Threat response system: Parallel brain processes in pain vis-à-vis fear and anxiety
Open accessAbstract
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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Albinni, B., Zimmerman, M. S., Alasha, V. J., Ross, J., Crankshaw, L., Hu, S. R., Schuster, N. M., & Case, L. K. (2026) · The Journal of Physiology · doi:10.1113/jp290243 · Cited by 2 · see citing works
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Pain, Fear, Anxiety, and Stress: Relations to the Endogenous Opioid System
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Another piece in the marijuana for pain quandary
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Physiologic stress and its effect on health and welfare
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Un ou plusieurs inconscients dans nos neurones ?
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Anchoring Post-Secondary Readiness in Social-Emotional Learning
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Cistite idiopática felina: Revisão de literatura
Silva, J. G. S. E., Barbosa, G. C. C., & de Souza, S. S. (2022) · Editora Poisson eBooks · doi:10.36229/978-65-5866-216-7.cap.48
O papel do médico veterinário na segurança alimentar
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Impacto da pandemia Covid-19 sob as medidas de erradicação da febre aftosa no estado do Amazonas
da Silva, M. D. A., da Silveira, H. A., de Souza, S. S., & Raizer, M. D. M. (2022) · Editora Poisson eBooks · doi:10.36229/978-65-5866-216-7.cap.01
Prevalência de casos de doença do trato urinário inferior felino em uma clínica
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Extração de dentição supranumerária em cão: Relato de caso
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Aplicação da ecografia ocular pelos veterinários na cidade de Manaus – AM
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Complicações do uso anestésico em cães e gatos geriátricos
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Erkrankungen von Leber und Pankreas
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Fear memory engram is the mind-killer
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A valuation based theory of learning’s origin and development
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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
- Publisher
- Frontiers Media SA
- Published
- 2018-02-20
- Volume
- 9
- Pages
- 29-29
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC5826179
- 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
- gold
- doi.org
- 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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