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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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“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]
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“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]
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Metadata
- 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 (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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
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