Reward deficiency and anti-reward in pain chronification

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:68

Review

Borsook, D.^1,2,3,4,7  Linnman, C.^1,2,3,7  Faria, V.^1,2,3,5,7  Strassman, A. M.^6,7  Becerra, L.^1,2,3,4,7  Elman, I.^8,9 

[1] Boston Childrens Hosp, Ctr Pain & Brain, Boston, MA 02115 USA

[2] Massachusetts Gen Hosp, Boston, MA 02114 USA

[3] Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA

[4] Mclean & Massachusetts Gen Hosp, Dept Psychiat, Boston, MA USA

[5] Uppsala Univ, Dept Psychol, Uppsala, Sweden

[6] Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA

[7] Harvard Med Sch, Boston, MA USA

[8] Wright State Univ, Boonshoft Sch Med, Dept Psychiat, Dayton, OH 45435 USA

[9] Dayton VA Med Ctr, Dayton, OH USA

关键词: Reward;    Motivation;    Aversion;    Analgesia;    Amygdala;    Habenula;    Nucleus accumbens;    Dopamine;    Addiction;    Stress;    Pain;   

DOI  :  10.1016/j.neubiorev.2016.05.033

来源: Elsevier

【 摘 要 】

Converging lines of evidence suggest that the pathophysiology of pain is mediated to a substantial degree via allostatic neuroadaptations in reward- and stress-related brain circuits. Thus, reward deficiency (RD) represents a within-system neuroadaptation to pain-induced protracted activation of the reward circuits that leads to depletion-like hypodopaminergia, clinically manifested anhedonia, and diminished motivation for natural reinforcers. Anti-reward (AR) conversely pertains to a between-systems neuroadaptation involving over-recruitment of key limbic structures (e.g., the central and basolateral amygdala nuclei, the bed nucleus of the stria terminalis, the lateral tegmental noradrenergic nuclei of the brain stem, the hippocampus and the habenula) responsible for massive outpouring of stressogenic neurochemicals (e.g., norepinephrine, corticotropin releasing factor, vasopressin, hypocretin, and substance P) giving rise to such negative affective states as anxiety, fear and depression. We propose here the Combined Reward deficiency and Anti-reward Model (CReAM), in which biopsychosocial variables modulating brain reward, motivation and stress functions can interact in a 'downward spiral' fashion to exacerbate the intensity, chronicity and comorbidities of chronic pain syndromes (i.e., pain chronification). (C) 2016 The Authors. Published by Elsevier Ltd.

【 授权许可】

Free