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Reward deficiency and anti-reward in pain chronification
D Borsook1, C Linnman2, V Faria3
1Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospitals, USA; Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, USA; Department of Psychiatry, Mclean and Massachusetts General Hospital, USA; Harvard Medical School, Boston MA, USA.
Neuroscience and Biobehavioral Reviews
|June 2, 2016
Summary
Chronic pain involves neuroadaptations in reward and stress circuits. The Combined Reward deficiency and Anti-reward Model (CReAM) explains how these factors worsen pain chronification.
Area of Science:
- Neuroscience
- Pain Research
- Psychiatry
Background:
- Chronic pain pathophysiology involves allostatic neuroadaptations.
- Reward deficiency (RD) and anti-reward (AR) systems are implicated.
- These adaptations affect reward, motivation, and stress circuits.
Purpose of the Study:
- To propose the Combined Reward deficiency and Anti-reward Model (CReAM).
- To explain how biopsychosocial factors interact in chronic pain.
- To elucidate mechanisms of pain chronification.
Main Methods:
- Conceptual model development.
- Integration of existing neurobiological evidence.
- Analysis of reward and stress circuit interactions.
Main Results:
- RD involves hypodopaminergia, anhedonia, and reduced motivation.
- AR involves over-recruitment of limbic structures and stress neurochemical release.
- CReAM posits a 'downward spiral' interaction exacerbating pain.
Conclusions:
- The CReAM model offers a framework for understanding chronic pain.
- Biopsychosocial variables critically modulate pain intensity and chronicity.
- This model may inform therapeutic strategies for chronic pain syndromes.
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