Abstract
Brain circuits involved in pain chronicity shift from areas involved in nociceptive processing to those associated with emotional and motivational processes. They overlap with circuits relevant for anxiety, fear and depression and are characterized by deficient prefrontal control mechanisms. Noninvasive brain stimulation techniques such as repetitive transcranial magnetic stimulation, transcranial direct and alternating current stimulation directly impact on these circuits and pain. Neurofeedback and brain-computer interfaces as well as various types of cognitive and behavioral interventions also alter these circuits. The analysis of brain changes related to pain chronicity helps to mechanistically tailor interventions to patient characteristics, can increase treatment efficacy and efficiency and can identify new treatment approaches.
Zusammenfassung
Chronische Schmerzen entstehen in Schaltkreisen des Gehirns, die weniger mit nozizeptiver Verarbeitung zu tun haben, sondern in emotionale und motivationale Verarbeitungsprozesse involviert sind. Diese überlappen mit Schaltkreisen, die für Angst, Furcht und Depression relevant sind und sind auch durch eine defiziente präfrontale Hemmung charakterisiert. Verfahren der nichtinvasiven Hirnstimulation wie die repetitive Hirnstimulation, transkranielle Gleichstromstimulation oder die transkranielle Wechselstromstimulation können diese Schaltkreise und damit Schmerz direkt beeinflussen. Neurofeedback und Gehirn-Computer Schnittstellen ebenso wie verschiedene kognitive und verhaltensbezogene Trainingsverfahren können diese Hirnregionen ebenfalls verändern. Die Analyse von Hirnveränderungen, die mit chronischem Schmerz in Zusammenhang stehen, kann Interventionen mechanistisch auf Patientencharakteristika zuschneiden, die Effektivität und Effizienz von Behandlungen verbessern und trägt dazu bei, neue Behandlungsansätze zu entwickeln.
Funding source: Deutsche Forschungsgemeinschaft
Funding source: Bundesministerium für Bildung und Forschung
About the authors
Herta Flor is Full Professor of Clinical and Cognitive Psychology, Medical Faculty Mannheim, Heidelberg University and Scientific Director of the Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Mannheim. She studied psychology in Würzburg, Tübingen and Yale University and acts as the deputy Spokesperson of the Heidelberg Pain Consortium funded by the German Research Foundation. Her interests focus on learning and brain plasticity mechanisms and the development of novel behavioral interventions in mental disorders and specifically pain. She received numerous awards for her work, among them the Lifetime Achievement Award of the International Association for the Study of Pain. She holds honorary doctoral degrees from Aalborg University and the Free University Amsterdam.
Rohini Kuner is a Full Professor of Pharmacology at Heidelberg University. She is the Spokesperson of the Heidelberg Pain Consortium funded by the German Research Foundation. She was trained in pharmacology and neuroscience at the University of Iowa City, USA, the Max Planck Institute for Medical Research and Heidelberg University.
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Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
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Research funding: The submitted article does not contain information about medical device(s)/drug(s). This work was supported by German Research Foundation (DFG) within the Collaborative Research Center (SFB) 1158 (projects B01, B03, B06 and B07), by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung; PerPAIN consortium, FKZ:01 EC1904A) and the Baden-Württemberg Stiftung Internationales Spitzenförderungprogramm. No benefits in any form have been or will be received from a commercial party directly or indirectly related to the subject of this article.
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Conflict of interest statement: The authors declare no conflicts of interest regarding this article.
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