Emotional and motivational pain processing : current state of knowledge and perspectives in translational research

Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

It has been well-documented that the brain changes in states of chronic pain. Less is known about changes in the brain that predict the transition from acute to chronic pain. Evidence from neuroimaging studies suggests a shift from brain regions involved in nociceptive processing to corticostriatal brain regions that are instrumental in the processing of reward and emotional learning in the transition to the chronic state. In addition, dysfunction in descending pain modulatory circuits encompassing the periaqueductal gray and the rostral anterior cingulate cortex may also be a key risk factor for pain chronicity. Although longitudinal imaging studies have revealed potential predictors of pain chronicity, their causal role has not yet been determined. Here we review evidence from studies that involve non-invasive brain stimulation to elucidate to what extent they may help to elucidate the brain circuits involved in pain chronicity. Especially, we focus on studies using non-invasive brain stimulation techniques [e.g., transcranial magnetic stimulation (TMS), particularly its repetitive form (rTMS), transcranial alternating current stimulation (tACS), and transcranial direct current stimulation (tDCS)] in the context of musculoskeletal pain chronicity. We focus on the role of the motor cortex because of its known contribution to sensory components of pain via thalamic inhibition, and the role of the dorsolateral prefrontal cortex because of its role on cognitive and affective processing of pain. We will also discuss findings from studies using experimentally induced prolonged pain and studies implicating the DLPFC, which may shed light on the earliest transition phase to chronicity. We propose that combined brain stimulation and imaging studies might further advance mechanistic models of the chronicity process and involved brain circuits. Implications and challenges for translating the research on mechanistic models of the development of chronic pain to clinical practice will also be addressed

Brain-behaviour correlates of habitual motivation in chronic back pain

Nees F, Ruttorf M, Fuchs X, Rance M, Beyer N. Brain-behaviour correlates of habitual motivation in chronic back pain. Scientific Reports. 2020;10(1): 11090

Jugendliches Alkoholkonsumverhalten während der COVID-19-Pandemie und die Bedeutung von Achtsamkeit

Zielsetzung: Kognitive und psychosoziale Faktoren können zu individuellen Veränderungen im Alkoholmissbrauch beitragen und führen im Jugendalter zu einer erhöhten Vulnerabilität. In diesem Kontext spielt die aktuelle COVID-19 Pandemie eine wichtige Rolle. In der aktuellen Studie wird untersucht, ob ein Anstieg negativer Gedanken in der Pandemie einen Risikofaktor für einen erhöhten Alkoholkonsum darstellt und welche Rolle hierbei Achtsamkeit spielt. Methodik: An der Untersuchung nahmen 72 Jugendliche (36 weiblich, Alter 15.13 ± 1.0 Jahre) teil, von denen N = 21 einen Onlinefragebogen vollständig während der ersten Lockdown-Phase der Pandemie (Frühjahr 2020) und dem Übergang in die zweite Welle im Abstand von jeweils 14 Tagen und über 6 Wochen zu ihrem Alkoholkonsum, Kognitionen, Emotionserleben und ihrer sozialen Belastung ausfüllten. Ergebnisse: Während sich der Alkoholkonsum der Jugendlichen im Verlauf der Pandemie nicht signifikant veränderte, zeigten sich deutlichere Veränderungen in den kognitiven und psychosozialen Belastungen der Jugendlichen. Negative Gedanken waren hierbei ein signifikanter Prädiktor für den Alkoholkonsum zu Beginn der zweiten COVID-19-Welle (b = 1.314, p < .01). Dieser Zusammenhang wurde durch Trait-Achtsamkeit signifikant moderiert (b = -.283, p < .01). Diskussion: Negative Gedanken scheinen ein wichtiger Faktor für das Alkoholkonsumverhalten im ersten Verlauf der COVID-19 Pandemie zu sein und könnten somit das Risiko eines Alkoholmissbrauchs im weiteren Verlauf der Pandemie deutlich erhöhen. Achtsamkeit scheint solchen negativen Entwicklungen entgegenwirken zu können.Objective: Cognitive and psychosocial factors contribute to individual differences in alcohol (mis)use and increase the risk of alcohol abuse during adolescence. In this context, the COVID-19 pandemic is of high importance. The current study investigates whether an increase in negative thoughts during the COVID-19 pandemic is a risk factor for heightened alcohol use, and the extent to which mindfulness plays a role. Methods: We examined 72 adolescents (36 female, age 15.13 ± 1.0 years), with N = 21 completing an online survey over 6 weeks, with an interval of 14 days, during the fi rst lock-down in Germany (Spring 2020) and the transition into the second wave, to examine alcohol use, emotional fac- tors and social burdens during the COVID-19 pandemic. Results: While alcohol use did not signifi cantly change during the fi rst wave of the pandemic, more clear changes were observed for cognitive and psychosocial factors. Negative thoughts at the end of the fi rst lock down hereby signifi cantly predicted alcohol use at the beginning of the second wave (b = 1.314, p < .01). Trait mindfulness served as a signifi cant moderator in this context (b = -.283, p < .01). Conclusion: Negative thoughts seem to play an important role for alcohol use during the fi rst wave of the COVID-19 pandemic and could therefore increase the risk of substance abuse considerably in the following course of the pandemic. Mindful- ness seems to counteract such negative developments

Prediction Along a Developmental Perspective in Psychiatry: How Far Might We Go?

Most mental disorders originate in childhood, and once symptoms present, a variety of psychosocial and cognitive maladjustments may arise. Although early childhood problems are generally associated with later mental health impairments and psychopathology, pluripotent transdiagnostic trajectories may manifest. Possible predictors range from behavioral and neurobiological mechanisms, genetic predispositions, environmental and social factors, and psychopathological comorbidity. They may manifest in altered neurodevelopmental trajectories and need to be validated capitalizing on large-scale multi-modal epidemiological longitudinal cohorts. Moreover, clinical and etiological variability between patients with the same disorders represents a major obstacle to develop effective treatments. Hence, in order to achieve stratification of patient samples opening the avenue of adapting and optimizing treatment for the individual, there is a need to integrate data from multi-dimensionally phenotyped clinical cohorts and cross-validate them with epidemiological cohort data. In the present review, we discuss these aspects in the context of externalizing and internalizing disorders summarizing the current state of knowledge, obstacles, and pitfalls. Although a large number of studies have already increased our understanding on neuropsychobiological mechanisms of mental disorders, it became also clear that this knowledge might only be the tip of the Eisberg and that a large proportion still remains unknown. We discuss prediction strategies and how the integration of different factors and methods may provide useful contributions to research and at the same time may inform prevention and intervention

Stress-induced analgesia in patients with chronic musculoskeletal pain and healthy controls

Introduction: Individuals with chronic musculoskeletal pain show impairments in their pain-modulatory capacity. Stress-induced analgesia (SIA) is a paradigm of endogenous pain inhibition mainly tested in animals. It has not been tested in patients with chronic pain despite the important role of stress in pain modulation and the chronicity process. Methods: SIA was tested in 22 patients with chronic musculoskeletal pain and 18 healthy participants matched for age and gender. Pain thresholds, pain tolerance and suprathreshold pain sensitivity were examined before and after a cognitive stressor. Additionally, chronic stress levels, pain catastrophizing and pain characteristics were assessed as potential modulating factors. Results: Patients with chronic musculoskeletal pain compared to healthy controls showed significantly impaired SIA (F(1,37)=5.63, p=.02) for pain thresholds, but not pain tolerance (F(1,37)=0.05, p=.83) and stress-induced hyperalgesia (SIH) to suprathreshold pain ratings (F(1,37)=7.76, p=.008). Patients (r(22)=-0.50, p=.05) but not controls (r(18)=-0.39, p=.13) with high catastrophizing had low SIA as assessed by pain thresholds. In controls suprathreshold pain ratings were significantly positively correlated with catastrophizing (r(18)=0.57, p=.03) and life-time stress exposure (r(18)=0.54, p=.03). In patients neither catastrophizing (r(22)=0.21, p=.34) nor stress exposure (r(22)=0.34, p=.34) were associated with suprathreshold SIH. Discussion: Our data suggest impairments of SIA and SIH in patients with chronic musculoskeletal pain. Catastrophizing was associated with deficient SIA in the patients and higher pain ratings in controls. High life time stress also increased pain ratings in the controls