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Cognitive and emotional control of pain and its disruption in chronic pain
Open accessAbstract
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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“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.”
From Patient action as means and end of chronic pain care: Risks and routes to meaningful action (2017) · cites this paper as [3]
In the citing paper
“That is, the pgACC facilitates top-down regulation of negative effect, affective modulation of pain, and autonomic regulation.11,16,101,120,121”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [16]
In the citing paper
“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]
In the citing paper
“previous experiences, expectations, mood, conditioning, desires, sensitization/habituation, and other cognitive factors can dramatically amplify and/or attenuate pain.78, 83–87”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [83]
In the citing paper
“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].”
From Distinct Brain Systems Mediate the Effects of Nociceptive Input and Self-Regulation on Pain (2015) · cites this paper as [13]
In the citing paper
“Heat-pain versus Warmth was predicted by activation in many regions associated with nociceptive processing and endogenous pain control36,37, such as right (contralateral) dpINS, bilateral S2, medial thalamus and periaqueductal gray (PAG).”
From Separate neural representations for physical pain and social rejection (2014) · cites this paper as [37]
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Metadata
- 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
- PMC
- PMC4465351
- 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
- FWCI
- 8.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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 (medical) › 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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