The interaction between stress and chronic pain through the lens of threat learning

Inge Timmers*, Conny W. E. M. Quaedflieg, Connie Hsu, Lauren C. Heathcote, Cynthia R. Rovnaghi, Laura E. Simons

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Stress and pain are interleaved at multiple levels - interacting and influencing each other. Both are modulated by psychosocial factors including fears, beliefs, and goals, and are served by overlapping neural substrates. One major contributing factor in the development and maintenance of chronic pain is threat learning, with pain as an emotionally-salient threat – or stressor. Here, we argue that threat learning is a central mechanism and contributor, mediating the relationship between stress and chronic pain. We review the state of the art on (mal)adaptive learning in chronic pain, and on effects of stress and particularly cortisol on learning. We then provide a theoretical integration of how stress may affect chronic pain through its effect on threat learning. Prolonged stress, as may be experienced by patients with chronic pain, and its resulting changes in key brain networks modulating stress responses and threat learning, may further exacerbate these impairing effects on threat learning. We provide testable hypotheses and suggestions for how this integration may guide future research and clinical approaches in chronic pain.
Original languageEnglish
Pages (from-to)641-655
Number of pages15
JournalNeuroscience and Biobehavioral Reviews
Volume107
DOIs
Publication statusPublished - Dec 2019

Keywords

  • Chronic pain
  • HPA axis
  • Stress
  • Cortisol
  • Learning and memory
  • Threat learning
  • Fear avoidance model
  • Pain
  • LOW-BACK-PAIN
  • DORSOLATERAL PREFRONTAL CORTEX
  • ADVERSE CHILDHOOD EXPERIENCES
  • PITUITARY-ADRENAL AXIS
  • MOVEMENT-RELATED PAIN
  • EXPOSURE IN-VIVO
  • PSYCHOSOCIAL STRESS
  • SALIVARY CORTISOL
  • FIBROMYALGIA PATIENTS
  • PSYCHOLOGICAL STRESS

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