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Role of the Prefrontal Cortex in Pain Processing.

Wei-Yi Ong1,2, Christian S Stohler3, Deron R Herr4

  • 1Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore. wei_yi_ong@nuhs.edu.sg.

Molecular Neurobiology
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Summary

The prefrontal cortex (PFC) plays a dual role in pain, mediating pain relief and potentially causing chronic pain. Its structure and function can be altered by pain but may recover with treatment.

Keywords:
AntinociceptionNociceptionPainPrefrontal cortex

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Area of Science:

  • Neuroscience
  • Pain Research
  • Cognitive Neurology

Background:

  • The prefrontal cortex (PFC) is crucial for executive functions and pain processing.
  • PFC function in pain relies on its extensive connections with brain regions like the hippocampus, amygdala, and periaqueductal gray (PAG).
  • Neuroinflammation and altered gene expression in the PFC are observed during acute and chronic pain states, affecting its structure and connectivity.

Purpose of the Study:

  • To explore the multifaceted role of the medial prefrontal cortex (mPFC) in pain modulation.
  • To investigate the mechanisms by which the mPFC influences pain perception and chronification.
  • To examine the PFC's involvement in the biopsychosocial aspects of pain management and its structural changes.

Main Methods:

  • Review of existing literature on prefrontal cortex function in pain processing.
  • Analysis of neurobiological changes (neurotransmitters, gene expression, glial cells, neuroinflammation) in the PFC during pain.
  • Examination of the mPFC's connections (cortical, corticostriatal) and their roles in antinociception and pain chronification.

Main Results:

  • The mPFC exhibits dual roles: mediating pain relief via PAG connections and potentially inducing pain chronification through corticostriatal pathways.
  • PFC alterations, including grey matter loss, are linked to pain, depression, anxiety, and cognitive deficits.
  • Successful chronic pain treatment can lead to reversible changes in PFC grey matter.

Conclusions:

  • The PFC is a key player in both pain control and the development of chronic pain conditions.
  • The PFC integrates sensory information and influences pain perception, with implications for conditions like placebo analgesia.
  • Therapeutic interventions targeting the PFC, encompassing pharmacological, physical, and psychological approaches, are vital for effective pain management.