Cited by 880Pain Mechanisms and TreatmentsPain Management and TreatmentPain Management and Placebo Effect

Towards a theory of chronic pain

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Apkarian, A. Vania, Baliki, Marwan N., Geha, Paul Y.·2009·Progress in Neurobiology

Abstract

In this review, we integrate recent human and animal studies from the viewpoint of chronic pain. First, we briefly review the impact of chronic pain on society and address current pitfalls of its definition and clinical management. Second, we examine pain mechanisms via nociceptive information transmission cephalad and its impact and interaction with the cortex. Third, we present recent discoveries on the active role of the cortex in chronic pain, with findings indicating that the human cortex continuously reorganizes as it lives in chronic pain. We also introduce data emphasizing that distinct chronic pain conditions impact on the cortex in unique patterns. Fourth, animal studies regarding nociceptive transmission, recent evidence for supraspinal reorganization during pain, the necessity of descending modulation for maintenance of neuropathic behavior, and the impact of cortical manipulations on neuropathic pain is also reviewed. We further expound on the notion that chronic pain can be reformulated within the context of learning and memory, and demonstrate the relevance of the idea in the design of novel pharmacotherapies. Lastly, we integrate the human and animal data into a unified working model outlining the mechanism by which acute pain transitions into a chronic state. It incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronic pain conditions within a single model.

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Crossref · 10.1016/j.pneurobio.2008.09.018

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  • The transition from acute to chronic pain entails a transition in the salience of pain, from viewing a painful percept as a sign of external threat to an indication of an internalized disease state.

    “As stated by Apkarian et al, 7 the transition from acute to chronic pain entails also a transition in the salience of pain, wherein the condition shifts from viewing a painful percept as a sign of external threat into an indication of an internalized disease state.”

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Authors
Apkarian, A. V., Baliki, M. N., & Geha, P. Y.
Affiliations
Northwestern University (US)
Corresponding author
Apkarian, A. Vania
Venue
Progress in Neurobiology
Publisher
Elsevier BV
Published
2009-02
Volume
87
Issue
2
Pages
81-97
ISSN
0301-0082 (ISSN-L)
OpenAlex
W1995458911
Cited by
876
References
151
Citations by year
2026: 62 · 2025: 57 · 2024: 41 · 2023: 28 · 2022: 35 · 2021: 51 · 2020: 46 · 2019: 53 · 2018: 48 · 2017: 65 · 2016: 55 · 2015: 47 · 2014: 68 · 2013: 57 · 2012: 59
FWCI
3.69
Type
journal article
Language
en
Open access
Locations
  • Progress in Neurobiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Neurological Disorders and Stroke (NS 57704, R21NS053602, NS35115, NS53602, R01NS057704, R01NS035115)
Topics
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Keywords
chronic pain, nociception, descending pain modulation, neuropathic pain, cortical reorganization, acute to chronic pain transition, pain mechanisms, pharmacological pain management
MeSH terms
Animals, Brain, Brain Mapping, Chronic Disease, Humans, Pain, Pain Management

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