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Pain & the Brain: How Pain Alters the Brain, and How Perception Shapes Pain

Credits: None available.

Pain & the Brain: 

How Pain Alters the Brain, & How Perception Shapes Pain


There is strong and convincing evidence that specific brain properties contribute to the risk of developing chronic pain and that the transition to chronic pain involves brain adaptations that, to a large part, construct and mold the state of chronic pain. Psychological and personality factors, socioeconomic status, and brain properties all contribute to chronic pain.

Human neuroimaging studies and complementary animal experiments now identify the gross elements of the brain involved in the chronification of pain. The emotional brain (i.e., the corticolimbic system) plays an important role in the modulation of acute pain and in the prediction and amplification of chronic pain.

The interrelationship between patient-reported outcomes (PROs)and pain ratings, especially in the clinical setting, remains minimally explored. Early work within this purview demonstrates surprising relationships between personality, pain ratings, and clinical pain states. 

Desirable Physician Attributes

  • Patient Care [ACGME/ABMS & IOM] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
  • Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  • Employ Evidence-based Practice [IOM] Integrate best research with clinical expertise and patient values for optimum care and participate in learning and research activities to the extent feasible

Accreditation & Designation

Release date: This activity was released 8/28/2021.

Termination date: The content of this activity remains eligible for CME Credit until 8/27/2024, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships

Neither the presenter, reviewers nor any other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, any financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Additional Reading

  • Berger, S. E., Branco, P., Vachon-Presseau, E., Abdullah, T. B., Cecchi, G., & Apkarian, A. V. (2021). Quantitative language features identify placebo responders in chronic back pain. Pain, 162(6), 1692-1704.
  • Apkarian, A. V. (2021). The Necessity of Methodological Advances in Pain Research: Challenges and Opportunities. Frontiers in Pain Research, 2, 10.
  • Vachon-Presseau, E., Berger, S. E., Abdullah, T. B., Griffith, J. W., Schnitzer, T. J., & Apkarian, A. V. (2019). Identification of traits and functional connectivity-based neurotraits of chronic pain. PLoS Biology, 17(8), e3000349.
  • Vachon-Presseau, E., Centeno, M. V., Ren, W., Berger, S. E., Tetreault, P., Ghantous, M., ... & Apkarian, A. V. (2016). The emotional brain as a predictor and amplifier of chronic pain. Journal of Dental Research, 95(6), 605-612.
  • Baliki, M. N., & Apkarian, A. V. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), 474-491.
  • Hashmi JA, Baliki MN, Huang L, Parks EL, Chanda ML, Schnitzer T, Apkarian AV. Lidocaine patch (5%) is No more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study. Mol Pain 2012;8:29.
  • Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci 2015;16:403–18.
  • Vachon-Presseau E, Berger SE, Abdullah TB, Huang L, Cecchi GA, Griffith JW, Schnitzer TJ, Apkarian AV. Brain and psychological determinants of placebo pill response in chronic pain patients. Nat Commun 2018;9:3397.
  • Reckziegel, D., Abdullah, T., Wu, B., Wu, B., Huang, L., Schnitzer, T. J., & Apkarian, A. V. (2021). Hippocampus shape deformation: a potential diagnostic biomarker for chronic back pain in women. Pain, 162(5), 1457-1467.
  • Phelps, C. E., Navratilova, E., & Porreca, F. (2021). Chronic pain produces reversible memory deficits that depend on task difficulty in rats. The Journal of Pain.



  • 0.75 - Physician
  • 0.75 - Non-Physician

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