Psychological processing in chronic pain: a neural systems approach
Open accessAbstract
Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology.
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Harm expectations that cause fear and avoidance have a particularly salient influence on pain-related functional outcomes and treatment responsiveness.
“GL challenges harm expectations that cause fear and avoidance, which have a particularly salient influence on pain-related functional outcomes[14; 52; 70; 71] and treatment responsiveness[54].”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [52]
In the Introduction, section 2, the paper says that continued fear of movement can lead to avoidance behaviors that maintain or worsen pain and promote disability. It also describes exposure treatment as challenging fear expectancies, but does not establish that those expectations influence treatment responsiveness. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCognitive interventions have focused mainly on trying to reduce the threat value of pain, with some good evidence that we are identifying relevant processes.
“Cognitive interventions have focused mainly on trying to reduce the threat value of pain, with some good evidence that we are identifying relevant processes. 1,12,13”
From Patient action as means and end of chronic pain care: Risks and routes to meaningful action (2017) · cites this paper as [13]
In §2, the paper describes graded exposure as targeting fear of pain and correcting fear expectancies, and reports evidence for acceptance-based treatment and associated changes in cognitive control. It does not establish that cognitive interventions have *mainly* focused on reducing pain’s threat value. §5 also characterizes the effects of current behavioral therapies in controlled trials as relatively weak. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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- Authors
- Simons, L. E., Elman, I., & Borsook, D.
- Affiliations
- Boston Children's Hospital (US)
- Veterans Administration (US)
- Corresponding author
- Simons, Laura E.
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 39
- Pages
- 61-78
- ISSN
- 0149-7634 (ISSN-L)
- PMC
- PMC3944001
- OpenAlex
- W2065687898
- Cited by
- 359
- References
- 273
- Citations by year
- 2026: 16 · 2025: 27 · 2024: 26 · 2023: 27 · 2022: 26 · 2021: 32 · 2020: 39 · 2019: 45 · 2018: 29 · 2017: 36 · 2016: 23 · 2015: 19 · 2014: 14
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (K24NS064050, NS064050)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD067202, HD067202)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic pain, pain neuroscience education, neural circuits, emotional pain, interoception, cognitive processes, pain phenotypes, psychological treatment of pain, pain expression
- MeSH terms
- Brain, Female, Humans, Male, Nerve Net, Sex Factors, Chronic Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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