Towards a taxonomy of pain modulations

doi:10.1016/j.tics.2015.02.007

Trends in Cognitive Sciences

Volume 19, Issue 4, April 2015, Pages 180-182

https://doi.org/10.1016/j.tics.2015.02.007 Get rights and content

The subjective experience of pain is affected by various modulating factors, such as the sufferer's level of anxiety or distraction. A recent study sheds light on the neural underpinnings of pain modulation and illustrates how we can advance towards an integrated psychological, neurobiological and clinical taxonomy of pain modulations.

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Acknowledgments

The authors’ work was supported by grants from the Deutsche Forschungsgemeinschaft (PL 321/10-1, PL 321/11-1, RTG 1373 to M.P.; FOR 1328, SFB 936 to U.B.) and the Medical Research Council UK to K.W.

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The available evidence does not so far allow more systematic mapping of the relationship between oscillations, cerebral information flow, and the experience of pain and its modulations. This lack of evidence is at least partly due to a lack of a systematic understanding of pain modulations [96]. Conversely, the systematic assessment of brain oscillations might represent a promising approach to establish a taxonomy [96] or ontology [97] of different types of pain modulation based on patterns of oscillations and cerebral information flow.
Pain is an integrative phenomenon that results from dynamic interactions between sensory and contextual (i.e., cognitive, emotional, and motivational) processes. In the brain the experience of pain is associated with neuronal oscillations and synchrony at different frequencies. However, an overarching framework for the significance of oscillations for pain remains lacking. Recent concepts relate oscillations at different frequencies to the routing of information flow in the brain and the signaling of predictions and prediction errors. The application of these concepts to pain promises insights into how flexible routing of information flow coordinates diverse processes that merge into the experience of pain. Such insights might have implications for the understanding and treatment of chronic pain.
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In this chapter, we summarize the neurocognitive processes underlying acute pain and the impact of emotions on these processes. First, we briefly introduce the neural substrates of nociception and pain, as well as emotions, and potential shared networks. Then, we focus on the emotional modulation of experimentally induced acute pain by affective visual stimuli, both affective scenes and emotional faces. Thus we review literature investigating the influence of emotions on subjective, peripheral, and cerebral correlates of pain perception. A special section thereby deals with the effect of facial expressions of pain perception and on the mutual influences. Overall, a viewpoint emerges that emotions can exert their effects at multiple levels of pain processing (supraspinal and spinal). However, it also becomes clear that pain reversely influences emotion perception, although future research needs to probe the effects of pain at various levels of emotion processing by using different psychophysiological methods. Furthermore, the emotion–pain interactions and their neural substrates, which potentially are characterized by multiple feedback mechanisms, still need to be clarified more precisely.
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Trends in Cognitive Sciences

SpotlightTowards a taxonomy of pain modulations

Section snippets

Acknowledgments

Trends Cogn. Sci.

Prog. Neurobiol.

Trends Cogn. Sci.

Cognitive and emotional control of pain and its disruption in chronic pain

Nat. Rev. Neurosci.

Direct evidence for spinal cord involvement in placebo analgesia

Science

Spotlight
Towards a taxonomy of pain modulations