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

Authors
  • Timmers, Inge1
  • Quaedflieg, Conny W E M2
  • Hsu, Connie3
  • Heathcote, Lauren C4
  • Rovnaghi, Cynthia R5
  • Simons, Laura E4
  • 1 Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, United States. Electronic address: [email protected] , (United States)
  • 2 Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. , (Netherlands)
  • 3 Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, United States. , (United States)
  • 4 Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, United States. , (United States)
  • 5 Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Stanford, CA 94304, United States. , (United States)
Type
Published Article
Publication Date
Oct 14, 2019
Volume
107
Pages
641–655
Identifiers
DOI: 10.1016/j.neubiorev.2019.10.007
PMID: 31622630
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. Copyright © 2019 Elsevier Ltd. All rights reserved.

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