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Review
. 2018 Feb 20:9:29.
doi: 10.3389/fpsyt.2018.00029. eCollection 2018.

Threat Response System: Parallel Brain Processes in Pain vis-à-vis Fear and Anxiety

Igor Elman  1 , David Borsook  2
Affiliations
Review

Threat Response System: Parallel Brain Processes in Pain vis-à-vis Fear and Anxiety

Igor Elman et al. Front Psychiatry. .

Abstract

Pain is essential for avoidance of tissue damage and for promotion of healing. Notwithstanding the survival value, pain brings about emotional suffering reflected in fear and anxiety, which in turn augment pain thus giving rise to a self-sustaining feedforward loop. Given such reciprocal relationships, the present article uses neuroscientific conceptualizations of fear and anxiety as a theoretical framework for hitherto insufficiently understood pathophysiological mechanisms underlying chronic pain. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain and nociception plus amygdala, anxiety, cognitive, fear, sensory, and unconscious. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) parallelism between acute pain and fear and between chronic pain and anxiety; (2) all are related to the evasion of sensory-perceived threats and are subserved by subcortical circuits mediating automatic threat-induced physiologic responses and defensive actions in conjunction with higher order corticolimbic networks (e.g., thalamocortical, thalamo-striato-cortical and amygdalo-cortical) generating conscious representations and valuation-based adaptive behaviors; (3) some instances of chronic pain and anxiety conditions are driven by the failure to diminish or block respective nociceptive information or unconscious treats from reaching conscious awareness; and (4) the neural correlates of pain-related conscious states and cognitions may become autonomous (i.e., dissociated) from the subcortical activity/function leading to the eventual chronicity. Identifying relative contributions of the diverse neuroanatomical sources, thus, offers prospects for the development of novel preventive, diagnostic, and therapeutic strategies in chronic pain patients.

Keywords: amygdala; cognitive; fear; nociception; sensory; unconscious.

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Figures

Figure 1
Figure 1
Schematic overview of the neurobiological processes underlying evolution of chronic pain and anxiety disorders. Sensory inputs concerning threats are relayed to the amygdala and other limbic structures, e.g., the central nucleus, the nucleus accumbens, the basal nucleus for generation of fear- or acute pain-related physiological (e.g., autonomic nervous system) behavioral (e.g., freezing, escape, fight, and avoidance), and cognitive responses (77, 78). Anxiety- and chronic pain symptomatology are characterized by the engagement of the of the extended amygdala structures, e.g., the bed nucleus of the stria terminalis along with allostatic load in the form of massive outpouring of stressogenic neurotransmitters and hormones manifested in negative affective states (10, 92).
Figure 2
Figure 2
Schematic overview of the two-system construct underlying chronic pain and anxiety disorders. Sensory inputs of nociceptive nature may give rise to pain; while threatening visual, auditory, gustatory, olfactory, or tactile stimuli may bring out fear. Pain is conceptualized to be a failure of the limbic system to gate components of nociceptive information from reaching conscious awareness (12). In psychological terms, anxiety represents a failure to defend against unconscious libidinal threats (66). Chronic pain and anxiety symptoms may be attributed to a disintegration of two-system construct (15) comprised of subcortical circuits mediating unconscious threat-related physiologic, emotional, and behavioral responses in conjunction with linked, yet potentially independent higher corticolimbic network producing cognitive experiences.
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References

    1. Mendell LM. Constructing and deconstructing the gate theory of pain. Pain (2014) 155(2):210–6.10.1016/j.pain.2013.12.010 - DOI - PMC - PubMed
    1. Katz J, Rosenbloom BN, Fashler S. Chronic pain, psychopathology, and DSM-5 somatic symptom disorder. Can J Psychiatry (2015) 60(4):160–7.10.1177/070674371506000402 - DOI - PMC - PubMed
    1. Butler AS, Xi J, Cox TL, Pope AM, Randall D, Bowman V. Relieving Pain in America. A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; (2011).
    1. Keefe FJ, Pryor RW. Encyclopedia of Pain. Berlin, NY: Springer; (2007).
    1. Gallego R. White on Black. Orlando, FL: Harcourt Books; (2006).

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