Cited by 215Pain Mechanisms and TreatmentsPain Management and Placebo EffectPain Management and Treatment

Pain and analgesia: the value of salience circuits

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Borsook, David, Edwards, Robert, Elman, Igor, Becerra, Lino, Levine, Jon·2013·Progress in Neurobiology

Abstract

Evaluating external and internal stimuli is critical to survival. Potentially tissue-damaging conditions generate sensory experiences that the organism must respond to in an appropriate, adaptive manner (e.g., withdrawal from the noxious stimulus, if possible, or seeking relief from pain and discomfort). The importance we assign to a signal generated by a noxious state, its salience, reflects our belief as to how likely the underlying situation is to impact our chance of survival. Importantly, it has been hypothesized that aberrant functioning of the brain circuits which assign salience values to stimuli may contribute to chronic pain. We describe examples of this phenomenon, including 'feeling pain' in the absence of a painful stimulus, reporting minimal pain in the setting of major trauma, having an 'analgesic' response in the absence of an active treatment, or reporting no pain relief after administration of a potent analgesic medication, which may provide critical insights into the role that salience circuits play in contributing to numerous conditions characterized by persistent pain. Collectively, a refined understanding of abnormal activity or connectivity of elements within the salience network may allow us to more effectively target interventions to relevant components of this network in patients with chronic pain.

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Crossref · 10.1016/j.pneurobio.2013.02.003

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  • A higher stimulus intensity is likely to be more salient, and thus have more importance assigned to it which could increase its influence on perceived pain.

    “A higher stimulus intensity is likely to be more salient, and thus have more importance assigned to it which could increase its influence on perceived pain54.”

    From Boundary effects of expectation in human pain perception (2019) · cites this paper as [54]

  • Emotional distress and psychosocial stress increase the likelihood of transition from acute to chronic musculoskeletal pain.

    “emotional distress and psychosocial stress have been shown to increase the likelihood of transitioning from acute to chronic musculoskeletal pain 18, 36, 37, 41, 42.”
  • Prospective studies suggest that pre-morbid psychological dysfunction is a risk factor for later development of many chronic pain conditions, including musculoskeletal pain and functional pain disorders.

    “prospective studies suggest that pre-morbid psychological dysfunction represents a risk factor for the future development of numerous chronic pain conditions including musculoskeletal pain and functional pain disorders 14, 36–39.”

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Authors
Borsook, D., Edwards, R., Elman, I., Becerra, L., & Levine, J.
Affiliations
  • Boston Children's Hospital (US)
  • Brigham and Women's Hospital (US)
  • Cambridge Health Alliance (US)
  • University of California, San Francisco (US)
Corresponding author
Borsook, David
Venue
Progress in Neurobiology
Publisher
Elsevier BV
Published
2013-05
Volume
104
Pages
93-105
ISSN
0301-0082 (ISSN-L)
OpenAlex
W2008554353
Cited by
215
References
171
Citations by year
2026: 15 · 2025: 17 · 2024: 10 · 2023: 20 · 2022: 21 · 2021: 16 · 2020: 14 · 2019: 19 · 2018: 15 · 2017: 15 · 2016: 16 · 2015: 23 · 2014: 9 · 2013: 4 · 2012: 1
FWCI
1.91
Type
journal article
Language
en
Open access
Locations
  • Progress in Neurobiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (5r01ns065051-02)
  • National Institute on Aging (R01AG034982)
  • National Institute of Neurological Disorders and Stroke (R01-NS-065051, K24NS064050)
Topics
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
salience network, chronic pain, pain perception, analgesia, placebo analgesia, pain catastrophizing, pain underreporting, noxious stimuli, brain circuits
MeSH terms
Analgesia, Analgesics, Animals, Humans, Pain, Pain Measurement, Pain Management

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