The interaction between stress and chronic pain through the lens of threat learning

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:107

Review

Timmers, Inge¹  Quaedflieg, Conny W. E. M.²  Hsu, Connie³  Heathcote, Lauren C.¹  Rovnaghi, Cynthia R.⁴  Simons, Laura E.¹ 

[1] Stanford Univ, Sch Med, Dept Anesthesiol Perioperat & Pain Med, 1070 Arastradero Rd,Suite 300, Palo Alto, CA 94304 USA

[2] Maastricht Univ, Dept Clin Psychol Sci, POB 616, NL-6200 MD Maastricht, Netherlands

[3] Northwestern Univ, Feinberg Sch Med, 420 E Super St, Chicago, IL 60611 USA

[4] Stanford Univ, Sch Med, Dept Pediat, 770 Welch Rd,Suite 435, Stanford, CA 94304 USA

关键词: Chronic pain;    HPA axis;    Stress;    Cortisol;    Learning and memory;    Threat learning;    Fear avoidance model;    Pain;   

DOI  :  10.1016/j.neubiorev.2019.10.007

来源: Elsevier

【 摘 要 】

Stress and pain are interleaved at multiple levels - interacting and influencing each other. Both are modulated by psychosocial factors including fears, beliefs, and goals, and are served by overlapping neural substrates. One major contributing factor in the development and maintenance of chronic pain is threat learning, with pain as an emotionally-salient threat - or stressor. Here, we argue that threat learning is a central mechanism and contributor, mediating the relationship between stress and chronic pain. We review the state of the art on (mal) adaptive learning in chronic pain, and on effects of stress and particularly cortisol on learning. We then provide a theoretical integration of how stress may affect chronic pain through its effect on threat learning. Prolonged stress, as may be experienced by patients with chronic pain, and its resulting changes in key brain networks modulating stress responses and threat learning, may further exacerbate these impairing effects on threat learning. We provide testable hypotheses and suggestions for how this integration may guide future research and clinical approaches in chronic pain.

【 授权许可】

Free