An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior Greenwald & Shafritz (2018)

An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior Greenwald & Shafritz (2018)

 

1. What is the cause of pain hypersensitization in the peripheral nervous system, in general terms?

 

  • In general terms, the cause of pain hypersensitization in the peripheral nervous system is central sensitization, where prolonged peripheral nociceptive input results in the excitatory release of chemicals, which triggers a transduction cascade.

 

  • Hypersensitization: receptors more sensitized, more receptors in post-synaptic membrane, phosphorylate them to make them more sensitive to the ligand that binds

 

  • Chronic pain is related to deeper circuits in the brain

 

2. What is catastrophization and what is its relationship to classical conditioning? Be able to explain it in general terms (no specific conditioning paradigms are required).

 

  • Catastrophization is the belief that pain symptoms are indicative of a far worse injury, in turn resulting in pain-related fear and pain-related anxiety.

 

  • Its relationship to classical conditioning is that pain-related fear can be acquired through Pavlovian fear conditioning.

 

3. Which cortical network is involved in the perception and integration of acute pain signals?

 

  • The Salience Network is involved in the perception and integration of acute pain signals.

 

4. The dysregulation of which cortical network is associated with the development of chronic pain?

 

  • Dysregulation of the DMN is associated with the development of chronic pain.

 

5. Can the PAG-RVM system in the brainstem be controlled by cortical networks?

 

  • Yes, the PAG-RVM system in the brainstem can be controlled by cortical networks.

 

6. What does CRPS stand for? Know in general terms what this condition is (https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome).

 

  • CRPS stands for complex regional pain syndrome, and this condition is a pain disorder characterized by allodynia, swelling, dysautonomia, and temperature changing that cannot be attributed to another physiological disorder.

 

7. Pain sensation and perception are remarkably malleable. Is it related to cortical reorganization?

 

  • Pain sensation and perception are remarkably malleable, but they are not related to cortical reorganization.

 

8. In one study, back pain was classified as “acute” if it lasted less than 3 months and “chronic” otherwise. Which cortical network showed increased activation in each of the two groups? Based on these data, is correct to say that with time pain may get incorporated into your model of reality (i.e., it becomes you)?

 

  • The Salience Network (ACC and insula) showed increased activation in each of the chronic and not chronic back pain groups.

 

  • Pain may move into the DMN if persistent, and it make it it's home so it is correct to say that with time, pain may get incorporated into your model, this is why people struggle with chronic pain even though they have already been operated on

 

9. Look at Table 1 and think if you can suggest it to someone you know.

 

  • Okay.

 

10. What simple technique can be used to normalize dysregulation within the DMN?

 

  • Mindfulness meditation can also help to normalize dysregulation within the DMN.