New developments in the understanding and management of persistent pain
Abstract
PURPOSE OF REVIEW: It is proposed that central rather than peripheral factors may be important in pain chronicity. We review recent empirical findings on these processes and discuss implications for treatment and prevention. RECENT FINDINGS: The literature on neuroimaging of pain and on learning processes shows that learning-induced functional and structural brain changes involving sensorimotor, as well as limbic and frontal, areas are important in the transition from acute to chronic pain. These alterations share many similarities with brain changes in emotional disorders and the specificity for pain needs to be determined. Further important contributors to chronic pain may be disturbed processing of the body image, impaired multisensory integration and faulty feedback from interoceptive processes. These findings have led to new treatment approaches that focus on the extinction of aversive memories, restoration of the body image and normal brain function and include approaches such as brain stimulation, mirror training, virtual reality applications or behavioral extinction training. SUMMARY: We propose that chronic pain is characterized by learning-related and memory-related plastic changes of the central nervous system with concomitant maladaptive changes in body perception. These alterations require new treatments that focus on the alteration of central pain memories and maladaptive body perception.
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Harm expectations that cause fear and avoidance have a particularly salient influence on pain-related functional outcomes and treatment responsiveness.
“GL challenges harm expectations that cause fear and avoidance, which have a particularly salient influence on pain-related functional outcomes[14; 52; 70; 71] and treatment responsiveness[54].”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [14]
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The association between physical activity and Body Awareness:
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- Authors
- Flor, H.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Flor, Herta
- ORCID
- Flor, Herta
- Venue
- Current Opinion in Psychiatry
- Published
- 2012-03
- Volume
- 25
- Issue
- 2
- Pages
- 109-113
- ISSN
- 0951-7367 (ISSN-L)
- OpenAlex
- W2076438733
- Cited by
- 125
- References
- 28
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 8 · 2023: 6 · 2022: 13 · 2021: 7 · 2020: 4 · 2019: 9 · 2018: 8 · 2017: 10 · 2016: 11 · 2015: 11 · 2014: 11 · 2013: 8 · 2012: 4
- FWCI
- 14.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic pain, central sensitization, neuroplasticity, pain memory, extinction training, body image, multisensory integration, interoception, mirror training, virtual reality, brain stimulation, neuroimaging of pain, transition from acute to chronic pain, pain management
- MeSH terms
- Body Image, Brain, Conditioning, Operant, Humans, Neuronal Plasticity, Perception, Self Concept, Empirical Research, Chronic Pain, Pain Management, Neuroimaging
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