Cited by 100Pain Mechanisms and TreatmentsPain Management and TreatmentPain Management and Placebo Effect

Threat response system: Parallel brain processes in pain vis-à-vis fear and anxiety

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Elman, Igor, Borsook, David·2018·Frontiers in Psychiatry

Abstract

Pain is essential for avoidance of tissue damage and for promotion of healing. Notwithstanding the survival value, pain brings about emotional suffering reflected in fear and anxiety, which in turn augment pain thus giving rise to a self-sustaining feedforward loop. Given such reciprocal relationships, the present article uses neuroscientific conceptualizations of fear and anxiety as a theoretical framework for hitherto insufficiently understood pathophysiological mechanisms underlying chronic pain. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain and nociception plus amygdala, anxiety, cognitive, fear, sensory, and unconscious. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) parallelism between acute pain and fear and between chronic pain and anxiety; (2) all are related to the evasion of sensory-perceived threats and are subserved by subcortical circuits mediating automatic threat-induced physiologic responses and defensive actions in conjunction with higher order corticolimbic networks (e.g., thalamocortical, thalamo-striato-cortical and amygdalo-cortical) generating conscious representations and valuation-based adaptive behaviors; (3) some instances of chronic pain and anxiety conditions are driven by the failure to diminish or block respective nociceptive information or unconscious treats from reaching conscious awareness; and (4) the neural correlates of pain-related conscious states and cognitions may become autonomous (i.e., dissociated) from the subcortical activity/function leading to the eventual chronicity. Identifying relative contributions of the diverse neuroanatomical sources, thus, offers prospects for the development of novel preventive, diagnostic, and therapeutic strategies in chronic pain patients.

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Crossref · 10.3389/fpsyt.2018.00029

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  • The positive association between BNST volume and perceived stress and depressive symptomatology provides further support for a role for the BNST in stress response and allostasis.

    “Our finding of a positive association between BNST volume and self-reported perceived stress and depressive symptomatology, provides further support for a putative role for BNST in both stress response and allostasis [48,55].”

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  1. [4]Keefe FJ Pryor RW Encyclopedia of Pain. Berlin, NY: Springer (2007).
  2. [20]Merskey H Bogduk N International Association for the Study of Pain. Task Force on Taxonomy. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: IASP Press (1994).
  3. [29]Feist J Feist GJ Theories of Personality. Boston: McGraw Hill Higher Education (2009).
  4. [36]Raniga P Bryan P Egan G Resting State Functional Coupling between the Ascending Synchronising System, Limbic System and the Default Mode Network via Theta Oscillations. bioRxiv (2016). Available from: https://www.biorxiv.org/content/early/2016/11/08/086058

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Authors
Elman, I., & Borsook, D.
Affiliations
  • Wright State University (US)
  • Boston Children's Hospital (US)
Corresponding author
Elman, Igor
Venue
Frontiers in Psychiatry
Published
2018-02-20
Volume
9
Pages
29-29
ISSN
1664-0640 (ISSN-L)
OpenAlex
W2789447644
Cited by
100
References
145
Citations by year
2026: 9 · 2025: 12 · 2024: 9 · 2023: 14 · 2022: 29 · 2021: 10 · 2020: 7 · 2019: 5 · 2018: 5
FWCI
0.89
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Health Services Research and Development (1 I01 CX001118–01A2)
Topics
  • Health Sciences › Medicine › Physiology › 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, anxiety, fear, threat response, amygdala, nociception, cortico-limbic network, thalamocortical circuits, pain-related cognitions, pain chronification

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