Chronic pain and the interoceptive and control networks

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Chapter 10 endnote 26, from How Emotions are Made: The Secret Life of the Brain by Lisa Feldman Barrett.
Some context is:

Emotion, acute pain, chronic pain, and stress are constructed in the same networks, the same neural pathways to and from the body, and most likely the same primary sensory region of cortex, so it is completely plausible that we distinguish emotion and pain by concept ​— ​that is, via the concepts the brain applies to make sense of bodily sensations.

By now, you should not be surprised to learn that our favorite pair of brain networks — the interoceptive and control networks — are routinely implicated in chronic pain. Whereas nociceptive pain is associated with increased activity in posterior insula (where primary nociceptive cortex is located, along with primary interoceptive cortex),[1] chronic back pain (for which a sustained injury can be found less than 1% of the time)[2] is associated with both activation and connectivity changes within the interoceptive network and the control network.[3][4][5] The brain regions that transform nociception into pain, known as the “pain matrix,” overlap with the interoceptive network. Regions in the control network also plays a significant role.[6][7] In fact, people with chronic pain have atrophy in the visceromotor regions in the interoceptive network. This atrophy is in exactly the same regions that become atrophied in chronic stress, in chronic pain,[8] depression,[9] childhood abuse,[10] over 15000 patients diagnosed with schizophrenia, bipolar, depression, addiction, OCD, and anxiety,[11] chronic stress[12] and childhood abuse.[13]


Notes on the Notes

  1. Segerdahl, Andrew R., Melvin Mezue, Thomas W. Okell, John T. Farrar, and Irene Tracey. 2015. "The dorsal posterior insula subserves a fundamental role in human pain." Nature Neuroscience 18 (4): 499-500.
  2. Van den Bosch, M. A. A. J., W. Hollingworth, A. L. Kinmonth, and A. K. Dixon. 2004. "Evidence against the use of lumbar spine radiography for low back pain." Clinical Radiology 59 (1): 69-76.
  3. Apkarian, A. Vania, Marwan N. Baliki, and Melissa A. Farmer. 2013. "Predicting transition to chronic pain." Current Opinion in Neurology 26 (4): 360-367.
  4. Kucyi, Aaron, and Karen D. Davis. 2015. "The dynamic pain connectome." Trends in Neurosciences 38 (2): 86-95.
  5. Denk, Franziska, Stephen B. McMahon, and Irene Tracey. 2014. "Pain vulnerability: a neurobiological perspective." Nature neuroscience 17 (2): 192-200.
  6. Tracey, Irene, and Patrick W. Mantyh. 2007. "The cerebral signature for pain perception and its modulation." Neuron 55 (3): 377-391.
  7. Legrain, Valery, Gian Domenico Iannetti, Léon Plaghki, and André Mouraux. 2011. "The pain matrix reloaded: a salience detection system for the body." Progress in Neurobiology 93 (1): 111-124.
  8. Smallwood, Rachel F., Angela R. Laird, Amy E. Ramage, Amy L. Parkinson, Jeffrey Lewis, Daniel J. Clauw, David A. Williams et al. 2013. "Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume." The Journal of Pain 14 (7): 663-675.
  9. Kaiser, Roselinde H., Jessica R. Andrews-Hanna, Tor D. Wager, and Diego A. Pizzagalli. 2015. "Large-scale network dysfunction in major depressive disorder: a meta-analysis of resting-state functional connectivity." JAMA Psychiatry 72 (6): 603-611.
  10. Sheridan, Margaret A., and Katie A. McLaughlin. 2014. "Dimensions of early experience and neural development: deprivation and threat." Trends in Cognitive Sciences 18 (11): 580-585.
  11. Goodkind, Madeleine, Simon B. Eickhoff, Desmond J. Oathes, Ying Jiang, Andrew Chang, Laura B. Jones-Hagata, Brissa N. Ortega et al. 2015. "Identification of a Common Neurobiological Substrate for Mental Illness." JAMA Psychiatry, 72 (4): 305-315.
  12. Ansell, Emily B., Kenneth Rando, Keri Tuit, Joseph Guarnaccia, and Rajita Sinha. 2012. "Cumulative adversity and smaller gray matter volume in medial prefrontal, anterior cingulate, and insula regions." Biological Psychiatry 72 (1): 57-64.
  13. Hart, Heledd, and Katya Rubia. 2012. "Neuroimaging of child abuse: a critical review." Frontiers in Human Neuroscience 6 (52): 1-24.