding how the brain works and how experiences such as pain can be supported biologically, which highlights the need for further research. Neuroscience research makes a number of valuable contributions in this area:

 

  1. Knowledge towards empowerment: Providing new knowledge about how brain mechanisms can impact on pain experience could already be useful information for patients and their supporters/carers, so that they can use this knowledge to better self-manage their condition. For example, just the wisdom of knowing that the pain experienced in the body is actually constructed in the brain, could empower individuals to recognise, learn and master psychological and behavioural self-management techniques that can directly influence these mechanisms via their effects on brain physiology.

 

  1. Recognition: A problem frequently reported by patients with chronic pain is recognition of their pain experience by others (especially in cases where no medical cause for the pain has yet been found), and that the lack of such social support considerably compounds the problem. Neuroscience research can improve recognition, among healthcare professionals, patients and their carers, of the role the brain plays in chronic pain. For example, we are in the process of discovering brain mechanisms of pain that could potentially be translated into new diagnostic tests that could potentially reveal whole new subclasses of medical disorders contributing to pain. This new knowledge will improve medical education and the clinical management of chronic pain, reducing the stigma of “invisible” chronic pain symptoms.

 

  1. New treatments: The discovery of brain mechanisms of pain will provide new avenues for pain treatment. In the decades to come, emerging breakthroughs in pain neuroscience will transform patient care. However, so far, neuroscience research has only rarely been successful in developing new treatments (although see the Neurotherapy page for new potential in innovative treatment approaches), instead having more success in investigating and understanding how current treatments might work. Where those treatments involve psychological intervention, neuroscience research can gain insights into the brain mechanisms contributing to (or alternatively, providing resilience to) pain symptoms.

 

Thus, studying the neuroscience of pain is a positively reinforcing cycle: it can potentially improve the psychological and clinical management of pain, but also the study of psychological treatments can enable new neuroscientific discoveries to better treat pain.

 

CHRISTOPHER BROWN

 

Brain mechanisms of human pain perception and behaviour

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