Neuroplasticity in chronic pain: insights into diagnosis and treatment

Chronic pain is a universal problem that directly evolves the central nervous system, altering both its structure and function. This review discusses neuroplastic alterations in critical areas in the brain like the anterior cingulate cortex, insula, prefrontal cortex, primary (S1) and secondary (S2) somatosensory cortices, and thalamus. These regions exhibit gray matter decrease and changes in connectivity during chronic pain. Several cortical networks, mainly the central executive network, the default mode network, and the salience network exhibit neuroplasticity which reallocates cognitive and emotional resources to pain processing. Thus, it was reported that sensitivity to pain enhances emotional suffering, indicating that altered connectivity and functional reorganization of these networks support maladaptive pain processing and underpin chronic pain persistence. Neuroplasticity-focused treatments such as brain stimulation, neuro-feedback, and exercise-based therapies constitute potential interventions for preventing such negative changes. Further, innovative neuroimaging biomarkers are effective in demonstrating precise neural changes and in providing information about the diagnosis of chronic pain syndromes. This review highlights neuro-plastic changes in chronically painful patients and acknowledges the brain's plasticity as a target for chronic pain treatment. It, also, points to the diagnostic strategies and practical interventions that address these alterations.