Ref Forebrain Pain Mechanisms

[Diane]

Forebrain Pain Mechanisms - full access.

VERY juicy read. Very.

Abstract
Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain.

Keywords: Pain, emotion, cognition, decision-making, amygdala, prefrontal cortex

There's even a deep model in there, Figure 1.
I was inspired by it enough to make a few treatment suggestion slides using it. See pdf attached.

[Richard Finn]

That pdf you made is GREAAAAT!!!!!! (Add Tony Tiger roar)

Richard

[Diane]

Thanks.
I made a second version, added another slide.

[ian s]

Thanks very much Diane . Maybe this will add to the post or re ignite interest in Zusmans paper.
http://www.somasimple.com/forums/sho...sman+forebrain

ian

[ste5e]

I particularly liked "Neuropathic pain may be considered a progressive nervous system disease that results from poorly-defined neurophysiological and neurochemical changes." Which made me think a bit more about my practice. I suspect this is the same for a wider group of conditions including FMS. And as the article later asks is it chicken or egg. Our traditionally body biased view of things is probably why NP and FMS, CWPS have been so difficult to treat - it never was a body problem in the first place.

and more importantly

"Based on these results we hypothesize that there is not simply a direct link between the degree of nociception and the overall experience of pain (!) and furthermore, voluntary brain mechanisms can modulate that pain experience." Bing! A quality article quoting quality sources in a sensible, measured way bangs out a commercially relevent validating conclusion. Bing. Bing! BING! We can teach 'voluntary'.

Yes its nice to know that the neuromatrix is probably a simplification - I suspect that has been apparent to most for some time - but it makes the mysterious brain a workable, understandable place, which is what simplifications are meant to do, eh?

"Are cortical changes the consequence or cause of persistent pain?" Interesting. Or both in two different populations which we are yet to differentiate between? Anyway nice to have it in print in a good article we can quote.

Fantastic find and a cracking start to Monday morning,

Kind thoughts,
Steve