Cited by 2,076Pain Mechanisms and TreatmentsPain Management and Placebo EffectPain Management and Treatment

Cognitive and emotional control of pain and its disruption in chronic pain

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Bushnell, M. Catherine, Čeko, Marta, Low, Lucie A.·2013·Nature Reviews Neuroscience

Abstract

Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind-body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states - important components of mind-body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.

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Crossref · 10.1038/nrn3516

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  • Both cognitive regulation and emotional regulation may be important in this context, and their exclusion for a complete focus on motor activity weakens the model elaborated by Sullivan and Vowles.

    “Both cognitive regulation (rational self-talk) and emotional regulation (e.g. self-soothing) may also be important here, 3 and their exclusion for a complete focus on motor activity weakens the model elaborated by Sullivan and Vowles.”
  • The pgACC facilitates top-down regulation of negative affect, affective modulation of pain, and autonomic regulation.

    “That is, the pgACC facilitates top-down regulation of negative effect, affective modulation of pain, and autonomic regulation.11,16,101,120,121”
  • Some of the brain regions consistently activated by nociceptive stimulation also show abnormal structure and function in chronic pain disorders, suggesting they may be involved in nociceptive processing and/or pain modulation.

    “Some of these regions also exhibit abnormal structure and function in chronic pain disorders, suggesting that they may be implicated in nociceptive processing and/or pain modulation2, 16, 23”

    From The dorsolateral prefrontal cortex in acute and chronic pain (2017) · cites this paper as [16]

  • Context-such as prior experience, expectations, mood, conditioning, desires, sensitization or habituation, and other cognitive factors-strongly shapes the subjective experience of pain.

    “previous experiences, expectations, mood, conditioning, desires, sensitization/habituation, and other cognitive factors can dramatically amplify and/or attenuate pain.78, 83–87”
  • Both lateral and medial systems thought to mediate "sensory" versus "affective" aspects of pain (e.g., S2/dpINS and dACC/aINS) are strongly responsive to nociceptive input.

    “both lateral and medial systems thought to mediate “sensory” versus “affective” aspects of pain (e.g., S2/dpINS and dACC/aINS, respectively) are strongly responsive to nociceptive input [13],[71].”

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Authors
Bushnell, M. C., Čeko, M., & Low, L. A.
Affiliations
National Institutes of Health (US)
Corresponding author
Bushnell, M. Catherine
Venue
Nature Reviews Neuroscience
Published
2013-05-30
Volume
14
Issue
7
Pages
502-511
ISSN
  • 1471-003X (ISSN-L)
  • 1471-0048
OpenAlex
W1999460576
Cited by
2,076
References
183
Citations by year
2026: 193 · 2025: 217 · 2024: 199 · 2023: 190 · 2022: 213 · 2021: 213 · 2020: 170 · 2019: 165 · 2018: 150 · 2017: 120 · 2016: 120 · 2015: 69 · 2014: 50 · 2013: 4 · 2012: 1
FWCI
8.93
Type
journal article
Language
en
Open access
Locations
  • Nature reviews. Neuroscience (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Center for Complementary and Alternative Medicine
  • National Center for Complementary and Integrative Health (ZIAAT000024)
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
chronic pain, pain modulation, cognitive control, emotional control, mind-body interventions, meditation, yoga, cognitive behavioral therapy, endogenous pain control, brain circuits, neural mechanisms of pain
MeSH terms
Attention, Brain, Cognition, Emotions, Humans, Pain Perception, Chronic Pain, Pain Management

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