Psychobiological mechanisms of pain persistence

ongoing

Persistent or chronic pain is a key medical and societal problem. In the last decades, biomedical research has undertaken enormous efforts to develop treatments for persistent pain, but the results have been disappointing. This project proposes a radical shift, namely to target the early development of pain persistence and to investigate psychological interventions directed at negative expectations, control and reward in experimental long-term pain studies. A methodological work package will develop novel tools, such as MR spectroscopy of the spinal cord, to track metabolic changes related to persistent pain, and to identify the mechanisms of the proposed interventions. All studies are guided by an integrative model outlining how psychological factors, such as negative expectations and loss of control, can affect the development of pain persistence, and more importantly, how to counteract this process. We will, for example, augment the perception of pain decreases by expectations or use reward manipulations to reinstantiate the effectiveness of the pain modulatory system. Finally, the model proposes that the inability to control pain leads to a state of helplessness. Consequently, the role of helplessness will be investigated and we will test interventions with the goal to allow subjects to regain control over their pain. This will be possible, through the development of a novel pain assessment device, which can be used to detect spontaneous pain decreases and prompt the subject to perform an action (i.e. self-administer a putative treatment). Through the illusion of control, subjects perceive that their action is causal for the pain relief, even though it is actually pain reductions that trigger their action. In the future, this will also allow treatment of patients in which pain is already persistent, and allow them to regain perceived control over, and hence reduce, their pain.