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

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Towards a theory of chronic pain

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

DOI 10.1016/j.pneurobio.2008.09.018PMC PMC2650821

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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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Authors: Apkarian, A. V., Baliki, M. N., & Geha, P. Y.
Affiliations: Northwestern University (US)
Corresponding author: Apkarian, A. Vania
ORCID: Apkarian, A. Vania
Baliki, Marwan N.
Geha, Paul Y.
Venue: Progress in Neurobiology
Publisher: Elsevier BV
Published: 2009-02
Volume: 87
Issue: 2
Pages: 81-97
ISSN: 0301-0082 (ISSN-L)
DOI: 10.1016/j.pneurobio.2008.09.018
PMC: PMC2650821
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: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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 (medical) › 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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