Beyond nociception: the imprecision hypothesis chronic pain
Date
2015
Authors
Moseley, G.L.
Vlaeyen, J.W.S.
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Journal article
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Pain, 2015; 156(1):35-38
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Abstract
Chronic pain is the most burdensome health issue facing the world today; its cost to Western countries is comparable with that of diabetes and cancer combined. Our understanding of the pathophysiology of chronic pain has increased substantially over the past 20 years, including but not limited to changes in the brain. However, we still do not know why chronic pain develops in some people and not in others, although we do know that the type or extent of their injury, personality, occupation, postcode, education level, race, or religion are not strong predictors. Extensive research into the genetics of chronic pain has also thus far been underwhelming, perhaps because too many genes are involved and results are conflicting.
Chronic pain is very difficult to treat; 60% of those with chronic pain will still be in pain after 1 year. It seems that despite extensive advances in multiple fields, we have made little ground. In this topical review, we put forward a new hypothesis of chronic pain that explains the most common painful disorders, such as chronic widespread pain, nonspecific back or neck pain, and fibromyalgia. Our hypothesis draws on a long history of fundamental research in associative learning and is based on 2 core assumptions (1) that pain can be considered a response, not just a stimulus, and (2) that encoding non-nociceptive information predictably coincident with nociceptive input underpins the response to subsequent similar events.
Briefly, our hypothesis posits that the precision with which multisensory information (temporal, proprioceptive, spatial) about the painful event is encoded and represented in the brain will determine the degree to which the painful response will subsequently generalize to similar events.
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Copyright 2014 International Association for the Study of Pain