Cognitive and affective neuroscience of chronic pain: relevance for Physiotherapy

Abstract

Background: Chronic pain is the main reason for medical consultation, as well as one of the main burdens of the health system in the developed world. However, current therapies are still inadequate for certain types of chronic pain, as in the case of fibromyalgia syndrome, or cause intolerable side effects (such as opioids). Understanding the neurophysiological and psychobiological bases of chronic pain is crucial to develop adequate and efficient strategies for the multidisciplinary evaluation and treatment of pain. Objective: The aim of this work is to provide a brief summary of the current state of the art to clarify the most effective strategies for the treatment of chronic pain. Methods: Narrative literature study developed in a reference world center to study of chronic pain. Results: In the last decades, it has been demonstrated that the plastic changes that occur in the brain are key for understanding the maintenance of pain over time. Research has provided evidence that patients with chronic pain displayed abnormal brain processing of body information and that negative emotional states can significantly alter brain functioning and amplify the suffering associated with pain. On the other hand, it has been suggested that strengthening emotional regulation skills through cognitive reassessment and suppression as used in cognitive-behavioral therapy or mindfulness can help regulate pain and emotion in patients with chronic pain. However, the brain mechanisms involved in these regulatory processes must still be elucidated, before being transferred to clinical practice. Conclusion: Cognitive and affective neuroscience is fundamental to physiotherapists understanding chronic pain.