Advances in pain research and therapy

Abstract

Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in areas that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. Functional reorganization in several brain areas related to the processing of pain was observed in neuropathic and musculoskeletal pain. In chronic low back pain and fibromyalgia patients the amount of reorganizational change increases with chronicity, in phantom limb pain and other neuropathic pain syndromes cortical reorganization is correlated with the amount of pain. These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the brain. Learning processes that contribute to the development of pain-related memory traces are predominantly implicit and involve processes such as sensitization, operant and classical conditioning or priming. Cortical plasticity related to chronic pain can be modified by behavioral interventions that provide feedback to the brain areas that were altered by pain memories. These behavioral interventions can be enhanced by pharmacological agents that prevent or reverse maladaptive memory formation.