Pain Regulatory Mechanisms and Neuroadaptability to Pain: Relevance for Chronic Pain Vulnerability?

The inability to predict treatment trajectories and co-incidence of chronic pain following injury indicates a major unmet need for methods to predict potential vulnerability. A fundamental characteristic of the central nervous system is the ability to adapt to changes within the body and surroundings. When an injury results in pain, the nervous system produces a dynamic neuroplastic response which normalises through healing. Such nervous system changes likely serve a protective role, but in susceptible individuals, these injury-related changes may become dysfunctional, with functional loss that cease to correlate with tissue injury and frequently persisting despite injury resolution. Recent breakthrough findings and novel methodologies have progressed our understanding of the neuroadaptability to pain. In this workshop different neuroadaptive mechanisms will be presented based on electrophysiological, psychophysical, and brain imaging studies. It is outlined as five concise presentations on various expressions of pain neuroadaptability and a panel discussion to end.

Dr. Bannister will discuss novel endogenous mechanisms underpinning nociception in animals and pain in humans, focusing on approaches to harness or reinstate activity in modulatory pathways activated upon stimulus offset, onset and conditioning, with a focus on pharmacological and anatomical signatures of spinal transmission inhibitory and facilitatory neuroadaptive processes.

Dr. Crawford will continue with a similar topic, discussing the relative expression rates and likely cortico-brainstem systems underlying significant expression of neuroadaptability mechanisms like conditioned pain modulation, offset and placebo analgesic responses in a large cohort of pain-free humans, alongside their interactions with pain sensitivity, demography, and psychological factors. Extending these ideas, he will then discuss their utility for assessing chronic pain vulnerability.

Dr. Davis will discuss individual differences in bottom-up (temporal summation of pain) and top-down (conditioned pain modulation) behavioural neuroadaptability measures and neural activity related to pain and its modulation based on fMRI and MEG. She will discuss how the variability and modulation of state and trait features of brain-behaviour relationships can inform the development of individualised treatment of chronic pain using neuromodulation.
Dr. Schabrun will illustrate how neuroadaptability in the somatosensory domain is related to the transition from acute to chronic low back pain. Using measures of sensory evoked brain potentials and data from a prospective longitudinal cohort study, she will discuss the finding that low somatosensory cortex activity predicts chronic pain vulnerability and highlight future opportunities for treatment.

Finally, Dr. Graven-Nielsen will show unique data linking various types of neuroadaptability to pain in the somatosensory, motor, cognitive-affective and pain-regulatory domains. This will include data based on cutting-edge human neurophysiological assessments of brain neuroadaptability in the sensory and motor domains, pain-regulatory behavioural assessments (e.g. conditioned pain modulation and offset analgesia), and psychological profiling (e.g. psychological flexibility). Preliminary data on traits across different neurobehavioral domains will be illustrated and used to hypothesise chronic pain vulnerability.

This workshop will provide exciting and novel insights across the spectrum of neuroadaptability to pain and will allow the audience to explore important future directions in the field.