From the Pain Matrix to Functional Networks: A Narrative Review of Chronic Pain Mechanisms Across Adult and Pediatric...

Background: While region-based models have informed pain neuroscience, chronic pain is now increasingly conceptualized as a network disorder. This narrative review aimed to critically examine the conceptual evolution of chronic pain models from region-based representations toward large-scale functional network frameworks across adult and pediatric populations while exploring how emerging artificial intelligence (AI)-driven approaches may support future precision pain medicine. Methods: A structured literature search was performed in PubMed, Scopus, and Web of Science, focusing on the scientific output addressing adult and pediatric chronic pain, pain-related neuroplasticity, functional network alterations, neuromodulation, and AI-based applications in pain medicine. Results: The reviewed literature supports a progressive conceptual shift from region-based representations of pain toward network-oriented models involving dysfunctional interactions among the salience, default mode, central executive, and sensorimotor networks. Although emerging evidence suggests developmental network alterations in pediatric chronic pain, current conclusions remain limited by the relative scarcity of longitudinal neuroimaging studies. Emerging AI applications demonstrate promising potential for objective pain assessment, trajectory prediction, and personalized therapeutic decision-making. Conclusions: The transition from the pain matrix to functional network models represents one of the most important conceptual advances in contemporary pain neuroscience. A network-based perspective may accelerate AI-enabled pain biomarkers and individualized interventions.